Exercise and cancer – Knowledge

1. What this article is about

The professional bodies in cancer medicine today recommend that people with cancer do regular aerobic and strength training during treatment [1], [2]. For a long time the advice was different. Until the 2000s, patients were told to rest [7]. This article explains why the advice has turned around. It says what exercise is proven to do before, during and after treatment, how much is enough and what counts as safe today.

At the centre is cancer-related fatigue. It is the most common burden during and after cancer treatment. The largest review of its treatment without drugs comes from Switzerland. It compared 245 trials and was published in the British Journal of Sports Medicine in 2018 [3]. Roger Hilfiker, who wrote this article, is its first author. Our practice offers the programme Exercise and cancer. Both are stated in the Transparency section.

This article is written for patients and their families. The conversation with your treatment team remains necessary. Which form of exercise suits you depends on your disease, your treatment and your blood counts. Section 8 says when to ask.

2. What cancer-related fatigue is

Cancer-related fatigue is a persistent exhaustion caused by the cancer or its treatment. It is far greater than the previous effort would explain. Sleep brings little recovery. It affects the body, the emotions and thinking: the legs feel heavy, mood is low, concentrating is hard [4]. Many people describe it as the burden that interferes most with daily life.

The causes are many and not yet fully understood. Inflammatory messengers in the blood, changes in the stress hormone system, anaemia, sleep disturbance, pain and low mood all contribute. Added to that is the loss of muscle mass and stamina during treatment [6].

2.1 How common it is

A 2020 review pooled 84 studies with about 145,000 people with cancer. On average, 52 in 100 reported cancer-related fatigue. Depending on the study, it was 14 to 100 in 100. More often affected were people with reduced physical performance, with combined chemotherapy and radiotherapy, with sleep disturbance, pain or depression, and women [5].

In some people the fatigue persists after treatment ends. About a quarter to a third still report it years later [6].

2.2 Why rest alone prolongs it

When you are tired, you rest. With flu that is right, and after a few days your strength is back. Cancer-related fatigue runs differently. Treatment lasts weeks to months. In that time the body breaks down muscle and stamina it hardly uses. With less muscle, every activity costs more effort. The exhaustion grows, and you rest even more. A cycle forms that feeds itself [6].

Exercise interrupts this cycle. It preserves muscle and stamina, improves sleep and lowers inflammatory messengers in the blood [6], [7]. That is why the first recommendation of every guideline today is the same: avoid inactivity [2]. How much muscle one week of rest costs is described in our article Muscle lost in days, rebuilt in weeks.

3. What exercise does: the evidence

3.1 245 trials compared

The 2018 review pooled 245 randomised trials. In each trial, chance decided who received a treatment for fatigue and who received usual care. The treatments compared were aerobic training, strength training, both combined, yoga, tai chi, relaxation exercises, massage and behavioural therapy. A network meta-analysis combined all comparisons, including those never tested directly against each other [3].

The effect is given as an effect size. This number makes trials with different questionnaires comparable. A value around 0.2 counts as small, around 0.5 as medium, from 0.8 as large. A negative sign here means less fatigue.

Effect sizes against usual care, from [3]. The confidence ranges are wide. For massage during treatment it runs from −1.55 to −0.01, for combined training from −1.01 to −0.34.

The table shows three things. First: every form studied eased the fatigue. Second: during treatment, relaxation, massage and combined training ranked highest. The figure for massage rests on few trials, and its confidence range is the widest. The figure for combined training rests on many trials and is the most reliable. Third: after treatment, yoga and combined training ranked highest. The authors concluded that patients can choose among several effective forms [3].

3.2 What newer studies show

Since 2018, two further network meta-analyses have appeared. A 2023 study compared 56 trials of exercise alone. Combined aerobic and strength training had the highest probability of being the most effective form, followed by yoga and regular everyday physical activity. That held during and after treatment [8].

A 2026 study examined 64 trials with 5,156 women with breast cancer. It also asked about the amount. For fatigue and preserving muscle mass, combined training was most effective; for strength and everyday function, strength training. A measurable effect began at as little as 10 to 40 minutes of training a week. For fatigue, the effect grew with the amount and reached a plateau at large volumes. For muscle mass and strength, it kept growing across the whole range studied [9]. Section 7.2 returns to this.

The Cochrane review of exercise for cancer-related fatigue pooled 56 trials with 4,068 participants. At the end of the programmes, fatigue in the exercise groups was lower by an effect size of 0.27 than in the comparison groups. The benefit appeared during and after treatment, more clearly in breast and prostate cancer than in blood cancers [11]. For yoga in breast cancer, a separate Cochrane review of 24 trials found an effect size of −0.48 against no treatment [12].

Exercise also acts on mood. A review found an effect size of −0.22 on depressive symptoms in people after cancer. Programmes with supervision, outside the home and with at least 30 minutes per session worked more strongly [14].

3.3 Exercise compared with medication

A 2017 review compared the four most commonly recommended treatments for cancer-related fatigue across 113 trials with 11,525 participants. Exercise reached an effect size of 0.30, psychological treatments 0.27, both together 0.26. Drugs reached 0.09, and this value was barely distinguishable from zero [10]. The authors recommended exercise and psychological treatments as first choice.

Two points matter with these figures. The effect sizes are smaller than in the table above because this review calculated differently. And part of every improvement would have occurred without treatment, because fatigue declines on its own after cancer treatment ends. The effect sizes describe the difference from the comparison group and already take that into account.

4. Exercise before treatment

Between diagnosis and an operation there are usually two to six weeks. Exercise in this time is called prehabilitation. The aim: whoever goes into surgery with more strength and stamina has more reserve for the time after.

Lung cancer is the best studied. A review pooled 13 randomised trials with 806 participants across several cancer types. In people before lung surgery, complications after the operation occurred about half as often as without exercise. The hospital stay was on average almost three days shorter. For oesophageal, bowel and liver cancer no difference was found. There the trials were small [15]. The American Society of Clinical Oncology therefore names exercise before lung surgery as an option that doctors can raise [1].

A 2025 trial tested a home programme in 182 people with lung cancer. A physiotherapist put it together according to the person's mobility and supervised it remotely. It began about two weeks before surgery and continued afterwards. Two months after surgery, fatigue in the exercise group was unchanged. In the comparison group it had increased. The six-minute walking distance rose by 14 metres in the exercise group and fell by 10 metres in the comparison group. Overall this difference was statistically uncertain. In women it was larger than in men [16].

In colon cancer, a trial in several countries tested a four-week programme before surgery: supervised training three times a week, plus nutritional counselling, psychological support and help with stopping smoking where needed. Of 100 people with this programme, 17 had a severe complication after surgery. Of 100 people with usual preparation, 30 did [17]. The trial was ended earlier than planned because of the pandemic. It shows what a programme of several components achieves. How much each component contributes cannot be read from it.

5. Exercise during treatment

During treatment there are two aims: to ease fatigue and to keep the loss of strength and stamina small. Both are well studied in randomised trials, above all in breast and prostate cancer.

5.1 During chemotherapy

A Dutch trial split 230 women with breast cancer during chemotherapy into three groups: usual care, a light home programme, or supervised aerobic and strength training at moderate to high effort. Both exercise groups lost less stamina and reported less nausea and pain. Only the supervised training also preserved strength and eased physical fatigue. In this group the chemotherapy dose needed adjusting less often. Both exercise groups returned to work earlier [18].

A Canadian trial with 242 women found similar results: strength training during chemotherapy preserved muscle mass and strength, and more women were able to receive the planned chemotherapy in full. The training caused no lymphoedema [19]. Two German trials compared strength training with a relaxation group, so that the effect of the group itself was accounted for. During chemotherapy, physical fatigue rose in the relaxation group and stayed stable in the strength training group [20]. A Swedish trial showed that 16 weeks of strength training with short intense intervals prevented the rise in fatigue during chemotherapy [21].

5.2 During radiotherapy

Radiotherapy causes fatigue, and the fatigue grows over the weeks of treatment. In 155 women with breast cancer, a trial compared twelve weeks of strength training with twelve weeks of relaxation during radiotherapy. Physical fatigue was lower in the strength training group at the end. Everyday function and pain also came out better [22]. In men with prostate cancer, strength and aerobic training eased fatigue during radiotherapy. Strength training was still working six months later and additionally improved strength, quality of life and blood fats [23].

5.3 During hormone therapy

In prostate cancer, the male sex hormone is often suppressed for months or years. The treatment costs muscle mass and strength and raises body fat. A trial with 57 men showed that twelve weeks of combined training reversed this loss: muscle mass increased, strength, walking speed and balance improved, fatigue decreased. An inflammation marker in the blood fell [24]. In breast cancer, hormone therapy usually lasts five to ten years. Joint pain and weight gain are common side effects. Here exercise acts over the long period after the main treatment, see section 6.

5.4 Nerve damage, strength and quality of life

Some chemotherapies damage the nerves in the hands and feet. This shows as tingling, numbness or sensitivity to cold. A trial with 355 people tested a six-week walking and strength programme at home during such a chemotherapy. The sensation of cold and heat in hands and feet was about half a point lower on a scale of 0 to 10 in the exercise group. For tingling the difference was similar in size but statistically uncertain [25]. Whether exercise can prevent nerve damage therefore remains open [2].

Two large analyses using the data of individual participants from 34 and 28 trials sum up what exercise during and after treatment does for quality of life, everyday function and strength. The effects are small but present in all subgroups: in young and old people, across cancer types and treatments. Supervised programmes work more strongly than unsupervised ones. For strength, exercise during treatment worked more strongly than afterwards [26], [27].

6. Exercise after treatment

6.1 Back to everyday life

After the last chemotherapy or radiotherapy, many expect their strength to come back by itself. Often that takes longer than expected. Fatigue does decline, but in some people it persists for months [6]. Added to that is the muscle lost during the months of treatment.

A Cochrane review of women with breast cancer after completing treatment pooled 63 trials with 5,761 women. Exercise improved quality of life, everyday function, mood and stamina. The effect on fatigue lasted three months and longer after the programmes ended [13]. After treatment, yoga and combined aerobic and strength training ranked highest in the 2018 review [3]. Whoever wants to work full time and run a household again needs strength and stamina. That is why after treatment we recommend a programme that contains both.

6.2 What the studies say about the further course

Many people ask whether exercise influences the course of the cancer itself. Observational studies have shown for years that people who move a lot after diagnosis live longer. A review of 136 studies found this association for at least eleven cancer types, most strongly in breast and colorectal cancer [29], [30]. Such studies show an association. Whether the exercise is the cause stays open in them: those who are healthier move more, and those who move more may be healthier for other reasons [31].

Since 2025 there has been a randomised trial with hard endpoints. The CHALLENGE trial followed 889 people after surgery and chemotherapy for colon cancer over three years. By chance, one half received a structured exercise programme with personal coaching, the other half information material on healthy living. At five years, 80 in 100 people from the exercise group were alive without recurrence and without a new cancer. In the comparison group it was 74 in 100. At eight years, 90 in 100 from the exercise group were alive and 83 in 100 from the comparison group. Muscle and joint complaints occurred in 19 in 100 in the exercise group and in 12 in 100 in the comparison group [28].

This trial is the first of its kind. It applies to colon cancer after completed chemotherapy. Whether the same holds for other cancers has not yet been tested in randomised trials. How exercise might act on the course is being researched: physical activity changes immune cells, inflammatory messengers and metabolic hormones in the blood [32]. Exercise complements cancer treatment.

7. How much exercise, and which

7.1 What the professional bodies recommend

The World Health Organization recommends adults 150 to 300 minutes of moderate-intensity activity a week or 75 to 150 minutes of vigorous activity, plus strength training for the large muscle groups on two days. This recommendation explicitly applies to people with cancer too [33]. Moderate intensity means: you can still talk, but no longer sing.

The international expert group of the American College of Sports Medicine derived from the trials in 2019 a minimum dose that demonstrably eases fatigue: three times a week 30 minutes of moderate aerobic training, plus strength training twice a week, over eight to twelve weeks [2]. The American Society of Clinical Oncology adopted this line in its 2022 guideline: doctors should recommend regular aerobic and strength training during treatment [1].

In practice this means: brisk walking, cycling, swimming or an exercise bike for the aerobic part. For the strength part, exercises for legs, trunk, back and arms with a weight that becomes hard after 8 to 15 repetitions. Whoever prefers yoga has good evidence for that too [3], [12].

7.2 Even a little works

During chemotherapy, 150 minutes a week is too much for many people. Then a smaller amount applies. The 2026 study of women with breast cancer showed that a measurable effect on fatigue, strength and everyday function begins at as little as 10 to 40 minutes of training a week [9]. More does more, up to a certain volume. Whoever walks only ten minutes on a bad day has achieved something on that day.

Adapt the amount to your treatment. In the days after a chemotherapy dose less is possible than in the week before. Many programmes therefore plan in waves: light in the first days after the dose, more towards the end of the cycle.

7.3 Supervised or alone?

The analyses using individual participants' data agree: supervised exercise acts more strongly on fatigue, quality of life, everyday function and strength than unsupervised exercise [34], [26], [27]. For fatigue the difference was an effect size of 0.18. Supervised programmes of twelve weeks or less worked more strongly than longer ones [34]. One possible reason: with supervision people train harder than they would dare on their own.

You can also train alone. Home programmes work too, as the lung cancer trial and the light home programme of the Dutch trial show [16], [18]. The Australian professional body for exercise science recommends supervision above all at the start, in advanced disease and with other medical conditions [35]. After that you can continue at home.

8. Safety: what applies today

The professional bodies consider exercise safe for people with cancer, including during treatment [2], [35]. In the trials, serious incidents caused by the exercise were rare. Some situations still call for adjustment. The following points describe what the professional bodies recommend today. The decision in your case rests with your treatment team.

8.1 Blood counts

Chemotherapy temporarily lowers the number of red blood cells, white blood cells and platelets. With marked anaemia, stamina is lower and you get out of breath faster. Then train more lightly and for shorter periods. With very low platelets, the risk of bleeding rises. Then avoid sports with a risk of falls or impact, and very heavy weights. With very low white blood cells, the risk of infection is raised. Then avoid crowded gyms and swimming pools and train at home or in the practice. Your treatment team knows your current values and tells you below which value to pause [35].

8.2 Port and catheter

With a port under the skin you can exercise. Avoid direct pressure and friction on the site, for example from rucksack straps or a barbell on the shoulder. Movements of the arm and shoulder are allowed. In the first days after insertion, take it easy until the wound has healed. A catheter that exits through the skin calls for more caution: swimming and bathing are then usually excluded. Ask your treatment team what applies to your system.

8.3 Bone metastases

For a long time, deposits in the bone counted as a reason against any exercise. The evidence has changed that. A review pooled 17 trials of exercise in bone metastases. Serious incidents caused by the exercise were rare, and none involved the bone metastases. Almost all programmes were supervised by professionals [40]. A trial in men with prostate cancer and bone metastases showed better everyday function and more leg strength after three months, without fractures and without more bone pain [39].

The rule today is: exercise, but adapt the exercises to where the metastases are. The professional leaves the affected bones without heavy loads and impact and trains the other body parts as usual. That needs a professional who knows the images and talks to the treatment team [2].

8.4 Lymphoedema

After breast cancer surgery with removal of lymph nodes, the rule for a long time was: spare the arm, lift nothing heavy. Two randomised trials have refuted this advice. In the first, 141 women with existing lymphoedema trained twice a week for a year with slowly increasing weights. An increase in arm swelling of 5 percent or more occurred in 11 in 100 women with training and 12 in 100 without. A worsening of the lymphoedema that needed treatment occurred in 14 in 100 with training and 29 in 100 without [36]. In the second trial, 154 women without lymphoedema but at risk of it trained. Lymphoedema developed in 11 in 100 with training and 17 in 100 without. Among women with five or more lymph nodes removed, it was 7 in 100 with training and 22 in 100 without [37]. A review of 29 studies confirmed in 2020: strength training is safe with lymphoedema and tends to reduce the swelling [38].

Two rules from these trials still apply: increase the weight slowly, and wear your fitted compression sleeve during training if you have one. What the lymphatic system does and when a swelling is lymphoedema is explained in our article Lymphatic drainage.

8.5 When to talk to your treatment team

Talk to your oncologist before you start, and tell us what was discussed. Interrupt the training and get in touch if one of the following signs appears:

• fever above 38 degrees or chills
• new breathlessness at rest, chest pain or palpitations
• dizziness or fainting
• new or increasing bone pain, especially with known metastases
• sudden swelling, redness or pain in an arm or leg
• bleeding, bruises without cause or blood in the urine
• nausea or vomiting that prevents drinking

With ordinary muscle tiredness after training and with sore muscles the next day, keep training. Both show that the muscle has worked.

9. What you should know

• Cancer-related fatigue affects about half of all people with cancer [5]. Rest alone prolongs it, because the body breaks down muscle and stamina [6].
• All forms of exercise studied ease the fatigue [3]. Combined aerobic and strength training has the most reliable evidence, during and after treatment [3], [8], [9].
• Exercise works more strongly than medication against fatigue: effect size 0.30 versus 0.09 [10].
• Before lung surgery, exercise halves complications and shortens the hospital stay by almost three days [15].
• During chemotherapy, exercise preserves strength and stamina, and chemotherapy can more often be given as planned [18], [19].
• After colon cancer, with a three-year exercise programme 80 in 100 were alive without recurrence at five years, without the programme 74 in 100 [28]. For other cancers such trials are still lacking.
• As little as 10 to 40 minutes a week has an effect [9]. The target is 150 minutes of aerobic activity and two strength sessions a week [33].
• Supervised exercise works more strongly than unsupervised [34]. Home programmes work too [16].
• With lymphoedema and bone metastases you can exercise, with adapted exercises [36], [40]. With low blood counts, train more lightly or pause [35].

References

All Digital Object Identifiers (DOIs) were checked against the Crossref registry. The links in the reference list lead via the DOI service to the publishers' pages. Some of these are located outside Switzerland and the EU. When you click, your IP address is transmitted to the respective provider. This does not happen on our own site.

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Transparency

• Authorship: Roger Hilfiker
• AI assistance: literature search and text draft were produced with Claude (Anthropic). Roger Hilfiker checked all statements, figures and sources and revised the text.
• Created: 7 November 2026
• Last updated: 7 November 2026
• Sources: the 40 papers in the reference list. All DOIs were checked against the Crossref registry.
• How the sources were found: searches of the PubMed and Crossref databases in November 2026 on exercise for cancer-related fatigue, prehabilitation, exercise during chemotherapy, radiotherapy and hormone therapy, exercise after treatment and survival, and on safety with lymphoedema and bone metastases. Plus the guidelines of the American and European societies for cancer medicine, the American College of Sports Medicine, Exercise and Sports Science Australia and the World Health Organization.
• Conflicts of interest: Roger Hilfiker is first author of the 2018 review that serves as the key study in this article [3]. It was produced at the University of Applied Sciences Western Switzerland HES-SO Valais-Wallis and was funded without industry money. Our practice offers the programme Exercise and cancer and earns from the treatment. This article therefore also names where the evidence is thin: for prehabilitation outside lung cancer, for the effect on the course of the disease outside colon cancer, and for nerve damage from chemotherapy.
• Funding: Physiotherapie Tschopp & Hilfiker, 3902 Glis. The article was produced from the practice's own resources.
• Next review: 7 November 2028.