Tips for getting started

It’s important to keep physically active. But you may need to be careful with the activities you choose. This will depend on the cancer, your treatment, its side effects and any other medical conditions you might have. Your doctor or specialist nurse can give you advice.

Chemotherapy, radiotherapy or recent surgery can affect the type of activity that is safe for you. For example, chemotherapy increases your risk of infection. If your white cells are low, your doctor may advise you to avoid pools or gyms. If you have long term treatment effects, such as lymphoedema or nerve damage, you’ll also need advice on what is safe.

It is important to get advice before you start becoming more active. Your cancer doctor, GP or specialist nurse can tell you what type of exercise is most appropriate for you. You can also get support from a physiotherapist or an occupational therapist.

We have lots of tips for getting started, including joining a walking group, playing a sport or encouraging your friends and family to join you. Setting yourself realistic targets and keeping a record of your progress will help you to stay active.

Tips for exercising safely

It is usually safe to start doing some physical activity during or after treatment. It can be hard to think about exercise when you are dealing with the symptoms of cancer or side effects of treatment. But becoming more active may help deal with this.

If you decide to do some type of physical activity, it is important to make sure you do it safely. Even if you did regular physical activity before you were diagnosed with cancer, you may need to be more careful. Below are some general tips for keeping safe when doing any type of physical activity:

  • Start slowly and gradually build up.
  • Do not exercise if you feel unwell or if you have any symptoms that worry you.
  • If you have bone problems, you should avoid uneven surfaces and activities that increase the risk of falling. You should also avoid high-impact activities such as running. See below for more information about if you have other medical conditions.
  • Wear well-fitting trainers or walking shoes.
  • Drink plenty of water, so you do not get dehydrated.
  • Protect yourself in the sun.
  • Have a healthy snack after exercising, such as a banana.

You should stop exercising if you get any sudden symptoms, including:

  • feeling dizzy
  • chest pain
  • a racing heart
  • breathing problems
  • feeling sick
  • unusual back or bone pain
  • unusual muscle pain
  • a headache that does not go away.

Speak to your doctor if you notice any of these, or any other symptoms.

After starting out with light exercise and trying to increase my walking levels, I have now gone on to working out three times a week and love it!

Clare


If you are having treatment

Surgery

Your doctor might encourage you to start some physical activity before surgery. This can help improve your general fitness level and help with your recovery.

It is important to start moving around as soon as possible after surgery. This reduces the risk of complications such as blood clots. But depending on the operation, there may be some activities you should avoid. For example, if you have a stoma, you may be given advice on which activities to avoid at first. Your surgeon, physiotherapist or nurse will tell you which activities you should avoid and for how long.

A physiotherapist or nurse may show you exercises to do when you get home. For example, women who have breast surgery are usually given arm and shoulder exercises to improve their flexibility.

If you had surgery to your pelvis, or near your hips, you may be shown exercises to help strengthen your stomach (core) and pelvic floor muscles. Try to do these for as long as you were advised to. If you have pain, discomfort or swelling that stops you doing them, tell the physiotherapist or nurse.

Chemotherapy

Chemotherapy can lower the number of blood cells made in the bone marrow. We need different types of blood cell to do different jobs. So when the number of blood cells is reduced, you may be at an increased risk of some problems.

Risk of infection

White blood cells help you fight infection. If your number of white blood cells is low, you are at an increased risk of getting an infection. While your number of white blood cells is reduced, your cancer doctor might advise you to avoid busy public places where you are more likely to get an infection. This might include swimming pools or gyms.

We have more information about avoiding infection when you have reduced immunity. This includes a video about neutropenic sepsis.

Bleeding and bruising

Platelets are cells that help the blood to clot. If your number of platelets is low, you are more at risk of bruising or bleeding. Your doctor may advise you to exercise gently and avoid high-impact activities. This is usually until the number of platelets is back to a safe level.

Anaemia

If your number of red blood cells is very low, you will feel very tired and sometimes breathless. This is called anaemia. If this happens, you may not feel like exercising or only be able to manage day-to-day activities. It is important to rest when you need to until the anaemia is reduced. 

Central and PICC lines

If you have a central line or PICC line, you should avoid swimming. This is because of the risk of infection. You should also avoid vigorous upper body exercises, which could displace your line.

Radiotherapy

If you have a skin reaction or redness due to radiotherapy, wear loose clothing when exercising to prevent rubbing against any areas of sensitive skin. 

You should avoid swimming, as the chemicals in the water can irritate your skin. After treatment ends and any redness or skin reaction has gone, it’s fine to swim again. Ask your radiotherapy team for advice about swimming during and after treatment.

To get to the top of your stairs can be a huge challenge if you’re undergoing chemotherapy. But if you can do that, then maybe you can do it twice the next day.

Michelle

Amrik reading a book

Alan on treatment and side effects

'The thought that I would not be able to carry on with these activities was extremely upsetting.'


If you have side effects or other medical conditions

Some treatment side effects or other medical conditions can affect which physical activities are right for you.

Bone problems

If you have bone thinning or cancer in the bones, it is usually best to avoid high-impact activities. This is because there is more risk of you breaking (fracturing) a bone with these. High-impact activities are things that involve pounding or repetitive actions. This might include jumping up and down on a hard surface or hitting a ball with a racket. Examples of high-impact activities include running, football, tennis, squash, hockey and contact sports such as judo and karate.

It may be safe for some people who have a higher risk of fracture to do some of these activities. This will depend on your personal risk of fracture and whether you have symptoms such as pain in the bones. If you are at a high risk of fracture, speak to your cancer doctor, specialist nurse or physiotherapist before any type of high-impact physical activity.

Some people with bone problems may also be advised to avoid exercises where you repetitively bend forward at the waist. This includes toe-touching and sit-ups. This is because of the risk to the spine and back. Many types of activity recommend bending and toe-touching as a warm-up. If you have secondary bone cancer in the spine or hip, check with your healthcare team whether this is safe for you to do.

If you have bone thinning or cancer in the bones it is usually safe for you to do low-impact, weight-bearing activities. Examples include:

It is also a good idea to do some exercises that improve your co-ordination and balance. This is to reduce your risk of falling. These exercises include low-impact dancing and tai chi.

Nerve damage (peripheral neuropathy)

Some chemotherapy drugs can damage the nerves. This causes numbness or tingling in your hands or feet, muscle weakness or difficulty with balance and co-ordination.

If your feet or balance are affected, then running or brisk walking (especially on uneven surfaces) or walking up and down steps may not be the best activity for you. Cycling or swimming may be more suitable. Remember to check your feet regularly for cuts or blisters.

If you have numbness and tingling in your hands, it may be difficult or dangerous to use free weights or resistance bands.

Lymphoedema

Physical activity can help you reduce the risk of developing lymphoedema. Or if you have lymphoedema, physical activity can help you manage it.

If you have lymphoedema, it is helpful to do the following:

  • Always wear a compression garment when you exercise.
  • Avoid doing heavy, repetitive action with the affected limb that you would not normally do.
  • Avoid working the muscles from one position without movement (static contractions). For example, avoid the plank position. This is when you hold your body in a press-up position without moving up and down.
  • Strength exercises are safe for people with lymphoedema and they may help prevent symptoms.
  • Swimming can be helpful if you have lymphoedema, as it gently massages the lymphatic vessels.
  • Build up the physical activity involving the affected arm or leg slowly.

Ask your lymphoedema specialist for advice. We have more information about lymphoedema.

Heart or lung problems

Most people with heart or lung problems can benefit from regular physical activity. Check with your doctor or specialist nurse before you start any exercise programme.

We have more information about heart health.

Medicines to thin the blood

If you’re taking medicine to thin the blood, you will bruise more easily. Avoid high-impact activities, as you could get knocked or fall over. Take extra care during activities to avoid damaging your skin.

Stoma

If you have had surgery for bowel cancer, you may have a stoma. You will need to learn new skills to manage this. You may also need time to adjust to the changes in your body. This may affect what physical activity you choose to do.

When any other wounds have properly healed, it is helpful to start with some exercise to strengthen the tummy (core) muscles. Your specialist nurse (sometimes called a stoma care nurse) can help you think about how to do some physical activity with the stoma. They can also advise you on any activities you need to avoid at first. They can also refer you to a physiotherapist.

We have more information about bowel cancer.

I am limited in what exercise I can do, but I still try to do little bits of movement. Especially weight-bearing exercise because that will keep the bones strengthened.

Christine


If you have advanced cancer

Physical activity is safe if you have advanced cancer. It has many of the same benefits as for people who do not have advanced cancer. It can help reduce symptoms such as tiredness, poor sleep and poor appetite. It can also improve bone health and general fitness.

If you have advanced cancer and want to get more active, the advice is the same as for people who do not have advanced cancer. You should start slowly and gradually build up the amount you do. To start with, try to reduce the amount of time you spend sitting or lying down during the daytime. Moving around the house and doing easy, everyday things will help. You may be able to do short walks or gentle stretching exercises. These will help build fitness and flexibility. This can help with everyday tasks such as putting on shoes, dressing or washing. 

Resistance exercises can also help strengthen your muscles and bones. This helps with getting in and out of chairs or baths, or going up and down stairs. Doing resistance exercises with exercises that improve balance can help reduce your risk of falls.  

If you were very active before cancer or treatment, you may not be able to do the same amount as before you were diagnosed.

Ask your cancer doctor or palliative care team for advice before you start any type of exercise. You may need to avoid some types of physical activity. For example, if the cancer is in the bones or you have bone thinning, you should usually avoid high-impact activities such as running, football or tennis.

We have more information about advanced cancer.

Living with advanced cancer

Amanda talks about her experiences of living with advanced breast cancer.

About our cancer information videos

Living with advanced cancer

Amanda talks about her experiences of living with advanced breast cancer.

About our cancer information videos


Who can help?

If you feel worried about starting physical activity, it can help to get advice. This might be if you have not been very active before or for a long time. The following professionals and organisations can help you.

Your doctor or nurse

It is best to talk to your cancer doctor, specialist nurse or GP before you start exercising. They can give you advice on whether it is safe for you to exercise. They can also give you information about any precautions you need to take.

Some GPs, cancer treatment centres and support groups have exercise referral schemes see below. These can refer you to a cancer exercise specialist. There may also be an exercise programme that is part of some research at your cancer treatment centre. Ask your cancer doctor or nurse for more information.

A physiotherapist or cancer exercise specialist

Your GP, cancer doctor or specialist nurse can refer you to a physiotherapist. Some areas may have qualified cancer exercise specialists who you can be referred to. A cancer exercise specialist is a fitness instructor who is qualified to help people with cancer to exercise safely. They might work in a gym or local leisure centre. They might offer personal training. Some cancer exercise specialists may offer classes in cancer information centres. You may also be able to refer yourself to a physiotherapist. 

A cancer exercise specialist or physiotherapist can help you:

You can ask them questions such as:

  • ‘I have never exercised before – how should I start?’
  • ‘How can I improve my shortness of breath and feel less tired?’
  • ‘How can I improve my balance?’
  • ‘Can I improve the strength of my arms or legs?’
  • ‘Which exercises can help me get up the stairs?’
  • ‘How hard should I exercise?’

If you have more specific needs, they may be able to arrange a rehabilitation programme for you.

You can also visit the Ask an Expert section on Macmillan’s Online Community. Here you can ask a physiotherapist any questions about getting active during or after your cancer treatment.

An occupational therapist

Your GP or cancer doctor may refer you to an occupational therapist. They can advise you on how to pace yourself and manage tiredness.

They can also suggest changes to your home that will make it safer and help you be more independent. Doing simple things for yourself in the home is a way of increasing your physical activity. If things are easier at home, you will also have more time and energy to do activities you like, such as walking or gardening.

Exercise referral schemes

Many people prefer to exercise in a group. If you think this might help, or you feel you need to exercise with an expert, you may want to join an exercise referral scheme. They are mostly held at local community centres, healthy living centres, leisure centres and libraries. Ask your GP, cancer doctor, physiotherapist or specialist nurse about any in your area. Not all areas have an exercise referral scheme, or the schemes may only be available for people with certain medical conditions.

Specially trained exercise professionals manage many of these schemes. But it is a good idea to check whether they have been trained to work with people who have or have had cancer.

When your doctor makes your referral, they will share some information about your health with the exercise professional. The exercise professional will keep this confidential.

Your trainer will explain the benefits and risks of increasing your physical activity. They will ask you to give your consent. This means you agree to the exercise plan and understand the benefits and risks. Your trainer will match the activities to your needs, interests and ability. They will help you decide whether it is best to exercise in a group or on your own.

Some areas also have schemes in care homes, hospices and day centres. They often include activities such as chair-based exercises, walking, dancing, pilates, gentle exercise to music, circuits, tai chi and yoga.

Back to Keeping active

Health walks

Walking is one of the most popular forms of activity and a great way to keep active. Health walk programmes are available across the UK.

Activities near you

There are lots of organisations and websites that can help you find out what activities are available near you.

Tools to help you move more

Taking part in physical activity during and after cancer treatment can play a huge part in enabling you to take back control. We have a range of tools to help you be more active.

Apps to help you

There are a number of digital applications that can help you on your journey to becoming more active.