Exercise When Blood Counts Are Low: What to Ask

This page is for people whose blood counts drop during cancer treatment and who want to keep moving safely. It explains which count is low, what that changes, and when to stop and call.

A complete blood count, or CBC, measures several things at once. When treatment knocks the numbers down, people say their counts are low, as if it were one condition. It is not. Three separate cells fail in three separate ways, and each one changes exercise differently.

• White cells, especially neutrophils, fight infection. Low neutrophils change where you exercise and who is around you.
• Platelets stop bleeding. Low platelets change what you do, mainly by ruling out things that can cause a blow or a fall.
• Red cells carry oxygen. Low red cells change how hard you can work.

Ask which one is low before changing anything. The answer points to a different fix each time.

Neutrophils are the white cells that fight bacteria. The absolute neutrophil count, or ANC, comes out of the CBC. Ask your team what your number means. NCI says infections during cancer treatment can be life threatening.

NCI's infection advice is about avoiding germs. So a useful change is the setting:

• Move it home, or go to the gym at its emptiest hour.
• Wipe equipment before and after, and wash your hands before you touch your face or eat.
• Skip crowds and stay away from anyone who is sick. NCI names both in its infection prevention advice.
• Ask your team whether swimming is safe for you.
• Ask whether outdoor walks are a good option for you.

The fever rule does not change because you exercised. CDC says a temperature of 100.4°F (38°C) or higher during chemotherapy means calling your care team right away, at any hour (CDC). NCI prints 100.5 °F (38 °C). Use 100.4 °F unless your team gave you a lower number, and do not assume a post-workout flush explains it.

Here is where most articles invent a number. This one will not.

NCI's guidance for people with low platelets is about avoiding injury, and it does not name a platelet count at which exercise must stop. The federal Physical Activity Guidelines do not name one either. So the number that governs you is your team's number, and you have to ask for it. Use these words:

• At what platelet count do you want me to stop resistance training?
• At what count should I avoid anything with fall or impact risk?
• At what count should I stop exercising and rest?
• My counts are drawn weekly. What do I do on the days in between, when I do not know today's number?
• Am I on a blood thinner or any medicine that adds to bleeding risk?

Ask your team about activities with a chance of a blow or a fall, such as contact sports or ladders, and about heavy lifting.

NCI's other low-platelet advice matters around exercise too. Avoid products containing aspirin or ibuprofen, and limit alcohol. Brush with a very soft toothbrush. Wear shoes even indoors. Use an electric shaver instead of a razor. Be careful with sharp objects. If bleeding starts, press firmly on the spot with a clean cloth and keep pressing until it stops.

Watch for the bleeding signs NCI lists:

• Bleeding that does not stop after a few minutes.
• Feeling confused or very sleepy.
• Bleeding from the mouth or nose or in vomit (vomiting blood means calling 911; see below).
• Urine that is red or pink.
• Stools that are black or bloody (black, tarry stools mean calling 911; see below).
• Periods heavier or longer than usual.
• Bad headaches or changes in vision.

Anemia means the red cell count is below normal, so less oxygen reaches your muscles. NCI lists the symptoms: extreme fatigue, shortness of breath, lightheadedness, dizziness, fainting, headache, fast heartbeat, and pale skin.

The instinct is to rest completely. NCI advises against that. Its guidance is to balance rest with activity, allow short naps, and remember that too much bed rest makes you weak. It also says to take short walks or exercise a little every day.

Practical translation:

• Cut intensity before you cut the habit. A short easy walk is still activity.
• Stand up slowly from the floor or a bench, and hold something.
• Stop and call 911 for chest pain, fainting, or trouble breathing. Do not drive yourself.

None of this means stopping. NCI reports that exercise training and testing are generally safe for cancer survivors. It also reports that a half hour of aerobic exercise three times a week improved anxiety, depression, fatigue, quality of life and physical function in cancer survivors.

The Physical Activity Guidelines for Americans set the adult target at 150 to 300 minutes a week of moderate activity, plus muscle-strengthening work on at least 2 days. For adults with chronic conditions, the guidelines say to be as physically active as your abilities allow. They also say to avoid inactivity and to be under the care of a health care provider. NCI's summary of the ACSM roundtable gives a workable dose: about 30 minutes of aerobic exercise three times a week, plus resistance training twice a week.

On a low-count week, the goal is to keep the habit alive at a smaller size, so you are not starting over when the numbers recover.

• Which count is low, what is the actual number, and when is it expected to recover?
• What is your cutoff for stopping resistance training, and for stopping exercise?
• Do I have any bone involvement that changes what is safe?
• Do I have a port or central line that limits certain movements?
• Would you refer me to a physical therapist or cancer rehabilitation program?
• Should I check my heart rate or blood pressure before exercising?

Call 911 or go to an emergency department for:

• Bleeding that will not stop after 10 minutes of firm pressure.
• Black, tarry stools, or vomiting blood or something that looks like coffee grounds (MedlinePlus).
• A severe headache, confusion, feeling very sleepy, or a change in vision.
• Fainting, chest pain, or trouble breathing, including breathlessness at rest. Do not drive yourself.

Stop and call your care team right away, at any hour, for:

• A temperature of 100.4°F (38°C) or higher, or the lower number your team gave you (CDC). If you cannot reach them quickly, call 911 or go to an emergency department.
• Bleeding that is still going after a few minutes of firm pressure. Keep pressing while you call.
• Bloody stools, or red or pink urine.

Get emergency care after any fall with a head strike while your platelets are low, even if you feel fine.

See Low Platelets During Chemotherapy, Low White Blood Cells During Chemotherapy, and Neutropenia During Chemotherapy for the counts themselves. See Neutropenic Fever During Cancer Treatment for the emergency plan. Also useful: Stretching After Cancer Surgery: What to Ask and Breathing and Relaxation Before Cancer Appointments.

• Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment, National Cancer Institute
• Anemia and Cancer Treatment, National Cancer Institute
• Infection and Neutropenia during Cancer Treatment, National Cancer Institute
• Physical Activity and Cancer Fact Sheet, National Cancer Institute
• Prescribing Exercise as Cancer Treatment, National Cancer Institute
• Physical Activity Guidelines for Americans, 2nd edition (PDF), U.S. Department of Health and Human Services
• Fever During Chemotherapy, CDC