What Increases Your Risk?

You may need to check with your doctor before starting an exercise program. Whether you need to talk to your health care team can depend on several factors including:

• Your cancer history
• Your cancer treatments (chemotherapy and chest radiation)
• Other medical history
• Other factors

Cancer History

It's important to consider your history of cancer before starting or restarting an exercise program.

Do you have early stage disease or are you living with advanced disease?

The goals of someone living with (or recovering from) early stage disease will likely be different from those of someone living with advanced disease. Also, certain exercises – such as high intensity aerobic exercise or resistance exercise – may not be safe for everyone, especially if you are living with advanced disease.

Has your cancer spread to your bones or nervous system?

Exercise may still be safe for people living with advanced disease, even if your bones or nervous system have been affected. However, it is important to speak to your doctor and an exercise specialist before exercising to ensure you lower your risk of falls and fractures!

Cancer Treatments

Before starting to exercise, the types of cancer treatments – whether you had surgery and what type of therapy you may have had – also should be considered.

If you received surgery: Ask your surgeon or oncologist if it is safe for you to start reintroducing exercise into your life. Specific considerations include:

❱❱ How long ago did you have surgery? If less than 3 or 4 months ago, it may not be safe for you to begin all types or intensities of exercise.

❱❱ Did you have major or minor surgery? More invasive surgeries take longer to heal than less invasive ones.

❱❱ Did you have lymph nodes removed? If so, and if the nodes were in or near the arms (shoulders) or legs (pelvis), you may be at higher risk for swelling of the arms or legs (lymphedema). Although lymphedema can be prevented and treated, it can't be cured.

❱❱ Do you have other surgery-related considerations? Patients in the process of, or who recently completed, reconstructive procedures need to be careful not to irritate the affected area to avoid infections.

❱❱ Have you had an ostomy? The major concerns around exercising with an ostomy include infection and herniation risks. An ostomy is a surgical procedure done to help the body remove waste when your digestive system is not working properly. An ostomy bag worn outside the body collects the waste. If you are living with an ostomy, you should avoid contact sports and water sports. However, you may be able to do other exercises safely, for example brisk walking and cycling. You also should avoid exercises that cause high levels of abdominal strain and obtain medical clearance before doing resistance exercise.

If you received chemotherapy, hormone therapy, or a targeted therapy:

❱❱ Is the treatment linked to higher risk of cardiotoxicity? If so, make sure there is a plan to monitor your heart health during and after treatment. If you had more than one such treatment, be sure to ask about possible combined risks for the treatments you are receiving or received.

❱❱ How much of the medication did you receive, and how long were you taking it? In many cases, cardiotoxicity risk adds up over time. The more medication you receive, or the longer you are taking the medication, the greater the risk.

❱❱ Are your blood counts in a safe range for exercising? Some treatments can affect components of your blood, such as red blood cells, white blood cells, platelets, or plasma volume. These levels can influence your safety and ability to exercise.

If you received radiation therapy:

❱❱ What area of the body was affected? Radiation may hurt your heart, lungs, blood vessels, nerves, and bones.

Other Medical History

In addition to your cancer history and treatments, your non-cancer health history is also important to keep in mind before starting an exercise program.

Have you been diagnosed with or are you living with a chronic health condition other than cancer?

If you have a preexisting or uncontrolled heart condition or cardiovascular disease, you need to check with your doctor to make sure it is safe for you to exercise.

Does heart disease run in your family?

If so, make sure you tell your oncologist at your next health visit.

Other Factors

Other health considerations may factor into whether you start an exercise program.

Your pre-cancer activity level or fitness

The more active and physically fit you were before your cancer diagnosis, the more you may be able to do after a cancer diagnosis. However, this is not always the case. Make sure you ask your oncologist if it's safe for you to return to your pre-diagnosis exercise program.

Your current condition and energy levels

Energy conservation is important – especially if you are feeling fatigued. Although it is important to challenge yourself, it is similarly important not to over-do it!