Strength Training During Cancer Treatment

This page is for people who want to do strength training during cancer treatment. It covers why it helps, how much to do, and which cautions apply to you.

Treatment costs muscle. Weeks of low activity, poor appetite, steroids, and hospital days all pull in the same direction. The loss shows up as trouble on stairs, trouble carrying groceries, and trouble getting off a low couch.

Strength training pushes back, and the evidence supports doing it during treatment rather than waiting.

NCI reports that the 2018 American College of Sports Medicine roundtable found exercise training and testing generally safe for cancer survivors. The same review found that moderate aerobic training, resistance exercise, or both, during and after cancer treatment, can reduce anxiety, depressive symptoms, and fatigue while improving quality of life and physical function.

Fatigue is the biggest prize. NCI reports that more than 80 percent of people receiving chemotherapy or radiation experience fatigue. It says that exercise, including walking, may help people feel better and have more energy during and after treatment.

One useful detail from NCI's summary of that roundtable: anxiety and depression did not improve with resistance training alone, but did improve when resistance training was combined with aerobic work. Lifting is part of the plan, not the whole plan.

The federal Physical Activity Guidelines for Americans set the standard for adults: muscle-strengthening activities of moderate or greater intensity, working all major muscle groups, on at least 2 days a week. That sits alongside 150 to 300 minutes a week of moderate aerobic activity.

The American Cancer Society says the same for survivors: strength work on 2 or more days a week, using hand weights, exercise bands, or bodyweight moves such as push-ups and squats. NCI's summary of the ACSM roundtable puts the practical dose at resistance training twice a week, plus about 30 minutes of aerobic exercise three times a week.

For anyone who cannot reach those numbers, the guidelines are explicit. Adults with chronic conditions should be as physically active as their abilities allow, should avoid inactivity, and should be under the care of a health care provider. Two short sessions a week is a real program.

ACS suggests hand weights, exercise bands, or bodyweight moves such as push-ups and squats. It advises beginning slowly, doing a few minutes of activity each day, and using short periods of exercise with frequent rest breaks. For example, you can split 30 minutes of activity into three 10-minute sessions. That structure fits chemotherapy weeks well.

Slowly increase how often and how long you exercise, and listen to your body to know when to slow down and rest. Ask your care team which moves are right for you, and how many to do.

Bone. NCI notes that chemotherapy, steroids, hormone therapy, and radiation can all thin bone, and that radiation thins it in the treated area. ACS advises caution with heavy weights or exercises that put too much stress on bones. This applies if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance, or weakness. Clear this with your oncologist before you lift heavy weights. ACS says to always check with your health care team before starting an exercise program. Ask directly whether you have any bone involvement.

Blood counts. We did not find a federal guideline that names a blood count number for strength training. Ask your team for the numbers that apply to you, and ask what to do on days between blood draws. If you are at higher risk of infection, ACS says you may need to stay away from public gyms and crowds until your risk returns to normal. NCI says anemia can lower your energy level.

Lines and ports. ACS is specific here. If you have a feeding tube or a central line in the chest, avoid pool, lake, and ocean water and other exposures that may cause infection. Do not do strength training that uses the muscles around the catheter, because that can dislodge it. Also ask your team which chest, shoulder, and overhead movements are allowed while a port site is healing, and how long that lasts.

Nerves and balance. ACS notes that numbness in the feet or balance problems raise fall risk, and suggests asking about devices that can help. It also advises staying away from uneven surfaces and exercising in a safe, well-lit place. In practice that favors seated and machine-based lifting, a wall or counter within reach, and bands over heavy free weights if your grip is unreliable.

NCI describes exercise as a natural pump for the lymph system that can improve the flow of lymph fluid, and notes that staying at a healthy weight helps keep lymphedema under control. NCI also reports the ACSM roundtable finding that exercise is safe for people with, or at risk of, breast cancer-related lymphedema, and that twice-weekly resistance training carries no increased lymphedema risk.

NCI says to talk with your doctor to find an exercise program that is safe for you. It says a certified lymphedema therapist can help with treatment, and that you should wear compression garments as your therapist advises. NCI also says to contact your doctor as soon as you notice heaviness or swelling. Do not train through it.

This feels backwards on a bad week, so plan for it in advance.

NCI advises choosing the activities most important to you, doing them when your energy is highest, and limiting the ones that add to fatigue. Apply that to lifting: put your session on the best day of the cycle, not a fixed weekday.

ACS says to exercise as you are able, not to push yourself while you are in treatment, and to rest when you need to. If you feel very tired, it suggests 10 minutes of light exercise a day and building up from there.

• Do I have any bone involvement or bone thinning that limits lifting?
• What are your cutoffs for platelets, neutrophils, and hemoglobin?
• Are there movement limits from my surgery, port, or line, and until when?
• Were lymph nodes removed, and am I at risk for lymphedema?
• Do I have neuropathy that should change how I train?
• Will you refer me to physical therapy or a cancer rehabilitation program?
• Are there weeks in my treatment schedule when I should back off?

Stop the session and call 911 or go to an emergency department for:

• Chest pain or pressure, pain spreading to the jaw or an arm, or an irregular heartbeat.
• Breathlessness that does not settle when you stop, or coughing up blood.
• Fainting, or a sudden severe headache, or sudden confusion, being hard to wake, or trouble speaking.
• Sudden weakness in the legs, or new trouble controlling your bladder or bowel.
• Bleeding that will not stop with steady pressure, or black, tarry stools.

Stop the session and call your care team right away, day or night, for:

• A temperature of 100.4 °F (38.0 °C) or higher while you are on treatment. CDC says to call your doctor right away, and warns that an infection during chemotherapy can be life-threatening. If you cannot reach your team, go to an emergency department and tell the staff you are having treatment.
• Chills, a sore throat, mouth sores, burning when you pass urine, or redness or swelling where a port or catheter enters your body. Do this even without a fever. A normal temperature is not a reason to wait.
• Sudden swelling, heaviness, or tightness in an arm or leg.

Stop the session and call your care team the same day for:

• Dizziness or vision changes that pass once you rest.
• New bone pain, or pain in one spot that does not settle with rest.
• New or worsening numbness or weakness in the hands or feet.
• Unusual bruising.

See Exercise During Cancer Treatment and Exercise After Cancer Treatment for the broader plan. Also useful: Neuropathy During Cancer Treatment, Getting Enough Protein During Cancer Treatment, Returning to Exercise After Cancer Surgery, and Balance and Fall Prevention After Cancer Treatment.

• Physical Activity and Cancer Fact Sheet, National Cancer Institute.
• Prescribing Exercise as Cancer Treatment, National Cancer Institute.
• Fatigue and Cancer Treatment, National Cancer Institute.
• Lymphedema and Cancer Treatment, National Cancer Institute.
• Late Effects of Cancer Treatment, National Cancer Institute.
• Physical Activity Guidelines for Americans, 2nd edition (PDF), U.S. Department of Health and Human Services.
• ACS Nutrition and Physical Activity Guideline for Cancer Survivors, American Cancer Society.
• Physical Activity When You Have Cancer, American Cancer Society.
• Fever and Cancer Treatment, Centers for Disease Control and Prevention.