What are the current exercise recommendations for adult cancer patients?

Exercise Recommendations for Cancer Patients

Adult cancer patients should engage in 150-300 minutes per week of moderate-intensity aerobic activity (or 75-150 minutes of vigorous-intensity activity) plus muscle-strengthening exercises at least 2 days per week, with physical activity assessment and counseling beginning immediately after diagnosis. 1

Timing of Exercise Initiation

• Physical activity assessment and counseling should begin as soon as possible after cancer diagnosis, with the goal of helping patients prepare for treatments, tolerate treatments better, and manage cancer-related symptoms and treatment side effects. 1

• Cancer survivors should avoid inactivity and return to normal daily activities as soon as possible after diagnosis or treatment. 1

• Exercise is beneficial before, during, and after cancer treatment, across all cancer types and for a variety of cancer-related impairments. 1

Specific Exercise Prescription

Aerobic Exercise

• 150-300 minutes per week of moderate-intensity physical activity (with 300 minutes being ideal for maximum benefit). 1
• Alternatively, 75-150 minutes per week of vigorous-intensity activity, or an equivalent combination of moderate and vigorous intensity. 1
• Activities should be performed in episodes of at least 10 minutes per session, preferably spread throughout the week. 1

Resistance Training

• Muscle-strengthening activities involving all major muscle groups at least 2 days per week. 1
• Benefits for fatigue have consistently been seen with interventions that combine aerobic and resistance training as well as resistance-only interventions. 1

Exercise Intensity

• Moderate to vigorous exercise is the best level of intensity to improve physical function and mitigate cancer-related impairments. 1
• For specific conditions like tai chi or qigong, low to moderate intensity is recommended. 1

Clinical Benefits and Outcomes

Exercise during and after treatment improves multiple critical outcomes:

• Reduces cancer-specific mortality by approximately 30% and all-cause mortality by 32%. 1
• Improves anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. 1
• May enhance tolerance to cancer treatments and improve functional outcomes. 1
• Supervised exercise yields superior benefits versus unsupervised exercise. 1

Specific Recommendations by Treatment Phase

During Active Treatment

• Clinicians should recommend exercise (aerobic, resistance, or combination) to reduce the severity of fatigue during cancer treatment, with exercise tailored to individual patient abilities and may be either supervised or unsupervised. 1
• Exercise should be tailored according to type of cancer, patient health, treatment modalities, and symptoms/side effects. 1

After Treatment Completion

• Exercise (aerobic, resistance, or combination) should be recommended to reduce cancer-related fatigue symptoms in adults who have completed cancer treatment. 1
• The ultimate aim is to achieve 150-300 minutes per week of moderate-intensity or 75-150 minutes per week of vigorous-intensity physical activity, plus muscle-strengthening activities on 2 or more days weekly. 1

Safety Considerations and Precautions

Important precautions to consider:

• Survivors undergoing radiation should avoid chlorine exposure to irradiated skin (e.g., from swimming pools). 1

• Survivors with indwelling catheters or feeding tubes should avoid pool, lake, or ocean water or other microbial exposures that may result in infections, and avoid resistance training of muscles in the catheter area to prevent dislodgment. 1

• Survivors with significant peripheral neuropathies or ataxia may have reduced ability to use affected limbs due to weakness or loss of balance—they may do better with a stationary reclining bicycle rather than walking on a treadmill. 1

• Survivors with multiple or uncontrolled comorbidities need modifications to their exercise program in consultation with their physicians. 1

• Some short-term restrictions may apply after major surgery or stem cell transplantation. 1

• Serious adverse events are not common with exercise interventions in cancer patients. 1

Delivery and Supervision

• Supervised exercise is preferred when possible, as it yields superior benefits compared to unsupervised programs. 1

• Exercise may be delivered through in-person supervised, remotely supervised, or home-based unsupervised programs. 1

• Individual needs should be considered and support provided (e.g., need for supervision, structured programs, availability of resources, behavioral motivation) to optimize exercise adherence. 1

• Support may be provided through local and institutional resources such as physical and occupational therapies and rehabilitation. 1

Additional Health Promotion Goals

Beyond exercise, cancer survivors should:

• Avoid obesity and maintain or increase muscle mass through diet and physical activity. 1

• Follow a healthy eating pattern that meets nutrient needs and is consistent with recommendations to prevent chronic disease. 1

• Achieve and maintain a healthy body weight by limiting consumption of high-calorie foods and beverages. 1

Common Pitfalls to Avoid

• Do not wait until after treatment completion to initiate exercise counseling—assessment should begin immediately after diagnosis. 1

• Do not assume all patients need medical clearance before starting moderate-intensity exercise—most cancer survivors can safely begin activity, though individual assessment is important for those with specific complications. 1

• Do not recommend complete rest or prolonged inactivity—even during active treatment, some level of physical activity is beneficial and safe for most patients. 1

• Do not prescribe only aerobic exercise—the combination of aerobic and resistance training provides optimal benefits. 1