‘Physical activity’ means any activity that takes physical effort. The word ‘exercise’ is often used to describe a specific, structured activity, such as going to a gym class. Physical activity doesn’t need to be done in a formal or structured way, though, for example mowing the lawn. The general recommendation is that you build it into your daily life.
Physical activity has lots of benefits. It can help to:
- improve overall physical health, enabling your medical team to provide optimum treatment
- reduce side effects of some treatments
- reduce risk of infections while you are on treatment
- reduce the risk of developing blood clots (thrombosis) while you are on treatment
- lessen fatigue
- increase muscle strength
- control your weight, blood pressure and blood-sugar levels
- reduce the risk of coronary heart disease
- manage stress and improve your general emotional wellbeing
- improves balance
- build bone density, which can prevent brittle bones (osteoporosis). This is particularly important for women who are having, or have had, treatments that affect their ovaries (such as 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.
What does research tell us?
Physical activity can have benefits before, during and after treatment for cancer. For example:
- A study looking into the benefits of physical activity in 122 people with Hodgkin and non-Hodgkin lymphoma found that aerobic (cardiovascular or ‘cardio’) activity improved physical functioning and quality of life, including in those having chemotherapy.
- An analysis of 44 studies (with a total of over 3,000 participants who were living with various types of cancer) found significantly reduced cancer-related fatigue in people who did moderate physical activity, including some strengthening activity.
- A review of 10 studies of people with blood cancers (including lymphoma) in hospital before having a stem cell transplant found improved cardiorespiratory (heart and lung) functioning in those who took physical activity.
- A review of three studies of people with blood cancers (including lymphoma) found a reduction in fatigue in people who participated in an exercise programme during their hospital stay for a stem cell transplant.
Although you may need to take some precautions, research suggests that taking physical activity before and after treatment for cancer is generally safe and beneficial.
You may be interested in reading a review of the evidence about physical activity and cancer published by Macmillan Cancer Support.
Watch Andy talk about the benefits of exercise and his experience of lymphoma.
In the UK, the current recommendations for physical activity are the same for people with cancer who are otherwise well as they are for people without cancer. Be realistic, though. You may need to build up gradually.
For adults, the recommendation is to do 150 minutes (2 hours and 30 minutes) of moderate activity in chunks of 10 minutes or more each week. If you prefer, you could instead do 75 minutes (1 hour and 15 minutes) of brisk activity.
One way to achieve the recommended amount of activity is to do 30 minutes of moderate physical activity on 5 days of the week. Moderate physical activity makes you breath more quickly but does not make you feel out of breath. You should do some strengthening activities two or three times a week, too. Examples include reaching up to the ceiling and stretching your arms out in front of you. Coordination and balance exercises and flexibility exercises are also recommended twice a week, particularly for people aged 65 years or over.
- mowing the lawn
- vacuum cleaning
- gentle cycling
- aqua aerobics
- digging in the garden
- getting in and out of a chair or squatting
- walking up stairs
- carrying shopping bags
- resistance-band training
- standing on one leg
- tai chi
Speak to your medical team about the type and intensity of physical activity that is safe for you. The main thing is to find a type that you enjoy – that way, you’re more likely to stick with it. For some people, physical activity is part of their social life. For example, you could play tennis or go for a walk with a friend. For others, physical activity gives an emotional outlet and an opportunity for quiet reflection and mental relaxation.
Hear Clare Lait, Macmillan Specialist Community Physiotherapist talk about lymphoma and the role of exercise.
Your emotional response to having lymphoma might affect the type of physical activity you choose to do. After a diagnosis of lymphoma, some people feel less confidence in their body, as though it has somehow let them down. Changes to your appearance might also lower your self-esteem and affect the type of activity you feel comfortable doing. Listen to yourself – do what feels right for you. This may mean building up your level of physical activity gradually.
Jennifer Woods and Aimee Green discuss fatigue and exercise after lymphoma, exploring what cancer-related fatigue is, guidelines for exercise and barriers to physical activity. They also suggest ways to improve fatigue and signpost to physical activity resources.
Seek advice about the type and intensity of physical activity that is suitable for you. Your clinical nurse specialist, a physiotherapist or cancer exercise specialist can be good people to ask. They can also advise on any precautions you should take based on your individual circumstances. For example, you might be advised against doing high-impact activity (such as running) if lymphoma affects your bones and you have a higher risk of bone fracture.
During, or soon after your treatment for lymphoma, you may be advised to avoid some activities, particularly if you have certain side effects, such as:
- Shortage of platelets (thrombocytopenia) is a common side effect of chemotherapy and some targeted therapies for lymphoma. You may also be thrombocytopenic if you have lymphoma that affects your bone marrow. If you have thrombocytopenia, you are at a greater risk of bruising and bleeding so you should avoid high-impact sports.
- Low neutrophils (neutropenia) is a common side effect of chemotherapy. It can also happen if you have lymphoma in the bone marrow. Neutropenia increases your risk of infection, so avoid places where the risk of infection is higher, such as public swimming pools and gyms. You are also more vulnerable to infection if you have HIV or have had a stem cell transplant (particularly an allogeneic stem cell transplant) within the last 6 to 12 months. Check with a member of your medical team if you have concerns about your risk of infection.
- Low red blood cells (anaemia) is a side effect of some treatments for lymphoma. It 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 physical activity may therefore be more difficult and you may need to reduce the amount of this type of exercise that you do. If you experience these symptoms and they do not improve, speak to a member of your medical team as you may need treatment.
- Lasting effects of chemotherapy drugs on your heart or lungs. You may feel short of breath and experience discomfort when you do high intensity exercise. Seek advice from your clinical nurse specialist or a cancer exercise specialist for guidance about suitable types of physical activity.
- Damage to the nerves of your peripheral nervous system (peripheral neuropathy) may cause muscle weakness and numbness in your hands or feet. Peripheral neuropathy can also affect your grip and balance, so consider the safety of your choice of exercise. For example, instead of cycling outside on a road, use a stationary (‘exercise’) bike indoors.
- Diarrhoea or vomiting can happen for lots of reasons, including as a side effect of lymphoma treatments and pain relief medication. It can also be a symptom of stress and anxiety. Diarrhoea and vomiting change the levels of certain minerals (such as sodium and potassium) in your body. Do not exercise while you have diarrhoea or vomiting as this could further affect such levels and make you unwell.
Swimming has many health benefits including increasing your aerobic fitness and flexibility. It also strengthens your core muscles (tummy or ‘abdominal’, back and pelvis). There may, however, be times that you should avoid public swimming pools, including 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 it could become dislodged or infected.
Your medical team might advise you against doing high-impact exercise, for example, if lymphoma affects your bones and/or you have a higher risk of bone fracture.
We offer below some general information about some of the questions people affected by lymphoma often ask about exercise. Speak to your clinical nurse specialist for guidance specific to your situation.
Isn’t it better to rest than to take exercise?
Rest is essential for recovery and should be part of your physical activity programme. However, evidence shows that it is both safe and beneficial to do physical activity during and after treatment for cancer.
Doing less physical activity can lead to muscle weakness and fatigue. Some people get into a cycle of doing less activity, feeling more tired, so doing less activity and so on. Try to keep up your physical activity levels so that you can continue with your normal activities and to help with your emotional wellbeing.
It is important to realise, however, that you might not be able to do as much physical activity now compared with before you had lymphoma. For some people, it can take a year or two before feeling fully back to how they were before having lymphoma. Build in regular breaks and give yourself enough time to recuperate afterwards.
Have a ‘rest day’ between any days that you do high intensity physical activity, where you take only gentler physical activity exercise.
It’s advisable to make a note of the type of exercise you do and how you feel at the time, straight after, and a day or two later. This helps to see how the physical activity sessions affect you – you can then make any changes accordingly.
Start with small amounts of physical activity and slowly build up. For example, begin by walking 3 times a week for 20 minutes. After a few weeks, if you feel able to do so, add an extra 10 to 15 minute walk each week. You can also build in more everyday physical activity, such as taking the stairs instead of the lift or escalator when you are out and about. The NHS website has further ideas and also gives suggestions for physical activity you can do at home. The National Heart, Lung and Blood Institute also have more information about physical activity, including guidance on how to build it up gradually.
If you’d like help in adapting exercises to make them manageable (or more challenging), your GP may be able to refer you to a physiotherapist or cancer exercise specialist.
Is yoga helpful?
Yoga combines breathing and stretching with controlled movements. It aims to increase your strength and flexibility. Most types of yoga don’t count towards the government’s recommendations of 150 minutes of exercise a week. However, yoga can strengthen and relieve tightness in muscles. It can also improve balance and coordination. Many people also say that yoga enhances their mental wellbeing by reducing the stress and anxiety they feel. The NHS website has more information about yoga.
Can physical activity help my recovery from treatment?
Physical activity can have a positive impact on recovery from cancer treatment. Exactly how it helps recovery is not yet known; however, research suggests that it can shorten recovery time, prevent physical and mental decline, lessen fatigue and improve mental wellbeing.
For your general health and wellbeing, it’s a good idea to keep up your fitness after lymphoma treatment. Benefits of doing so include reducing the risk of some of the longer term and late effects linked with some treatments, including heart (cardiovascular) disease, brittle bones (osteoporosis) and obesity.
Some people see the end of treatment as a good time to begin a healthier lifestyle. If you are interested in using a gym, some offer programmes specifically for people recovering after cancer treatment. There are also trained physiotherapists and exercise specialists who are skilled and knowledgeable in this field. Speak to your clinical nurse specialist for guidance on where to find one.
Can physical activity prevent a relapse (return) of lymphoma?
There is growing support for the potential role of physical activity in lowering the risk of cancer relapse (return). For example, a review of 100 studies found a lower rate of cancer recurrence and fewer side effects of treatment in people who kept up their physical activity compared with those who did very little.
Staying active can also increase the likelihood of you being well enough for optimum treatment in the future, should your lymphoma return.
Where can I find out more about physical activity?
If you would like to find out more about physical activity recommendations and suggestions, you may find the following resources helpful:
Active Nation is a charity that gives information about various types of physical activity, including where you can participate in these.
Macmillan Cancer Support help you to find activities in your area. They produce a Move more: Get active, feel good exercise booklet and DVD that you can order online.
MOVE is a charity that provides practical and online support to encourage people affected by cancer to be active.
The British Association of Sport and Exercises (BASES) have an Expert Statement on Exercise and Cancer Survivorship, which outlines research findings and recommendations.