4 Issues Facing Long-Term Cancer Survivors When Resuming Exercise

Long-term cancer survivors (LTCS) face unique issues when beginning an exercise program. Fatigue, muscle weakness, peripheral neuropathy and cardiopulmonary issues may impact the approach taken when guiding a long-term cancer survivor in recovery exercise. Exercise may also reduce these issues. It’s important to take all these factors into effect when building an exercise program for a long-term cancer survivor.


Cancer-related fatigue continues to be a chronic and persistent problem for approximately 33% of long-term breast cancer survivors,5 and between 17 .1% and 27% of long-term testicular cancer survivors.4,6 Fatigue increases in patients with high levels of neuropathy, with Raynaud-like symptoms and with anxiety and depression. Fatigue may be compounded by many years of inactivity and the physical debilitation that accompanies a sedentary lifestyle.

Physical activity reduces fatigue. Developing an exercise program for the LTCS with fatigue must begin and progress slowly. Patients may initially be shocked by their degree of debilitation but will quickly see gains in muscle strength and cardiovascular endurance.

Peripheral Neuropathy

Peripheral neuropathy is a side effect of some chemotherapy agents that does not appear to improve over time. Some preliminary studies suggest that exercise may actually improve PN but no interventions have been discovered that reverse or even prevent the neurologic damage.7

Muscle Weakness & Balance

When LTCS begin to exercise, their balance may be a significant issue. It is important to tailor an exercise prescription to not only strengthen muscles and improve aerobic capacity but also to focus on improving and restoring balance.

Exercises should focus on core and pelvic girdle strength and actual ability to balance on one foot. Improving balance not only reduces fall and fracture risk but also builds movement confidence in the survivor and helps them move with greater ease.

Recommended Exercises

The author recommends the following exercises: Dead Bug, Side Step with Resistance, and Single Leg Stance.

Note: It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient.

Cardiopulmonary Complications

Cardiopulmonary complications of cancer treatment can emerge during active treatment but generally become problematic at later stages of survivorship for a wide range of different cancers, such as breast, Non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and testicular cancer.1

Heart failure is an early sign that may occur during some chemotherapy (e.g. trastuzumab, doxirubicin) but may also present years later. Other cardiac complications include hypertension, arrhythmia, arterial stenosis, conduction disorders and valvular disease. Pulmonary effects may be related to chemotherapy or radiation therapy and include radiation pneumonitis, pulmonary fibrosis and a reduction in pulmonary function.

Studies observed that breast cancer survivors have accelerated aging primarily related to severe declines in cardiac function that can be reversed with physical activity.3 Preliminary evidence suggests that structured exercise rehabilitation in testicular cancer may prevent cardiovascular disease. 2 While more research is needed to determine the optimal dose, duration, and timing of structured exercise, the evidence is growing to support the notion that progressive exercise programs may not only reverse but also prevent some cardiopulmonary complications of cancer treatment.

The Power of Exercise

Restorative exercise, both aerobic and resistance exercises, are important for health promotion and quality of life of long-term cancer survivors.  Studies demonstrate that declines in muscle strength and cardiopulmonary function among long-term cancer survivors can be improved through structured exercise. These exercises should progress slowly and accommodate an individual’s physical limitations from cancer or other previous or current comorbidities. Well-designed restorative exercise programs can not only improve the quality of life of cancer survivors but can also be life changing.

  1. Carver, JR, Shapiro, CL, Ng, A, Jacobs, L, Schwartz, C, Virgo, KS, Hagery, KL, Somerfield, MR, Vaughn, DJ. American Society of Clinical Oncology Clinical Evidence Review on the Ongoing Care of Adult Cancer Survivors: Cardiac and Pulmonary Late Effects. 2008. 25(25): 3991-4008.
  2. Christensen, JF, Bandak, M, Campbell, A, Jones, LW, Hojman, P. Treatment-related cardiovascular late-effects and exercise training countermeasures in testicular germ cell cancer survivorship. Acta Oncology. 2015. 54(5): 592-599.
  3. Jones LW, Courneya KS, Mackey JR, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. Journal Clinical Oncology. 30:2530–2537.
  4. Orre, IJ, Fossa, SD, Murison, R, Bremnes, R, Dahl, O, Klepp, O, Loge, JH, Wist, E, Dahl, AA. Chronic cancer-related fatigue in long-term survivors of testicular cancer. Journal of Psychosomatic Research. 2008. 64(4): 363-371.
  5. Reinertsen, KV, Cvancarova, M, Loge, JH, Edvardsen, H, Wist, E, Fossa, SD. Predictors and course of chronic fatigue in long-term breast cancer survivors. Journal of Cancer Survivorship. 2010. 4(4), 405-414.
  6. Sprauten, M, Haugnes, HS, Brydoy, M, Kiserud, C, Tandstad, T, Bjoro, T, Bjerner, J, Cvancarova, M, Fossa, SD, Oldenburg, J. Chronic fatigue in 812 testicular cancer survivors during long-term follow-up: increasing prevalence and risk factors. Annals of Oncology 2015. 26(10):2133-2140.
  7. Wonders, KY. The effect of supervised exercise training on symptoms of chemotherapy-induced peripheral neuropathy. International Journal Physical medicine rehabilitation. 2014. 2:210