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Experts Update Exercise Guidelines for People Treated for Cancer

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The American College of Sports Medicine updated its guidelines on exercise for cancer prevention, as well as guidelines on exercise to ease a number of treatment side effects, including fatigue, depression, physical functioning, and quality of life.

The guidelines were published in the November 2019 issue of Medicine & Science in Sports & Exercise. Read “Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable.”

Exercise and breast cancer

Regular exercise is an important part of being as healthy as you can be. More and more research is showing that exercise can reduce the risk of breast cancer coming back (recurrence) if you've been diagnosed, as well as the risk of developing breast cancer if you’ve never been diagnosed.

A number of organizations, including the American Cancer Society and the American College of Sports Medicine, have published exercise recommendations for people living with and beyond cancer. Still, most people who have been diagnosed with cancer don’t do regular exercise.

There are three basic types of exercise:

  • Aerobic exercise uses the large muscles in your body in rhythmic, repetitive motions; examples are walking, running, bike riding, and dancing.
  • Flexibility exercise is basically stretching your muscles to keep them elastic and to keep your joints moving freely; examples are yoga, Tai Chi, foam rolling, and stretching.
  • Resistance exercise makes your muscles work harder by adding weight or resistance to the movement; examples are weight lifting, resistance band exercises, pull-ups, and push-ups.

New exercise guidelines for people with cancer

An international group of experts reviewed research on exercise for people living with and beyond cancer and developed new guidelines. The new guidelines include specific exercise recommendations to ease common cancer treatment side effects. The experts noted that supervised exercise programs — programs that are led by a trainer or instructor — seem to offer more benefits than unsupervised programs or programs that are done at home.

These new guidelines are different from guidelines released in 2010 that advised cancer survivors to meet the general public health exercise guidelines for all people: 150 minutes of exercise per week.

“With more than 43 million cancer survivors worldwide, we have a growing need to address the unique health issues facing people living with and beyond cancer and better understand how exercise may help prevent and control cancer,” said Kathryn Schmitz, professor of public health sciences at the Penn State College of Medicine and member of the Professional Advisory Board, in a statement. Schmitz is one of the authors of the new recommendations.

Overall, the new guidelines recommend people who have been treated for cancer should “avoid inactivity.” To ease the most common cancer treatment side effects and improve health, the experts recommend:

  • moderate-intensity aerobic exercise at least 3 times per week, for at least 30 minutes
  • resistance exercise at least 2 times per week, doing at least 2 sets of 8 to 15 repetitions, using a weight or resistance that is at least 60% of a person’s one-repetition maximum

Exercise recommendations to ease specific side effects are:

  • Anxiety: 30-60 minutes of moderate-intensity aerobic exercise 3 times per week for 12 weeks, or twice weekly combined 20-40 minutes of aerobic exercise plus 2 sets of 8-12 repetitions of resistance exercise for 6 to 12 weeks.
  • Depression: 30-60 minutes of moderate-intensity aerobic exercise 3 times per week for at least 12 weeks, or twice weekly combined 20-40 minutes of aerobic exercise plus 2 sets of 8-12 repetitions of resistance exercise for 6 to 12 weeks.
  • Fatigue: 30 minutes of moderate-intensity aerobic exercise 3 times per week.
  • Quality of life: Combined 30 minutes of moderate-intensity aerobic exercise plus 2 sets of 12-15 repetitions of resistance exercise 2 to 3 times per week for at least 12 weeks.
  • Lymphedema: A supervised resistance exercise program that slowly ramps up the resistance and focuses on the large muscle groups 2 to 3 times per week can help people with upper extremity lymphedema related to breast cancer treatment. For many years, doctors recommended that women skip exercise to reduce the risk of lymphedema or avoid making the condition worse. But more recent research has shown that a careful exercise program, supervised by a professional with knowledge about lymphedema, that starts low and increases slowly, can offer benefits. The researchers noted that the lymphedema exercise prescription was designed for safety or no harm rather than preventing lymphedema symptoms. The experts also noted that there isn’t enough evidence to decide if starting a resistance training program without supervision is safe for women with lymphedema or at-risk for the condition.
  • Physical function: 30-60 minutes of moderate-intensity aerobic exercise, 2 sets of 8-12 repetitions of resistance exercise, or combined 20-40 minutes of aerobic exercise plus 2 sets of 8-12 repetitions of resistance exercise 3 times per week for 8 to 12 weeks.

“Through our research, we've reached a point where we can give specific FITT exercise prescriptions — which means frequency, intensity, time, and type — for specific outcomes like quality of life, fatigue, pain, and others,” Schmitz said. “For example, if we're seeing a head and neck cancer patient with a specific set of symptoms, we could give them an exercise prescription personalized to them.

“Currently, an average person on the street will know that exercise is good for preventing and treating heart disease, but not for melanoma,” she added. “We want to change that. When researchers in the 1950s built an evidence base for exercise and heart disease, there was a shift in public knowledge about that connection. It's now time for the same thing to happen with exercise and cancer.”

Exercise safely

Because being diagnosed and treated for cancer can change how people move and function, the experts recommended that people tell their doctors they plan to start an exercise program and ask if they have any health conditions that may limit what they can do.

The researchers also recommended that people have a thorough evaluation of all aspects of their physical fitness before starting an exercise program, including strength, endurance, body composition, and flexibility.

Still, the experts did not want a doctor’s approval or a fitness evaluation to be a barrier to people exercising. If either one of these items is difficult to get, the experts recommended that a person start a low-intensity aerobic program, such as walking or slow bike-riding, or gentle stretching, with a slow increase in intensity.

What this means for you

If you’re recovering from breast cancer treatment, along with being busy with work, household chores, and family matters, finding time to exercise almost every day can seem impossible.

Still, these new recommendations allow you to break up your exercise into 20- or 30-minute sessions 2 to 3 times per week, rather than trying to find the time and energy to work out for an hour or more at one time.

Walking can be a great way to start. Maybe you walk 30 minutes before going to work and 20 minutes on your lunch break. You can add a few more minutes by parking farther away from your building or taking mass transit. Or you can make plans to walk with a friend after work — you’re more likely to stick with an exercise plan if someone else is counting on you. Plus, you can socialize at the same time.

Along with healthy diet and lifestyle choices, regular exercise is one of the best things anyone who has been diagnosed with breast cancer can do to feel their best and to keep the risk of breast cancer recurrence as low as it can be. This study adds to other research suggesting that regular exercise can help keep your physical and mental health in top shape. No matter how old you are, it’s never too late or too soon to get moving. And once you do start, keep at it!

Visit the Exercise section for tips on exercising safely and how to stick to an exercise routine.

To talk with others about the benefits of exercise, share exercise tips, and get encouragement, join the Discussion Board forum on Fitness and Getting Back in Shape.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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