Cancer & Physical Activity


Cancer is a group of conditions where the body's cells begin to grow and reproduce in an uncontrollable way. These cells can then invade and destroy healthy tissue, including organs. Up to two-thirds of all cancers are caused by chance genetic mutations (Tomasetti and Vogelstein, 2017) although it's been estimated that up to 43% of all cancer cases in the UK are preventable (Parkin et al, 2011). Cancer sometimes begins in one part of the body before spreading to other parts. This process is known as metastasis.

Around 298,000 new cases of cancer are diagnosed each year in the UK. More than one in three people will develop some form of cancer during their lifetime.1 Data suggests that increased levels of physical activity are associated with lower rates of colon and breast cancer3 but this article is focussed on the use of physical activity and exercise with those individuals that have been diagnosed with cancer.

Management and Medication

Treatment options for cancer can include surgery, radiation, chemotherapy, and immunotherapy

Effects on Exercise Response

Individuals with, or recovering from, cancer can have physical limitations that result from the disease itself and/or the treatment for the disease. The effect that the disease has on the body is directly related to the tissues affected, for example, shortness of breath may be experienced with lung disease, or anaemia may be experienced if the bone marrow is affected.

The side effects of treatments can also be varied and whilst some may be an acute effect that resolves itself once treatment has ended, other side effects may occur later in the treatment process and could be permanent. Scar tissue can result in impaired cardiac, pulmonary or musculoskeletal function with pain or loss of flexibility being experienced long after the cancer has been treated.

Benefits of Exercise Training

Studies have shown that regular, moderate-intensity aerobic exercise during cancer therapy results in reduced levels of fatigue, greater body satisfaction, maintenance of body weight.

Exercise Recommendations2

Other considerations are that an instructor should assess a client's medical condition, functional ability and general health prior to each exercise sessions. There should also be an awareness of where the client is in the treatment schedule and the implications of this to allow for adjustment of the exercise programme where required.


Whilst all cancer patients and survivors are subject to the regular list of absolute and relative contraindications to exercise, there are a number of measures and signs that suggest an individuals exercise routine should be curtailed or adapted.

Click here for more on special considerations for cancer survivors.


Key Guidelines

Buffart, L. M., Galvao, D. A., Brug, J., Chinapaw, M. J. M., & Newton, R. U. (2014). Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treatment Reviews, 40(2), 327-340. 

Cormie, P., Atkinson, M., Bucci, L., Cust, A., Eakin, E., Hayes, S., ... & Adams, D. (2018). Clinical Oncology Society of Australia position statement on exercise in cancer care. Medical Journal of Australia, 209(4), 184-187. [www]

Rock, C. L., Doyle, C., Demark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., Bandera, Elisa, V., et al. (2012). Nutrition and Physical Activity Guidelines for Cancer Survivors. CA: Cancer Journal for Clinicians, 00. doi:10.3322/caac.21142 [full text]

Santa Mina, D., Langelier, D., Adams, S. C., Alibhai, S. M., Chasen, M., Campbell, K. L., ... & Chang, E. (2018). Exercise as part of routine cancer care. The Lancet Oncology, 19(9), e433-e436. DOI: 

Suderman, K., McIntyre, C., Sellar, C., & McNeely, M. L. (2019). Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice. Current Cancer Therapy Reviews, 15(2), 100-109. 

Key Texts

Irwin, M.L. (2012) ACSM's guide to exercise and cancer survivorship. Champaign, IL: Human Kinetics [google books]

Courneya, K. S., & Friedenreich, C. M. (Eds) (2011). Physical activity and cancer. London: Springer [full text]

Image from: Hojman, P., Gehl, J., Christensen, J. F., & Pedersen, B. K. (2018). Molecular mechanisms linking exercise to cancer prevention and treatment. Cell metabolism, 27(1), 10-21. 

Further Reading 

ACSM (2010) American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise 42 (7):1409-1426 [full text]

Ballard-Barbash, R., Friedenreich, C. M., Courneya, K. S., Siddiqi, S. M., McTiernan, A., & Alfano, C. M. (2012). Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. Journal of the National Cancer Institute, 104(11), 815-840. 

Bower, J. E. (2014). Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature reviews Clinical oncology, 11(10), 597. 

Brown, J.K. et al (2003) Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices CA Cancer J Clin Vol. 53, 268-291 [full text]

Brown, J. C., Winters‐Stone, K., Lee, A., & Schmitz, K. H. (2012). Cancer, physical activity, and exercise. Comprehensive Physiology, 2(4), 2775-2809.

Buffart, L. M., Galvão, D. A., Brug, J., Chinapaw, M. J. M., & Newton, R. U. (2014). Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer treatment reviews, 40(2), 327-340. 

Campbell, A., Stevinson, C. and Crank, H. (2011). The BASES expert statement on exercise and cancer survivorship. The Sport and Exercise Scientist (28), 16-17 [full text]

Capozzi, L. C., Nishimura, K. C., McNeely, M. L., Lau, H., & Culos-Reed, S. N. (2016). The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med, 50(6), 325-338. 

Christensen, J. F., Simonsen, C., & Hojman, P. (2018). Exercise Training in Cancer Control and Treatment. Comprehensive Physiology, 9, 165-205. 

Cormie, P., Zopf, E. M., Zhang, X., & Schmitz, K. H. (2017). The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiologic Reviews, 39(1), 71-92.

Courneya, K. S., Rogers, L. Q., Campbell, K. L., Vallance, J. K., & Friedenreich, C. M. (2015). Top 10 research questions related to physical activity and cancer survivorship. Research quarterly for exercise and sport, 86(2), 107-116.

Courneya, Kz. S., Jones, L. W., Fairey, A. S., Campbell, K. L., Ladha, A. B., Friedenreich, C. M., & Mackey, J. R. (2004). Physical activity in cancer survivors : implications for recurrence and mortality Review Article. Cancer Therapy, 2, 1–12 [full text]

Courneya, K. S. (2003) Exercise in Cancer Survivors: An Overview of Research. Med. Sci. Sports Exerc., Vol. 35, No. 11,1846-1852 [abstract]

Cramp F, Byron-Daniel J. (2012) Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, Issue 11. Art. No.: CD006145. DOI: 10.1002/14651858.CD006145.pub3. [full text]

Czosnek, L., Richards, J., Zopf, E. et al. Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes. BMC Cancer 21, 643 (2021). 

Dimeo, F., Rumberger, B.G. and Keul, J. (1998) Aerobic exercise as therapy for cancer fatigue Med. Sci. Sports Exerc. Vol. 30, No. 4, 475-478 [full text]

Dimeo, F., Schwartz, S., Wesel, N., Voigt, A.& Thiel, E. (2008) Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment Annals of Oncology 19: 1495–1499 [full text

Doyle, C. et al. (2006) Nutrition and physical activity during and after cancer treatment: An American Cancer Society Guide for Informed Choices. CA: A Cancer Journal for Clinicians Vol.56, No.6, 323-53[full text]

Durstine, J.L., Moore, G.E., Painter, P.L. & Roberts, S. (eds) (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics

Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2009) Clinical Exercise Physiology (2nd Ed). Champaign IL: Human Kinetics [google books]

Fairey, A.S., Courneya, K.S., Field, C.J. and Mackey, J.R. (2002) Physical exercise and immune system function in cancer survivors: A comprehensive review and future directions Cancer Vol. 94, No. 2, 539–551[full text]

Galvao, D.A. and Newton, R.U. (2005) Review of Exercise Intervention Studies in Cancer Patients J Clin Oncol Vol.23, 899-909. [full text amongst others]

Hojman, P., Gehl, J., Christensen, J. F., & Pedersen, B. K. (2018). Molecular mechanisms linking exercise to cancer prevention and treatment. Cell metabolism, 27(1), 10-21. 

Humpel, N., Iverson, D.C. (2005) Review and critique of the quality of exercise recommendations for cancer patients and survivors Supportive Care in Cancer Vol. 13, No.7, 493-502 Doi: 10.1007/s00520-005-0811-x [abstract

Irwin, M.L. (2009) Physical activity interventions for cancer survivors. Br J Sports Med Vol.43, 32-8 [full text]

Jones, L.W., Demark-Wahnefried, W. (2006) Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncology, Vol. 7, 1017-26 [full text]

Kerr, J., Anderson, C., & Lippman, S. M. (2017). Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. The Lancet Oncology, 18(8), e457-e471. DOI: 

Lee, C. E., Leslie, W. D., & Lau, Y. J. (2012). A pilot study of exercise in men with prostate cancer receiving androgen deprivation therapy. BMC cancer, 12, 103.

Lynch, B. M., & Leitzmann, M. F. (2017). An Evaluation of the Evidence Relating to Physical Inactivity, Sedentary Behavior, and Cancer Incidence and Mortality. Current Epidemiology Reports, 1-11. 

Litterini, A. J., & Jette, D. U. (2011). Exercise for managing cancer-related fatigue. Physical Therapy, 91(3), 301-4 [full text]

Luctkar-Flude, M., Groll, D., Woodend, K., & Tranmer, J. (2009). Fatigue and physical activity in older patients with cancer: a six-month follow-up study. Oncology Nursing Forum, 36(2), 194-202. [abstract]

Mcgonigal, B. (2009). Fitness For Cancer Survivors. Idea Fitness Journal, (November-December), 53-59.McIntyre, P (2008) Why "plenty of bed rest" could be bad advice. Cancer World Sept/Oct. 52-56 [full text]

McTiernan, A. (Ed.) (2010) Physical Activity, Dietary Calorie Restriction and Cancer. London: Springer [google books][full text]

Meyerhardt, J.A. (2006) Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 Journal of Clinical Oncology, Vol 24, No 22, 3535-3541[full text]

Midtgaard, J., Christensen, J. F., Tolver, A., Jones, L. W., Uth, J., Rasmussen, B., ... & Rørth, M. (2013). Efficacy of multimodal exercise-based rehabilitation on physical activity, cardiorespiratory fitness, and patient-reported outcomes in cancer survivors: a randomized, controlled trial. Annals of oncology, mdt185. [full text]

Mishra, S. I., Scherer, R. W., Snyder, C., Geigle, P. M., Berlanstein, D. R., & Topaloglu, O. (2012). Exercise interventions on health‐related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews, (8). DOI: 10.1002/14651858.CD008465.pub2 

Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health‐related quality of life for cancer survivors. Cochrane Database of Systematic Reviews, (8). DOI: 10.1002/14651858.CD007566.pub2 

Mitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R. M., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014). Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clinical journal of oncology nursing, 18, 38-58. 

Moore, S. C., Lee, I. M., Weiderpass, E., Campbell, P. T., Sampson, J. N., Kitahara, C. M., ... & Adami, H. O. (2016). Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine, 176(6), 816-825. doi:10.1001/jamainternmed.2016.1548

Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., ... & Scarpato, J. (2017). Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: A meta-analysis. JAMA Oncology.

Newton, R.U. and Galvao, D.A. (2008) Exercise in Prevention and Management of Cancer Current Treatment Options in Oncology DOI 10.1007/s11864-008-0065-1 [full text amongst others]

Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., ... & Matthews, C. E. (2019). American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and science in sports and exercise, 51(11), 2391.  

Reeves, G. K., Pirie, K., Beral, V., Green, J., Spencer, E., & Bull, D. (2007). Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ, 335(7630), 1134. doi:10.1136/bmj.39367.495995.AE [full text]

Rock, C. L., Doyle, C., Demark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., Bandera, Elisa, V., et al. (2012). Nutrition and Physical Activity Guidelines for Cancer Survivors. CA: Cancer Journal for Clinicians, 00. doi:10.3322/caac.21142 [full text]

Russell, C., Noble, M., Kraemer, L. & Sharratt, M. (2009). Active Living for Older Adults in Treatment for Cancer. University of Waterloo, Waterloo, ON. Canada [full text]

Sasso, J. P., Eves, N. D., Christensen, J. F., Koelwyn, G. J., Scott, J., & Jones, L. W. (2015). A framework for prescription in exercise‐oncology research. Journal of cachexia, sarcopenia and muscle, 6(2), 115-124. 

Saxton, J., Daley, A. (eds) (2010) Exercise and Cancer Survivorship: Impact on Health Outcomes and Quality of Life. London: Springer [google books][full text]

Schmitz, K.H., Holtzman, J., Courneya, K.S. et al (2005) Controlled physical activity trials in cancer survivors: a systematic review and meta‐analysis. Cancer Epidemiol Biomarkers Prev. Vol.14, No.7, 1588–1595 [full text]

Schneider, C.M. and Dennehy, C.A. (2003) Exercise and Cancer Recovery. Champaign, IL: Human Kinetics [amazon]

Schneider, C.M., Hsieh, C.C., Sprod, L.K., Carter, S.D. and Hayward, R. (2007) Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training Ann Oncol Vol.18, No. 12, 1957-1962. [full text]

Schwartz, A.J. (2005) Cancer Fitness: Exercise Programmes for patients and survivors. New York, NY: Fireside [amazon][amazon preview]

Speck, R.M., Courneya, K.S., Mâsse, L.C., Duval, S. & Schmitz, K.H. (2010)  An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis J Cancer Surviv DOI 10.1007/s11764-009-0110-5 [full text]

Shen, D., Mao, W., Liu, T., Lin, Q., Lu, X., Wang, Q., ... & Wijndaele, K. (2014). Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One, 9(8), e105709.

Spence, R.R., Heesch, K. and Brown, W.J. (2010) Exercise and Cancer Rehabilitation: A Systematic Review. Cancer Treatment Reviews, Vol.36, No.2. 185‐194 [full text]

Sprod, L.K. (2009) Considerations for Training Cancer Survivors Strength Cond J. Vol. 31, No.1, 39–47[full text]

Sprod L.K., Hsieh C.C., Hayward R., Schneider C.M. (2010) Three vs. Six Months of Exercise Training in Cancer Survivors.  Breast Cancer Research and Treatment  121:412-419 [abstract]

Spruita, M.A., Janssena, P.P., Willemsenb, S.C.P. et al (2006) Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: A pilot study Lung Cancer Vol. 52, 257—260 [full text]Stevinson, C., Lawlor, D. & Fox, K. (2004) Exercise Interventions for cancer patients: systematic review of controlled trials. Cancer Causes & Control Vol.15: 1035-1056 [full text]

Stevinson, C., Campbell, K.L., Sellar, C.M. and Courneya, K.S. (2007) Physical Activity for Cancer Survivors: Potential Benefits and Guidelines In Feuerstein, M. Handbook of Cancer Survivorship Springer [full text]

Stout, N. L., Santa Mina, D., Lyons, K. D., Robb, K., & Silver, J. K. (2021). A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians, 71(2), 149-175. 

Takemura, N., Chan, S. L., Smith, R., Cheung, D. S. T., & Lin, C. C. (2021). The effects of physical activity on overall survival among advanced cancer patients: a systematic review and meta-analysis. BMC cancer, 21(1), 1-13. 

Thomas, R. J., Kenfield, S. A., & Jimenez, A. (2016). Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. British Journal of Sports Medicine, bjsports-2016.

Thomas, R. & Davies, N. (2007) Lifestyle during and after cancer treatment. Clinical Oncology19: 616-627 [full text]

Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: a meta-analysis. American journal of physical medicine & rehabilitation, 93(8), 675-686. 

Williamson, P. (2011) Exercise for Special Populations Philadelphia, PA: Lippincott Williams & Wilkins [google books

Winters-Stone, K. M., Neil, S. E., & Campbell, K. L. (2014). Attention to principles of exercise training: a review of exercise studies for survivors of cancers other than breast. Br J Sports Med, 48(12), 987-995. 

Further Links