Physical Activity Helps Alleviate Side Effects from Cancer Treatment

WHEN TIERNEY RICHARDS WAS DIAGNOSED with early-stage hormone receptor-positive breast cancer in January 2022, she and her health care team at UPMC Hillman Cancer Center in Pittsburgh discussed a treatment plan that included chemotherapy, surgery, radiation, medication—and physical activity.

“There were conversations about exercise from the very beginning,” recalls Richards, who is now 57 and a small business loan underwriter for the City of Pittsburgh.

Richards had been physically active for much of her life but had stopped her gym visits during the COVID-19 pandemic. When her oncologist brought up the possibility of resuming exercise, Richards felt too overwhelmed by her diagnosis to do so. Once she started chemotherapy, fatigue sapped her motivation. “I didn’t want to move,” she admits.

Richards started to gain weight, her energy was low, and she experienced neuropathy, which causes numbness or pain in the feet and hands. She asked her oncologist for advice, and he revisited the topic of physical activity. At his suggestion, Richards began taking her dog, Khya, for short morning walks and lunchtime visits to the local dog park. But she continued to feel debilitated and sensed that she needed more than brief walks to regain her energy and strength.

Richards asked her medical team for a referral to Moving Through Cancer, UPMC Hillman Cancer Center’s exercise oncology program, which helps patients build and maintain their fitness before, during and after cancer treatment. In April 2025, she began to meet regularly with an exercise physiologist and cancer exercise specialist who designed a personalized exercise plan tailored to her goals and her physical limitations.

Richards worked out at home three to four days a week while meeting with the exercise physiologist every six weeks. Using resistance bands and riding a recumbent bike helped her lose weight, improve muscle strength and increase mobility. She felt her mood and energy levels improve, and the neuropathy pain in her hands and feet became less bothersome. She now says she wishes she’d started the workouts sooner.

A growing body of research suggests that physical activity during and after cancer treatment can relieve symptoms and extend survival for people with cancer. However, “it’s not as simple as just telling people they should exercise,” says oncologist Jennifer Ligibel, who directs the Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute in Boston. Ideally, she explains, cancer centers should integrate exercise programs into cancer care and connect patients with fitness routines tailored to their needs.

How Physical Activity Benefits People With Cancer

Research shows aerobic and resistance exercise during cancer treatment can help ease fatigue; enhance cardiorespiratory fitness, physical function and strength; and improve mental health and quality of life. Recent studies have even found breast and colon cancer survivors who exercised regularly lived longer than those who were inactive. The evidence is strong enough that the American Society of Clinical Oncology advises patients to exercise throughout their treatment, while the American College of Sports Medicine recommends that cancer survivors continue to work out after treatment ends.

“One of the things that is amazing about exercise is how many systems in your body it impacts,” Ligibel says. “We know that it changes your gut microbiome. We know that it improves your metabolism and decreases inflammation.”

In a 2019 study, Ligibel and colleagues looked at 49 previously inactive women who were diagnosed with breast cancer and awaiting surgery. For an average of 29 days before their surgery, the women participated in either a self-guided relaxation program or twice-weekly supervised workouts that included aerobic exercise and full-body strength training. Researchers compared tissue from the participants’ initial biopsy with tissue collected at the time of surgery. They found that the women who exercised had less inflammation and better immune regulation in their tissue at surgery than they did at their initial biopsy, while those in the relaxation group did not. The results suggested that exercise can improve the tumor environment.

Exercise also can help build and maintain bone density, reducing the risk for fractures and osteoporosis, which is increased in people taking hormone therapy after treatment for breast or prostate cancer, says Kerri Winters-Stone, an exercise scientist at Oregon Health & Science University’s Knight Cancer Institute in Portland.

Physical activity, she says, increases blood flow, which may halt tumor progression and help deliver chemotherapy drugs to the tumors. Research also shows people who regularly exercise during treatment are more likely to complete treatment than those who do not work out. This may be because physical activity can help counter side effects, such as severe fatigue and neuropathy, that may cause patients to delay or halt chemotherapy, Winters-Stone says.

Research shows exercise is associated with improved mental health in adults with cancer, in part by decreasing inflammation. For Richards, working out gave her a way to take action. “With cancer, there’s so much that is outside of your control, and anything that you can control is important,” Richards says. “This is a part of the treatment plan that you really get to control.”

Overcoming the Hurdles to Movement

The American Cancer Society recommends that people with cancer get 150 to 300 minutes per week of moderate-intensity activity or 75 to 150 minutes of vigorous-intensity activity, along with muscle-strengthening activities twice a week. But these benchmarks may be hard for some to achieve, especially at first.

“When you’re going through treatment, it’s not always a reachable goal, especially for people who have never exercised before,” Winters-Stone says. However, some studies show at least 90 minutes of aerobic exercise each week, with or without two sessions of resistance training, can help to reduce many of the side effects of cancer treatment.

Still, many people with cancer experience intense and lingering fatigue related to their chemotherapy or radiation, says exercise oncologist Kathryn Schmitz, founder and director of UPMC Hillman Cancer Center’s Moving Through Cancer program. But, she notes, exercise boosts energy levels, as counterintuitive as it seems.

Schmitz recommends people who have trouble finding motivation to exercise start with just five minutes of movement, such as walking, and then pay attention to how they feel. “What I find is that people are shocked that they actually feel better after movement even when they are experiencing debilitating fatigue,” she says.

The increased energy can motivate people to make exercise a regular habit. An accountability partner who checks in to ask how your efforts are going or, better yet, exercises with you can also help. Winters-Stone created and tested an exercise program called Exercising Together, in which men with prostate cancer receiving radiation worked out with their spouses three times a week. Most couples reported positive feelings about the workouts.

Richards says regular appointments with her personal trainer at the hospital have helped her continue her exercise routine at home. “He is very motivating and genuine,” Richards says, and she’s eager to show him that she’s made progress between visits.

Get Help to Get Moving

There’s no one exercise plan that works for all people with cancer. For example, a 75-year-old woman who has cancer and other health conditions, who hasn’t been physically active and has side effects from treatment, such as peripheral neuropathy and fatigue, likely needs to work with a physical therapist before starting an exercise routine, Schmitz says. At the same time, people who are already rigorous exercisers may only need a little guidance to stay active, she adds.

Structured, clinic-embedded exercise support, like Moving Through Cancer at UPMC, is not the norm at all cancer centers, Winters-Stone and Schmitz say. But in place of that, oncologists may refer patients with pain or neuropathy to physical therapy, Schmitz says. And at some hospitals, physical medicine and rehabilitation doctors can review a patient’s treatment history and scans to suggest a tailored exercise option.

For people without access to resources like these, Livestrong at the YMCA offers fitness classes for cancer survivors, according to Schmitz, who helped shape the program. Another resource, she says, is the Maple Tree Cancer Alliance, which has more than a hundred locations globally. The organization offers a 12-week exercise program for people with cancer, and participants are matched to a program based on their current level of fitness.

The Zakim Center at Dana-Farber website includes prerecorded exercise videos taught by oncology exercise trainers who are certified through the American College of Sports Medicine, Ligibel says. And some specialists meet with patients remotely through telehealth.

Patients can also look for a personal trainer who is “at least comfortable working with someone who has a cancer history” and knows how to modify exercises based on the client’s limitations, Winters-Stone says. For people 65 and older, the Silver Sneakers program, which provides free in-person classes and on-demand videos for people with some Medicare Advantage plans, may be another way to get moving.

Currently, not enough hospitals offer exercise oncology programs designed to help patients stick with a fitness regimen, Schmitz and Ligibel say. In a commentary published Nov. 21, 2025, in the Journal of Cancer Oncology, they called for insurance companies to cover fitness trainers with cancer expertise so more people could experience the benefits of regular exercise.

Schmitz and Ligibel say they hope more cancer hospitals will set up programs to incorporate physical activity into treatment. “If exercise was a pill, we would all be prescribing it because there are very few things that have such wide-ranging benefits,” Ligibel says.

No matter what their hospital offers, Winters-Stone encourages people with cancer to seek ways to move more. “Patients have nothing to lose and everything to gain by getting active during their treatment in the best way they can,” she says. “Once people are able to engage in exercise regularly, the payoffs are going to be evident quickly.”

Cancer Today magazine is free to cancer patients, survivors and caregivers who live in the U.S. Subscribe here to receive four issues per year.