Can you exercise during chemotherapy? A UK guide

Yes. For most people, being physically active during chemotherapy is safe and recommended. Cancer Research UK and Macmillan both say activity during treatment is generally safe, and international guidelines advise regular aerobic and resistance exercise during active treatment. It helps fatigue, fitness and mood. How much depends on your blood counts and side effects each week, so check with your oncology team first. For the wider picture of support before, during and after treatment, see our guide to cancer rehabilitation in the UK.

Can I exercise during chemotherapy?

Cancer Research UK states that "international guidelines say it is safe to be active during cancer treatment and after" [9]. Macmillan agrees it "is generally safe" and may help you maintain fitness, strength and mental wellbeing [8].

The 2022 ASCO guideline, built on 42 systematic reviews of exercise, tells oncology teams to "recommend regular aerobic and resistance exercise during active treatment with curative intent" [2]. The 2019 ACSM roundtable found exercise "generally safe and well tolerated during and after cancer treatment" and advises everyone with cancer to "avoid inactivity" [1].

Every week will not look the same. Macmillan notes "there may be some weeks when you have to do less, such as immediately after chemotherapy" [8]. Doing less is fine; doing nothing for months is what the evidence warns against.

Does exercise during chemo help?

Yes. In trials of people having chemotherapy, those who exercised kept more of their fitness and strength, had fewer side effects such as nausea and pain, and those on supervised programmes were more likely to get through their planned chemotherapy than those who did not exercise [3][4]. The two best-known trials were in women having chemotherapy for breast cancer.

The PACES trial (230 patients) compared a low-intensity home programme and a supervised moderate-to-high-intensity aerobic and resistance programme against usual care. Both exercise groups lost less fitness, kept better physical functioning, had less nausea, vomiting and pain, and returned to work sooner. The supervised group also had better strength, less physical fatigue and fewer chemotherapy dose adjustments [3].

The START trial (242 patients) found resistance training improved strength, lean body mass and the chemotherapy completion rate compared with usual care, with no adverse events [4].

Across all cancers, a 2012 Cochrane review by Mishra and colleagues (56 trials, 4,826 participants) found exercise during active treatment improved quality of life, physical functioning and fatigue [6]. The same principles apply during radiotherapy; see our guide to exercise and cancer.

Chemo fatigue and exercise

Fatigue is the side effect people ask about most, and it is where exercise has the strongest evidence. A 2017 meta-analysis found exercise reduced cancer-related fatigue and did better than the medicines tested [7]. A 2012 Cochrane review by Cramp and Byron-Daniel found aerobic exercise helps fatigue during and after treatment [5], and the ACSM roundtable recommends moderate-intensity aerobic exercise three times a week for at least 12 weeks [1].

Macmillan's rule: "at the end of an activity, you should feel energised, not totally exhausted", and go "little and often" [8].

Chemo fatigue: where to read more

For most people chemo fatigue eases once treatment finishes, but it can carry on for "several weeks, months, or even years after treatment" [10]. Our guide to cancer-related fatigue explains what it feels like, why it can linger, the full evidence on exercise and what else helps.

What is the best exercise during chemotherapy?

There is no single best exercise. The evidence supports combining aerobic and resistance training, scaled to how you feel each week [1][2].

If you have numbness or tingling in your feet (peripheral neuropathy), Cancer Research UK suggests a stationary bike may be safer than walking or running [9].

How much exercise should you do during chemotherapy?

Cancer Research UK's general target is 150 minutes of moderate activity a week (for example 30 minutes, five times a week) or 75 minutes of vigorous activity, plus strength training twice a week and balance and flexibility work twice a week [9]. During chemotherapy, treat that as a direction of travel, not a pass mark, and expect to do less straight after treatment [8].

A sensible week might include:

• Walking as your aerobic base, increasing the distance as you are able.
• Resistance work two or three days a week with body weight, bands or light weights, progressed by someone who knows your treatment and your platelets. In START, women who did supervised resistance training three times a week were more likely to complete their planned chemotherapy than those who did not exercise [4].
• A lighter week straight after each infusion, building back up as you recover [8].

Chair exercises for chemo patients

On days when standing feels too much, seated exercise keeps you moving without the fall risk. The NHS sitting exercises are designed for people who have not exercised recently, using a solid, stable chair without wheels [12]:

• chest stretch (hold 5 to 10 seconds, repeat 5 times)
• upper-body twist (hold 5 seconds each side, 5 times each side); skip this one if cancer affects your bones [9]
• hip marching (5 lifts with each leg)
• ankle stretch (2 sets of 5 per foot), which the NHS notes also lowers the risk of a blood clot
• neck rotation (3 each side) [12]

Check with your team before starting if cancer affects your bones, you have a line or port in your chest, or your blood counts are very low (see the cautions below). The NHS suggests at least twice a week, building up slowly [12]. A clinical exercise physiologist can progress this into seated resistance work with bands as your energy returns.

Chemo brain and exercise

"Chemo brain" describes the memory and concentration problems the NHS lists as a common chemotherapy side effect [11]. It overlaps heavily with fatigue: difficulty concentrating and thinking clearly are core symptoms of cancer-related fatigue [10].

Cancer Research UK lists "thinking problems (cognitive impairment)" among the side effects physical activity can help reduce [9]. The research is less certain here than for fatigue. The 2019 ACSM roundtable found enough evidence to recommend exercise for fatigue, anxiety, depression, physical functioning and quality of life, but said its effects on cognitive functioning "remain uncertain" [1]. Treat chemo brain as another reason to keep active, not as something exercise is proven to fix.

Eating and drinking during chemotherapy

Macmillan says cancer and its treatment can cause problems with eating, including sickness, appetite loss and a sore mouth; some are caused by the cancer itself and others are side effects of treatment [13]. If you are struggling to eat or losing weight, a dietitian can help. Macmillan says: "You can ask your doctor or nurse at the hospital to refer you to a dietitian," and "in some hospitals, you can refer yourself" [13].

Our guide to nutrition during cancer treatment explains when to ask for a dietitian and how eating well fits with staying active.

Who should you see?

During chemotherapy you need someone who can adjust your exercise week by week around blood counts, sickness, neuropathy and fatigue, and who works alongside your oncology team. Clinical exercise physiologists (CEPs) prescribe and deliver exercise for long-term conditions, including cancer [16]. CEPs can join a voluntary register run by the Academy for Healthcare Science, which opened to CEPs in January 2022 [14] and is accredited by the Professional Standards Authority [15]. Physiotherapists, dietitians, specialist nurses and Level 4 cancer rehabilitation instructors also play a part. Our guide to your cancer rehabilitation team explains who does what, and cancer rehabilitation in the UK explains how to get support.

When to be cautious or talk to your doctor first

Cancer Research UK advises: "In general, if you have cancer, you should check with your doctor before starting any exercise" [9].

Make sure you know how to reach your chemotherapy team if you feel unwell, including at night and at weekends. Many hospitals run an acute oncology line; at Guy's and St Thomas' in London, for example, it offers "telephone support 24 hours a day, 7 days a week" for its patients [17]. The NHS says to call NHS 111 if you're not sure how to contact your care team [11]. Stop exercising and call if you notice any of the following.

• Signs of infection. Chemotherapy weakens your immune system. The NHS says to call your care team now if you have a high temperature (feeling hot, cold, sweaty or shivery) or other signs of infection such as a sore throat, cough, diarrhoea or pain when peeing [11].
• Low immunity and gyms. People with low immunity due to treatment should avoid public gyms and ask their medical team when it is safe to return [9]. Your team will tell you when in each cycle your risk of infection is highest; walk outdoors or exercise at home on those days.
• Low platelets. Some cancer treatments lower your platelets, so you bruise and bleed more easily. Your doctor may advise you to exercise gently and avoid high-impact activities until your count is back to a safe level [18].
• A central line or PICC line. Avoid swimming, because of the risk of infection, and avoid vigorous upper-body exercise, which could displace your line [18]. Ask your team before any upper-body resistance work.
• An implanted port. Avoid strenuous exercise for a few weeks after it is fitted [19]. Once it has healed, one NHS trust says you can swim and exercise as usual when the needle is not in place [20]. Ask your team what is safe while a needle is in.
• Anaemia. Lack of energy, shortness of breath and noticeable heartbeats can signal low red blood cells [11]. Ease off and tell your team.
• Possible blood clot. Throbbing or cramping pain, swelling and warmth in a leg or arm, or sudden breathlessness or sharp chest pain, need urgent contact [11].
• Neuropathy. Numbness or tingling in hands or feet affects balance; choose seated or supported exercise [9][11].
• Bone involvement. If cancer has spread to bone, avoid exercises that twist the spine [9], and have your team sign off any programme.

Getting matched with a specialist

The Health Nav matches people with verified clinical exercise physiologists, in person in parts of south-west London and remotely across the UK, to work alongside your NHS team. Dietitians, specialist nurses and other members of the wider team are reached through your hospital team or GP. Read more in what is a clinical exercise physiologist? and our exercise professional tiers guide.

If treatment has not started yet, see prehabilitation. For cancer-specific advice, see breast cancer exercise, bowel cancer exercise, prostate cancer exercise and exercise with other cancers, which covers blood cancers and stem cell transplant. When chemotherapy ends, see exercise after cancer treatment. Short answers to common questions are on our cancer FAQs page.

Request a match with a verified clinical exercise physiologist through The Health Nav. Questions first? Email support@thehealthnav.co.uk.

This article is general information and does not replace advice from your own healthcare team.

References

1. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine and Science in Sports and Exercise. 2019;51(11):2375-2390. https://doi.org/10.1249/MSS.0000000000002116
2. Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of Clinical Oncology. 2022;40(22):2491-2507. https://doi.org/10.1200/JCO.22.00687
3. van Waart H, Stuiver MM, van Harten WH, et al. Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. Journal of Clinical Oncology. 2015;33(17):1918-1927. https://doi.org/10.1200/JCO.2014.59.1081
4. Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007;25(28):4396-4404. https://doi.org/10.1200/JCO.2006.08.2024
5. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews. 2012;(11):CD006145. https://doi.org/10.1002/14651858.CD006145.pub3
6. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews. 2012;(8):CD008465. https://doi.org/10.1002/14651858.CD008465.pub2
7. Mustian KM, Alfano CM, Heckler C, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncology. 2017;3(7):961-968. https://doi.org/10.1001/jamaoncol.2016.6914
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