Benefits of Exercise: Living Life with Chemotherapy Fatigue

By Nicholas Zuk

Cancer-related fatigue (CRF) is the physical, emotional, and mental exhaustion that cannot be improved through sleep or rest in someone with cancer (American Cancer Society, 2024). CRF is often exacerbated through chemotherapy treatments, causing cancer treatment-related fatigue, or “chemo fatigue.” Chemo fatigue can occur both during treatment and can last for months or even years after chemotherapy has been completed. Chemo fatigue is unrelenting and can make even the most basic and routine activities challenging. Battling this fatigue can be extremely difficult. However, studies have shown that exercise can effectively combat exhaustion and boost energy throughout the day (Minton, Jane, & Jo, 2015). 

There are a variety of factors that intensify cancer-related fatigue caused by chemo. In general, chemotherapy attempts to stop cancer from spreading by killing cells in the process of dividing to prevent new cancer cells from being produced. This is done in various ways, either by damaging the part of the cell that makes the cell divide, interrupting the chemicals that initiate cell division, directly damaging the cells before division, or damaging cells while they are dividing. But chemo also kills healthy cells. As a result of this cellular damage, chemotherapy commonly leads to hormonal disruptions and anemia, conditions that can cause side effects such as nausea, loss of appetite, pain, hot flashes, anxiety, and, in some cases, depression (American Cancer Society, 2020). These compounding conditions and side effects cause physical and emotional exhaustion or chemo fatigue.

While chemo fatigue can make even basic tasks extremely tiring, exercise can improve energy levels in many ways. First, by strengthening the heart’s cardiac output through exercise, the body can deliver oxygen more efficiently to its tissues, increasing stamina and mobility over time (Nystoriak & Bhatnagar, 2018). This is essential for patients suffering from chemo fatigue because even a minor boost in energy can make the difference between being able to socialize, for example, or staying home. Second, exercise is essential because it is key to preventing muscle atrophy or deconditioning, which increases the amount of energy expended on any task, leading to increased fatigue. Finally, exercise increases endorphin and serotonin production, which not only improves energy levels in cancer patients but can also improve mental health by reducing both anxiety and symptoms of depression, leading to an enhanced quality of life overall (Mustian et al., 2009). However, only addressing the upsides of exercise, and not the challenges, would be an oversimplification of reality. Chemo fatigue stems from an incredibly invasive treatment that can create physical and psychological barriers that make maintaining an exercise routine nearly impossible. The variability in day-to-day energy levels, anxiety about overexertion, and fear of injury when in a vulnerable state can make choosing not to exercise easy. However, exercise’s benefits can help patients reclaim their lives, and some strategies can make exercise less daunting.

Consult with your doctor before introducing an exercise routine into daily life. If exercise is allowed, it is essential to identify enjoyable, low-impact activities, choose a time to exercise, and set short and long-term goals. First, beginning with low-intensity activities in 5-minute intervals, such as gentle stretching, yoga, tai chi, or short walks, can allow stamina to build slowly without overexertion (MSKCC, 2021). These forms of exercise also improve flexibility and balance. They can help alleviate muscle soreness and increase the strain muscles can handle. Cardio-focused exercises are perfect for increasing stamina and include low-intensity options such as walking, swimming, elliptical machines, rowing, cycling, and jogging at a comfortable pace that allows a patient to carry on a conversation comfortably. Strength training using resistance bands and light weights can mitigate muscle atrophy and sustain muscle tone. Incorporating one or all these forms of exercise can lead to overall improvement in both energy levels and strength. 

While exercise has many benefits, avoiding overtraining is extremely important for preventing injury and exhaustion that can dissuade someone from continuing a regimen. It is important to remember that consistency is more important than intensity. Similarly, while energy levels fluctuate daily, finding a workout time you feel comfortable with is essential. Try tracking your energy levels throughout the day for 1-2 weeks to identify when energy levels are stable enough to exercise. Or exercise the first thing in the morning. Even 5-10 minutes of gentle exercise can improve energy for the rest of the day. 

Finally, setting short and long-term goals can make maintaining a routine more manageable and achievable. Short-term exercise goals are goals that are achievable from day to day. For example, an ideal short-term goal when beginning could be walking for 15 minutes 3 times per week. A short, low-impact exercise session is easier to maintain regularly and will increase energy levels. Long-term goals are exercise goals that will be achievable in the future. For example, a patient may start walking 3 times a week and aim to be able to walk 5 times a week in the future.  The goal may also be to work towards extending the exercise session from 5 to 15 minutes.  Whether the exercise goals are short or long-term, it’s essential to break them into minor, manageable actions that make them feel less overwhelming and more achievable. Focus on maintaining or improving energy levels and overall well-being during treatment rather than aiming to lose weight or gain muscle mass. 

Once exercise becomes a regular part of a weekly schedule, it is vital to ensure proper nutrition to fuel workouts and prevent burnout. Hydration is critical for preventing muscle cramps and maintaining stamina and overall energy levels (JHM, 2022). A good rule of thumb is to drink 8-10 cups of water daily to maintain healthy hydration levels. Infusing water with lime, lemon, or sugar-free electrolyte powder significantly reduces flavor fatigue. Additionally, if water is not appealing, opting for electrolyte-rich drinks rich in sodium, potassium, and magnesium is a great way to replenish minerals lost during both exercise and chemotherapy (Smith, 2023). Sugary and caffeinated beverages should be avoided as much as possible because of their dehydrating effects.  

With this foundation, sample exercises and routines can be found online or provided by your doctor. Cancer treatment may offer wellness classes patients can attend virtually or in person throughout the week that focus on different forms of exercise. Patients who opt to exercise at home or on their own can benefit from the following sample routines intended for beginner, intermediate, and advanced exercise groups, which provide a clear starting point for incorporating exercise into daily life. 

For beginners, walking is an excellent baseline exercise that offers cardiovascular benefits and is easy to incorporate into daily routines. Even short, consistent walks can make a significant difference. Chair-based exercises, such as seated marches or arm raises, are safe options for improving strength and flexibility, particularly for those with mobility or balance challenges (MSKCC, 2022). Gentle stretching can ease muscle tension and improve range of motion, especially after surgery, and deep breathing exercises can help reduce stress and enhance lung capacity. A beginner routine might include a 5-minute warm-up with light seated marching, 10 minutes of walking, or 5 minutes of chair exercises, stretching, and deep breathing for cool-down. Gradually increasing duration and intensity ensures the routine remains effective and manageable.

Intermediates can build on existing strength and endurance to further reap energy benefits. Increasing walking speed or lightly jogging can further enhance heart health. Resistance training using light weights or resistance bands can help strengthen major muscle groups. Bicep curls, banded squats, and seated rows are ideal for maintaining and developing strength. Incorporating yoga sessions can improve overall mobility, balance, and mental well-being. Finally, either stationary or outdoors, cycling is a moderate-intensity option that targets lower-body strength and stamina. A good routine involves combining 1-2 activities and performing them 3-5 times a week for 15-30 minutes.

Advanced fitness level patients can benefit from incorporating higher-intensity activities. High-Intensity Interval Training (HIIT), which alternates between short bursts of intense activity and rest periods, efficiently boosts cardiovascular fitness and muscle strength. Advanced resistance training exercises, such as deadlifts, squats, and bench presses, help build muscle mass and improve overall physical capacity with proper form and moderate to heavy weights. Vigorous aerobic activities like running, swimming laps, or fast-paced cycling enhance stamina and cardiovascular endurance. Additionally, advanced yoga or Pilates sessions incorporating complex poses and sequences can improve core strength, flexibility, and mental focus. An effective advanced routine could include a 10-minute dynamic warm-up, a 15-minute HIIT session, 20 minutes of resistance training focusing on different muscle groups, and a 10-minute cool-down with stretching. These exercises can be performed 4-6 times a week, with careful attention to recovery and individual energy levels to prevent overtraining and injury.

Beginning an exercise routine while undergoing chemotherapy can be draining. However, the benefits of exercise can be a freeing experience that allows patients to reclaim their lives. By dedicating a small amount of time each day, the effects of chemo fatigue can be reduced, allowing for gradual improvement in strength and endurance. Eventually, by committing to a routine, patients can feel an improvement in their energy and physical well-being and live a more normal life.

References

American Cancer Society. (2020). Chemotherapy side effects. Retrieved from https://www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy/chemotherapy-side-effects.html 

American Cancer Society. (2024). Cancer-related fatigue: Managing fatigue. Retrieved from https://www.cancer.org/cancer/managing-cancer/side-effects/fatigue-weakness-sleep/fatigue.html 

Minton, O., Jane, M., & Jo, F. (2015). The role of behavioural modification and exercise in the management of cancer-related fatigue to reduce its impact during and after cancer treatment. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25751756/ 

Mustian, K. M., Peppone, L. J., Palesh, O. G., Janelsins, M. C., Mohile, S. G., Purnell, J. Q., & Darling, T. V. (2009). Exercise and cancer-related fatigue. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3156559/ 

Memorial Sloan Kettering Cancer Center. (2022). Chair exercises. Retrieved from https://www.mskcc.org/cancer-care/patient-education/chair-exercises 

Memorial Sloan Kettering Cancer Center. (2021). Managing cancer-related fatigue with exercise. Retrieved from https://www.mskcc.org/cancer-care/patient-education/managing-cancer-related-fatigue-exercise#:~:text=Pick%20an%20activity%20that%20you,%2C%20during%2C%20and%20after%20exercising. 

Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular effects and benefits of exercise. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6172294/ 

Smith, S. (2023). Electrolytes – what are they? what happens if you don’t have enough? Retrieved from https://www.roswellpark.org/cancertalk/202308/electrolytes-what-are-they-what-happens-if-you-dont-have-enough 

Johns Hopkins Medicine. (2023). Sports and hydration for athletes: Q&A with a Dietitian. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/nutrition-and-fitness/sports-and-hydration-for-athletes