Exercise with blood cancer: lymphoma, myeloma, leukaemia

For most people, yes, with changes that depend on your blood results and treatment. The international exercise roundtable found that exercise "training and testing were generally safe for cancer survivors" and advises everyone to "avoid inactivity" [2].

Lymphoma Action says "Physical activity can have benefits before, during and after lymphoma treatment" [3]. Leukaemia Care says keeping active "can help you prepare for and recover from treatment" [5]. Blood Cancer UK suggests aiming for "20-30 minutes of general activity every day" and muscle-strengthening activities "at least twice a week" [4]. If you are new to walking, Blood Cancer UK suggests you "start with five or 10 minutes a day and slowly build it up" [4].

Leukaemia Care advises you to "pace yourself and avoid overdoing it at times when you have more energy" [5]. Getting your fitness back can take a while. Lymphoma Action says "For some people, it can take a year or two to feel back to the level of physical fitness they had before having lymphoma" [3]. For general advice during treatment, see exercise during chemotherapy.

Probably, yes, at least for aerobic exercise. The 2019 Cochrane review looked at aerobic exercise (in most trials, "various walking intervention programmes") and found "moderate-certainty evidence that exercise probably improves fatigue", based on 9 trials and 826 patients [1].

In the review, "eight trials randomised people receiving stem cell transplantation" [1]. The review also found that "Depression might slightly be improved by exercising" [1]. The evidence has limits. The authors say "It remains unclear, whether physical exercise improves QoL" (quality of life), and they found "no evidence for a difference" in deaths between people who exercised and those who did not, though this was "low-certainty evidence" [1]. Exercise is support alongside treatment, not a treatment for the cancer.

Our guide to cancer-related fatigue covers pacing, sleep and the causes of fatigue your team can check, such as anaemia.

Only with your haematology team's agreement. Platelets help your blood clot. Leukaemia Care says "If you have severely low platelets, you're at a higher risk of bleeding. So, it's safer not to exercise without first checking with your haematology team" [5].

Lymphoma Action says that with a shortage of platelets "you are at a greater risk of bruising and bleeding", and "Doctors therefore ask you to avoid high-impact sports such as football and rugby" [3]. Your own team decides what your platelet count means for you, so ask them at each blood test what is safe that week.

Neutropenia means you have a low number of white blood cells called neutrophils, which makes it "particularly hard for your immune system to deal with infection" [6]. It "can be caused by the blood cancer itself" or by treatment, "particularly chemotherapy, stem cell transplant, or immunotherapy" [6].

You can usually keep moving, but where you exercise matters. Lymphoma Action says your team "might recommend that you avoid public gyms, swimming pools and spas" [3]. Leukaemia Care gives practical options [5]:

• go to the gym "at times you know are not busy";
• "sanitise equipment before and after using it";
• choose classes with "good ventilation and plenty of space between participants";
• "make the most of outdoor training sessions when the weather is good";
• follow an exercise video or "join an online yoga, pilates or movement class".

If you have a central line or PICC line, swimming in public pools may not be safe because of "a risk of it becoming dislodged or infected" [3]. If you get breathless, Leukaemia Care says this "could be because your condition, or treatment for it, has resulted in low numbers of red blood cells (anaemia)", and advises talking to your haematology team about whether exercise is safe for you and at what level [5]. Whatever you do, "take regular short breaks when needed and to keep hydrated" [5].

Often yes, with a programme built around where your bones are affected and how much pain you have. Myeloma UK says "Around 3 in every 4 patients have evidence of myeloma bone disease at diagnosis", and around 9 out of 10 have it at some point [8].

Myeloma UK's advice [8]:

• "The type of exercise you do will depend on the extent of your bone disease and the amount of pain you have."
• "Generally, low-impact gentle exercise, such as walking, swimming or cycling, is recommended."
• "High-impact exercise, such as running, tennis or contact sports, is usually not recommended."
• "Avoid over-exertion and heavy lifting to reduce risk of fractures."
• Talk to your doctor or nurse "before taking part in any new exercise or sport".

In a small study of 37 people with multiple myeloma who did 3 months of supervised exercise then 3 months at home, "There were no adverse reactions", and quality of life, fatigue and muscle strength improved [9]. There was no comparison group, and the authors say these benefits "await confirmation in randomized studies" [9]. For protecting bones more generally, see bone health after cancer.

Usually soon, in a small way, guided by your team. Leukaemia Care says experts have found that "even after an intensive treatment, like a stem cell transplant," you "may only need to take a short break from activity" [5]. If you are recovering from a transplant, it says to "be guided by your haematology and wider healthcare team" [5]. While you are in hospital, when it is safe for you to get moving, it suggests you "could start with 5 minutes of walking", "with the aim of gradually building up to 30 minutes" [5].

The exercise roundtable's advice after a transplant is to "Start with light intensity, short durations but high frequency and progress slowly", with "Home-based exercise encouraged" [2]. It recommends "A full recovery of the immune system" before you return to gyms shared with the public [2]. Lymphoma Action says your risk of infection "is further increased if you have HIV or have had a stem cell transplant", so check with your team how to limit that risk before you exercise around other people [3].

A 2021 review of 27 trials (2,432 people) having bone marrow transplants found "moderate-quality evidence" that exercise improves walking capacity, quality of life and fatigue, with effects "more pronounced in recipients of allogeneic transplantation" (from a donor) [10]. "No serious adverse events were associated directly with exercise" [10].

Stop and get medical advice if you feel unwell, and treat a possible infection as urgent. Blood Cancer UK says "if you get dizzy, feel unwell or have any unusual symptoms, stop and speak to a doctor" [4].

Leukaemia Care asks you to let your team know how you feel when you are moving, "Especially, if you're feeling unwell or if any side effects get worse when you're active" [5]. Lymphoma Action says "you should not exercise while you have diarrhoea or vomiting" [3].

If you might have an infection. Signs include "feeling hot or cold (a temperature that's higher or lower than normal)", a sore throat, "feeling dizzy or faint" and "pain, redness or discharge (fluid) around the site of a central line" [7]. If you are on treatment: "Call the emergency contact number you have been given and follow the advice. If you can't get through to the number you have been given, call 999 or get someone to drive you to A&E" [7]. If you are not on treatment: "Call your GP or hospital team. If you can't speak to your GP or hospital team, call 111" [7]. If you are neutropenic and go to A&E, tell the staff [6].

If you have lymphoma. Lymphoma Action says spinal cord compression "needs urgent medical attention", and "For most people, the first sign is pain in the spine, back or neck" [3].

If you have myeloma. Back pain, "Numbness, weakness or tingling in your legs and arms", problems walking, or problems passing urine or opening your bowels can be signs of spinal cord compression. Myeloma UK says this "is a medical emergency" and "you should seek medical advice immediately" [8].

Start with your haematology team. Leukaemia Care says "Your haematology team should discuss the benefits of keeping active with you at all stages of your condition" [5]. While you are in hospital, it says "A physiotherapist or occupational therapist may support you with this" [5]. Lymphoma Action says your medical team "might be able to refer you to a specialist physiotherapist for more guidance" [3].

Lymphoma Action adds that "Your clinical nurse specialist, a physiotherapist or cancer exercise specialist can be good people to ask" [3]. Clinical exercise physiologists (CEPs) are one kind of cancer exercise specialist, responsible for "prescribing and delivering evidence-based exercise", including in oncology "with patients with different types of cancer and at different stages of treatment" [11]. For local support, see cancer rehabilitation in London.

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