Exercise has a range of benefits and may help to reduce side effects of some treatments for lymphoma. It can:
- increase muscle and bone strength
- control your weight
- lower fatigue
- reduce your risk of infections (eg pneumonia) while you are on treatment
- reduce your risk of developing thrombosis (blood clots) while you are on treatment
- increase overall physical wellbeing, which can enable your medical team to provide optimum treatment
- enhance mental wellbeing and relieve stress.
Research carried out over 3 years studied the benefits of exercise in 122 people with Hodgkin and non-Hodgkin lymphoma. It found that aerobic (cardiovascular or ‘cardio’) exercise improved physical functioning and quality of life, even for people who were undergoing chemotherapy.
A review of 28 exercise programmes found that exercise can help to reduce cancer-related fatigue. Another analysis of 44 different studies (with a total of over 3,000 participants who were living with various types of cancer) had similar findings.
A research trial recently recruited participants to compare the benefits of relaxation and exercise on quality of life in people who have lymphoma. You can find out more about this study at ClinicalTrials.gov.
The amount of exercise you should do depends on factors like your general health and whether you are currently having treatment for lymphoma. Your emotional response to having lymphoma and personal preferences regarding exercise are also important. For some people, a little exercise is enough. Others are motivated to set goals and challenge themselves. Speak to your medical team for advice on the type and intensity of exercise that is best for you.
In the UK, current recommendations on exercise for people with cancer who are otherwise well are the same as they are for people without cancer. For adults, this is at least 30 minutes of activity 5 days a week. Ideally, you should do some physical activity every day. Visit the GOV UK website for more information about UK recommendations on physical activity.
Exercise doesn’t have to mean working out at a gym or running long distances. You probably already build activity in your daily life in many ways, for example when you:
- go for a walk
- climb stairs
- vacuum clean
- carry shopping bags
- do some gardening
- mow the grass.
NHS Choices have examples of light exercises you can do at home, including some you can do while sitting down. You may find these useful if you feel fatigued.
Increase your activity levels gradually, especially if you are not used to exercising. Alternate activity and rest to allow your body to recuperate. Remember that lymphoma and its treatment put a strain on your body. The time your body takes to recover after exercise can therefore be longer than it was before you had lymphoma.
Build up slowly the number of times a week you do physical activity. For example, begin by walking 3 times a week for 20 minutes. After a few weeks, add an extra 10–15 minute walk each week. You can also build in more ‘everyday’ physical activity, such as taking the stairs instead of the escalator when you are out and about. The National Heart, Lung and Blood Institute have information about physical activity, including building it up gradually.
For some people, exercise is a social activity. For others, it’s a time to be alone that provides a pleasant break. There are many different types of exercise; it’s important to find what you can safely enjoy. We strongly recommend that you speak to your doctor about which type and intensity of exercise is safe for you.
Exercise can be categorised as:
- aerobic (cardiovascular).
Some types of exercise may fall into 2 or 3 groups. An example is high intensity walking, which could be classed as all 3 categories. Some types of exercise are ‘high-impact’ (where both feet leave the ground at the same time) and some are ‘low-impact’ (where 1 foot stays on the floor at all times).
Weight-bearing exercises are those where you move against the force of gravity. High-impact examples include running, rowing and tennis. Low-impact examples include walking, lifting weights, and yoga. In some circumstances, your medical team might advise you against doing high-impact exercise (eg if lymphoma affects your bones and you are more at risk of a fracture).
Weight-bearing exercises help to build bone density, which can prevent osteoporosis (brittle bones). This is especially important for women who are having, or have had, treatments that affect the ovaries (eg pelvic radiotherapy).
If you have been through menopause, your level of oestrogen (a hormone that is essential for bone health) is lowered, which increases your risk of osteoporosis. Your medical team can advise you on the types of exercise that are suitable for you.
For more information about osteoporosis, see NHS Choices.
Muscle-strengthening exercises help to regulate blood pressure and blood sugar level. They also keep your bones healthy and help to maintain a healthy weight. Examples of muscle-strengthening exercises include push-ups, sit-ups, lifting weights and stretching resistance bands. Daily activities such as digging in the garden, carrying shopping and vacuum-cleaning also strengthen your muscles.
It’s important to maintain strength in your muscles so that you can keep up your normal tasks and activities. Any decrease in activity can lead to muscle weakness and fatigue (a common side effect of many treatments for lymphoma, including chemotherapy). This can result in a cycle where you do less activity, feel more tired, do less activity and so on.
Aerobic (cardiovascular) exercise
Aerobic exercise increases your heart rate while you are doing it and for a short while afterwards. Examples include running, swimming and high-intensity cycling.
The benefits of aerobic exercise include weight control and reduced risk of coronary heart disease.
Is yoga recommended for people with lymphoma?
Yoga is a type of exercise that combines breathing, stretching and controlled movement. It aims to increase your strength and flexibility. There are no research findings to suggest that yoga can help to prevent or treat cancer. However, some people find it helps them to feel better, both physically and emotionally.
You can read more about yoga on NHS Choices.
It is important to seek advice from your medical team about the type and intensity of exercise that is suitable for you.
Many people wonder if it is better to rest and save energy than it is to exercise. Friends and family may worry that you could overdo it. Although rest is essential in helping your recovery, evidence shows that it is both safe and beneficial to exercise during and after treatment for lymphoma. It is important to realise, however, that you might be able to do less exercise than you did before you had lymphoma. Build in regular breaks and give yourself enough time to recuperate after exercise.
Side effects of treatment for lymphoma
During or soon after your treatment for lymphoma, your medical team may advise you to avoid particular activities if you have certain side effects.
Side effects that can affect the type of exercise you can do include:
- Thrombocytopenia (low platelets) is a common side effect of chemotherapy and some newer, targeted therapies for lymphoma. You may also be thrombocytopenic if you have lymphoma in the bone marrow. Thrombocytopenia increases your risk of bruising and bleeding, so avoid high-impact sports.
- Neutropenia (low neutrophils) is a common side effect of chemotherapy, but can also happen if you have lymphoma in the bone marrow. Neutropenia increases your risk of infection, so avoid places where risk of infection is higher, such as public swimming pools and gyms. You are also more vulnerable to infection if you have HIV, or if you have had a stem cell transplant.
- Anaemia (low red blood cells) is a side effect of some treatments for lymphoma, but can also happen if you have lymphoma in the bone marrow. Anaemia lowers the amount of oxygen in your blood, making you feel tired and short of breath. High intensity exercise is likely to be more difficult.
- Some chemotherapy drugs damage your heart or lungs in the long-term, affecting how well your lungs work. You may then feel short of breath and experience discomfort when you do high intensity exercise.
- Peripheral neuropathy (damage to the nerves of your peripheral nervous system) may cause symptoms such as numbness in your hands and muscle weakness. It can affect your grip and balance, which could make some types of exercises unsafe. Consider suitable alternatives. For example, instead of cycling outside (where you might fall), use a stationary bike.
- Diarrhoea or vomiting can happen for various reasons, including as side effects of lymphoma treatments, pain relief medication, stress and anxiety. Diarrhoea and vomiting alter levels of certain minerals (eg sodium and potassium) in your body. Avoid exercise (which can further change your mineral levels) while you have diarrhoea or vomiting.
Swimming in public pools
Swimming has many health benefits. It fits into all 3 categories of exercise: aerobic, muscle-strengthening and weight-bearing. There may, however, be times when swimming carries risks for you. You may need to avoid public swimming pools if you are:
- neutropenic, in order to avoid infection from public pools and changing rooms
- having radiotherapy, as chlorine can irritate the area of skin that has received treatment
- have a central line in place, as swimming could dislodge it.
There is a lot of evidence that exercise can have a positive impact on recovery from cancer treatment. Although much of the research has been done on people who have had treatment for breast cancer, similar findings come from studies looking at other cancer types.
Exactly how exercise helps recovery is not yet known; however, its potential to shorten recovery time, ease fatigue and boost mental wellbeing are well recognised.
Some people see the end of treatment as a good time to begin a healthier lifestyle. Many local gyms offer programmes for people recovering after cancer treatment. You might prefer other forms of physical activity, eg gardening, dance classes, Pilates or Nordic walking. Doing these activities with other people can also provide a good opportunity to socialise and have fun.
There is growing support for the potential role of exercise in lowering the risk of cancer relapse (return). However, whether exercise can prevent recurrence of lymphoma, or any other type of cancer, is still unknown.
Keeping up your fitness after lymphoma treatment can reduce longer term risks (eg heart disease) associated with some treatments. It can also increase the likelihood that you are fit enough for optimum treatment in the future, should your lymphoma return.
Further information and resources
Active Nation is a charity that gives information about various types of physical activity, including where you can participate in these.
Walking for health is a scheme of guided walks available across England run by Macmillan Cancer Support and The Ramblers. Find your nearest local scheme using the online search tool.
NHS Choices have information about health and fitness, including government recommendations, benefits of exercise, and examples of simple exercises to try at home.
The British Association of Sport and Exercises have an Expert Statement on Exercise and Cancer Survivorship, which outlines research findings and recommendations.
Macmillan Cancer Support published a review that gives an overview of evidence and recommendations in relation to physical activity for people with cancer.