Getting Back to Daily Activity After Treatment

The last treatment does not come with a switch. People expect the end of chemotherapy or radiation to feel like a finish line, and instead find a long flat stretch where they look recovered and do not feel it.

Fatigue is the usual reason. NCI reports that more than 80 percent of people having chemotherapy or radiation experience it. It does not always leave on the day treatment ends. Meanwhile the scaffolding comes down: fewer appointments, fewer people asking, and an expectation that you are back.

Getting back is a project. Here is how to run it.

The federal Physical Activity Guidelines for Americans set the adult target at 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous-intensity activity. They also call for muscle-strengthening work of moderate or greater intensity involving all major muscle groups on 2 or more days a week.

The American Cancer Society applies the same figures to cancer survivors, framed as something to build up to.

Read those numbers as a destination. If you finished treatment last month, they are not week one.

The guidelines include a sentence that undercuts the intimidation of the numbers: "Some physical activity is better than none." Adults who sit less and do any amount of moderate-to-vigorous activity gain some health benefits.

They go further for people in your position. Adults with chronic conditions who are able should aim for the same 150 to 300 minutes. And when they are not able to meet the guidelines, "they should engage in regular physical activity according to their abilities."

That is permission written into national policy. A ten-minute walk on a bad week counts. It is not a failed workout.

Most people restart with walking alone and stall, because walking rebuilds only one of the three things treatment took.

Aerobic. Walking, cycling, swimming. This is the fatigue and stamina track, and it is where to start.

Strength. Two days a week, all major muscle groups. Treatment and inactivity both cost muscle. Muscle is what makes stairs, groceries, and getting off the floor feel normal again.

Balance. The guidelines specifically say older adults should do multicomponent activity that includes balance training as well as aerobic and muscle-strengthening work. This matters more if treatment left you with numb feet.

ACS is practical about starting from a low base. If you feel very tired, it suggests trying 10 minutes of light exercise each day and building up from there. It also notes that even a few minutes of activity each day will help you.

ACS also suggests short periods of activity with frequent rest breaks. For example, you can split 30 minutes into three 10-minute sessions. It advises slowly increasing how often and how long you exercise, and listening to your body to know when to slow down and rest. Ask your team when to add strength work, and start with body weight or light resistance.

Exercise is only part of getting back. Activity guidelines say nothing about the things people actually want back. These need specific answers from your team, not general ones.

Ask about work, and ask about a phased return rather than a date. Ask about driving, particularly if you are on medicines that affect alertness. Ask about lifting, with a number attached, if you had surgery. Ask about swimming pools, hot tubs, and public gyms, which come with infection questions. Ask about travel and flying. Ask about sex, which almost nobody raises and most teams are used to discussing.

Vague answers are worth pushing on. "Take it easy" tells you nothing about whether you can lift a toddler.

Cancer rehabilitation exists. Ask for it by name.

A physical therapist rebuilds strength, range of motion, and balance. An occupational therapist works on the actual tasks of your day, including energy conservation, which is a real technique rather than a slogan. If you had lymph nodes removed, a certified lymphedema therapist is a specific referral worth asking for.

NCI's fatigue guidance also points to energy conservation as a strategy: choose the activities that matter most to you and do them when you have the most energy.

ACS is clear that you should always check with your health care team before starting an exercise program. Several situations change the advice.

• Cancer in the bone, or osteoporosis. Use caution with heavy weights or exercises that stress the bones.
• Numb feet or balance problems. ACS notes this puts you at higher risk for falls, so choose stable surfaces and hold on when you need to.
• A port or catheter in place. Avoid strength training using the muscles in that area, which could dislodge it.
• Higher infection risk. You may need to stay away from public gyms and crowds until your risk returns to normal.
• Radiation therapy and swimming. Check with the radiation team before getting in a pool.

• Call 911 or go to an emergency department if you have chest pain, sudden or unusual breathlessness, an irregular or racing heartbeat, or you faint. Stop what you are doing. Do not wait for the clinic to open.
• Call 911 or go to an emergency department if you have sudden confusion or are hard to wake.
• Call your care team right away, day or night, if you have a temperature of 100.4°F (38°C) or higher. If you cannot reach your team, go to an emergency department. If you are on chemotherapy, CDC says to call your doctor right away and warns that an infection during chemotherapy can be life-threatening.
• If you are on chemotherapy or your white blood cell count may be low, call your care team right away, day or night, for chills, a sore throat, mouth sores, burning when you pass urine, or redness or swelling where a catheter enters your body. Do this even without a fever. A normal temperature is not a reason to wait.
• Call your care team right away if one arm or leg swells, or feels heavy, full, or tight. NCI says to contact your doctor as soon as you notice heaviness or swelling, because lymphedema is easier to control when treatment starts early.
• Call your care team right away if a calf becomes swollen, red, warm, or painful. If you also have chest pain or trouble breathing, call 911.
• Call your care team the same day if you feel very weak and tired even after resting or sleeping, or you cannot do your normal activities. NCI names this as something to report.
• Call your care team the same day if you feel dizzy or unsteady during or after exercise, or new or worsening bone pain appears, or you have pain in one spot that activity makes worse.

• What are my activity limits right now, with numbers rather than adjectives?
• Can I be referred to cancer rehabilitation, physical therapy, or occupational therapy?
• How long should I expect this fatigue to last, and what would make you investigate it?
• Should anything be checked before I start strength training, such as bones or heart?
• What is a realistic phased return to work in my case?
• Which late effects should I watch for, and who monitors them?

Read next: Survivorship, What to Expect at a Survivorship Visit, Your Survivorship Care Team, Walking Plan After Chemotherapy, and Breathing and Relaxation Before Cancer Appointments.

• https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• https://www.cancer.org/cancer/survivorship/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema