Exercise During Cancer Treatment – Evidence So Far – Part 2!

Hey Everyone,

So this is part 2 of this evidence based review on the benefits of exercise during cancer treatments.

Now, I’m the first to admit that this all reads a little “sciency” and not in line with how I normally communicate, but cancer is tough and getting people to exercise during treatments is very difficult, especially when they have so much family and peer pressure advising them to “take it easy, you need to rest”. For this reason I need to present the evidence so that readers understand that these are not simply my opinions 🙏 

In many cases (not all) rest is actually the worst thing that patients could do as exercise truly has a huge array of benefits. 

I’ll continue where I left off last week…

3) Cardio the day before chemotherapy: what we know

Most data here involve anthracycline regimens (e.g., doxorubicin) and focus on cardio protection:

• Single-bout pre-chemo (24 h prior) RCT (n=24): 30 minutes of vigorous treadmill exercise about 24 hours before the first doxorubicin dose attenuated the acute rise in NT-pro BNP (cardiac injury biomarker) and increased indices of systolic function vs control. 
• Repeated pre-chemo bouts (every cycle) RCT (n=24): Performing the same 24-hour-prior exercise before each of four cycles did not change end-of-treatment subclinical cardiotoxicity markers, but improved hemodynamics, musculoskeletal symptoms, mood, and body weight; no adverse events. 
• Reviews summarise these findings and preclinical mechanisms (e.g., mitochondrial protection; reduced permeability transition pore opening) supporting the concept of “exercise preconditioning.” Wiley Online Library

How this helps: While larger trials are needed, a single, supervised vigorous cardio session ~24 hours pre-anthracycline may blunt acute cardiac stress from the first infusion and help symptoms—without evidence of harm in small trials. This is not yet a universal recommendation and should be individualised with your oncology/cardiology team. 

4) Practical, evidence-informed exercise guidance (during treatment)

Always tailor to diagnosis, treatment plan, side-effects, and baseline fitness—confirm with your care team first.

• Aerobic training (core): Aim for 3 sessions/week, 20–40 min each at moderate intensity (e.g., brisk walking or cycling where you can talk but not sing). Progress toward 150–300 min/week as tolerated. Cancer Research UK
• Resistance training: 2 sessions/week, 1–3 sets of 8–15 reps for major muscle groups, start low, progress slow—particularly helpful for preserving lean mass during chemo. PMC
• On infusion weeks: Many patients feel best early in the cycle. Light movement (short walks, mobility work) is typically fine on rough days. Coordinate around antiemetic timing and fatigue. (Guideline-based good practice.) PMC
• If considering a “day-before-chemo” cardio session (anthracyclines): Consider a 30-minute brisk cycle/treadmill at ~70% heart-rate reserve or RPE ~14 (“somewhat hard”), ~24 hours pre-infusion, only if clinically safe (no fever, severe anaemia, unstable symptoms). Evidence shows biomarker benefits after the first dose and symptom benefits over cycles PubMed+1

Safety flags: pause or modify exercise with fever/infection, chest pain, severe shortness of breath, dizziness/syncope, uncontrolled pain, bone fragility sites, or severe anaemia; adapt modes with neuropathy or bone metastases (e.g., favour stationary cycling).

How to use this in practice

1. Do something, most days. Even short bouts help; build toward moderate aerobic exercise + 2 days of resistance training. PMC
2. Anchor your weekly “bigger” cardio on days you feel best (often early cycle). If you’re on anthracyclines and your team agrees, consider a 30-min brisk cycle/walk ~24 h pre-infusion as a cardio-oncology “pre-conditioning” option. PubMed+1
3. Flag safety issues early (fever, chest pain, marked breathlessness, dizziness, bone pain). Modify modes/intensity accordingly. Cancer Research UK

If you or anyone you know are currently undergoing treatment for cancer and don’t know where to begin to help restore energy, vitality and health whilst on your journey, drop me a line, I’d Love to be of assistance.

Until next time stay awesome!

Vanessa x