Walking Plan After Chemotherapy: What to Ask

Walking is the exercise most people can restart after chemotherapy, because it needs no equipment, no class, and no decision about whether you belong in a gym. It also scales down further than almost anything else. Four minutes is a real walk.

What follows is a plan with numbers in it. Take it to your team before you start, because a few situations further down change the advice.

The federal Physical Activity Guidelines for Americans set the adult goal at 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous activity, plus muscle-strengthening work on 2 or more days a week. The American Cancer Society applies the same numbers to people who have had cancer.

At 30 minutes a day, five days a week, walking alone reaches the bottom of that range. That is the shape of the destination.

The guidelines also say something that matters more in month one: "Some physical activity is better than none." And for people with chronic conditions who cannot meet the targets, the instruction is to be regularly active according to their abilities.

You do not need a heart rate monitor. CDC describes a talk test that does the job.

At moderate intensity, "a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity." At vigorous intensity, a person "cannot say more than a few words without pausing for a breath."

CDC also gives a pace: brisk walking counts as moderate at 2.5 miles per hour or faster. If a strolling pace is all you have for now, it still counts as activity. It just does not yet count toward the moderate-intensity total.

Walk at a comfortable pace until you feel mildly tired, then stop and write down the minutes. Do that three times in the first week. Your baseline is roughly the average, not the best of the three.

If you feel very tired, ACS suggests starting with 10 minutes of light exercise a day and building from there. If ten is too many, split it. Two five-minute walks are the same ten minutes.

This is one workable pattern, not a prescription. Adjust it to your baseline and your cycle.

• Weeks 1 and 2: 10 minutes, 5 days a week. Comfortable pace.
• Weeks 3 and 4: 15 minutes, 5 days a week. Start using the talk test.
• Weeks 5 and 6: 20 minutes, 5 days a week. Aim for brisk on at least two of them.
• Weeks 7 and 8: 25 to 30 minutes, 5 days a week. That is 125 to 150 minutes.

Three habits help it stick. Hold each step for a full week before increasing. Increase either the time or the pace, never both in the same week. And end each walk feeling like you could have done a few more minutes.

If your energy follows your cycle, build the plan around that rather than fighting it.

Put the shortest walks on the days you already know are worst, and the longer ones on the days you know are better. A week where you walk five times for eight minutes is a successful week.

When a bad stretch knocks you off, restart one step below where you stopped rather than from the beginning. Fitness does not disappear in five days.

Peripheral neuropathy is nerve damage that some chemotherapy drugs cause. NCI describes tingling, numbness, or a pins-and-needles feeling in the feet and hands, and being unable to feel pain from a cut or sore on your foot. Motor nerve damage can bring weak or achy muscles that make you lose balance or trip easily.

That changes how you walk, not whether you walk. NCI's own precautions:

• Wear sturdy shoes with soft soles, and wear shoes both inside and outside.
• Check your arms, legs, and feet for cuts or scratches every day. If you cannot feel a blister, you have to look for it.
• Move rugs out of your path so you will not trip.
• Get up slowly after sitting or lying down, especially if you feel dizzy.
• In cold weather, wear warm clothes to protect your hands and feet.

ACS adds that numbness in the feet or balance problems put you at higher risk for falls. Flat, familiar, well-lit ground is safer than uneven trails, ice, or dark evenings. Carrying a phone helps too.

Walking builds stamina and does little for strength or balance, so add both.

Strength work on 2 or more days a week, covering all major muscle groups, is part of the guidelines. Body weight and light resistance bands count.

The guidelines also state that older adults should do multicomponent activity that includes balance training alongside aerobic and muscle-strengthening work. If neuropathy is in the picture, that applies whatever your age, and it is worth doing with a physical therapist first.

ACS advises always checking with your health care team before starting an exercise program. These situations change the plan:

• Cancer in the bone, or osteoporosis. Use caution with heavy weights or anything that stresses the bones.
• A port or catheter. Avoid strength training that uses the muscles around it, which could dislodge it.
• Higher infection risk. You may need to stay away from public gyms and crowds until your risk returns to normal. Outdoors and quiet streets are easier.
• Radiation therapy. Check with the radiation team before swimming.

If any of these happen, stop walking. The first two groups need help straight away.

Call 911 if:

• You have chest pain, pressure, squeezing, or tightness, especially with shortness of breath, sweating, nausea, dizziness, or a racing heart. Do not walk home first or wait for it to pass.
• You suddenly become short of breath, or have sharp chest pain when you breathe in, especially if one leg is swollen. That can be a blood clot that has moved to the lungs.

Stop and call your care team right away if:

• You are far more short of breath than the pace should cause, even once you stop.
• You feel faint, dizzy, or unsteady, have blurred vision, or your heart races or pounds irregularly. If you pass out, or this comes with chest pain, call 911.
• A calf or arm becomes swollen, red, warm, or painful. The CDC says to tell your cancer doctor about these signs of a clot as soon as possible.
• Your temperature reaches 100.4 °F (38 °C) or higher. The CDC says to call your doctor immediately at that temperature during chemotherapy. If your own team gave you a different number, use theirs.

Stop and tell your team soon if:

• New bone pain appears, or pain in one spot that walking makes worse.
• You feel very weak and tired even after resting or sleeping. NCI names this specifically as something to report.

• Is walking safe for me right now, and is there any limit on distance or pace?
• Do my blood counts change what I can do this week?
• Should I avoid public spaces or gyms during any part of my cycle?
• Do I have neuropathy, and should I be assessed for fall risk?
• Can I be referred to physical therapy or a cancer exercise program?
• Which symptoms mean I stop walking and call you the same day?

Read next: Exercise After Cancer Treatment, Neuropathy During Cancer Treatment, Balance and Fall Prevention After Cancer Treatment, Getting Back to Daily Activity After Treatment, and Sleep Routine During Cancer Treatment.

• https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
• https://www.cdc.gov/physical-activity-basics/measuring/index.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems
• https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• 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://medlineplus.gov/ency/article/003079.htm
• https://www.cdc.gov/blood-clots/risk-factors/cancer.html
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html