Getting Back to Daily Activity After Treatment

The last treatment does not come with a switch. People expect the end of chemotherapy or radiation to feel like a finish line, and instead find a long flat stretch where they look recovered and do not feel it.

Fatigue is the usual reason. NCI reports that more than 80 percent of people having chemotherapy or radiation experience it, and it does not always leave on the day treatment ends. Meanwhile the scaffolding comes down: fewer appointments, fewer people asking, and an expectation that you are back.

Getting back is a project. Here is how to run it.

The federal Physical Activity Guidelines for Americans set the adult target at 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous-intensity activity. On top of that, muscle-strengthening work of moderate or greater intensity involving all major muscle groups on 2 or more days a week.

The American Cancer Society applies the same figures to cancer survivors, framed as something to build up to.

Read those numbers as a destination. If you finished treatment last month, they are not week one.

The guidelines include a sentence that undercuts the intimidation of the numbers: "Some physical activity is better than none." Adults who sit less and do any amount of moderate-to-vigorous activity gain some health benefits.

They go further for people in your position. Adults with chronic conditions who are able should aim for the same 150 to 300 minutes. And when they are not able to meet the guidelines, "they should engage in regular physical activity according to their abilities."

That is permission written into national policy. A ten-minute walk on a bad week counts. It is not a failed workout.

Most people restart with walking alone and stall, because walking rebuilds only one of the three things treatment took.

Aerobic. Walking, cycling, swimming. This is the fatigue and stamina track, and it is where to start.

Strength. Two days a week, all major muscle groups. Treatment and inactivity both cost muscle, and muscle is what makes stairs, groceries, and getting off the floor feel normal again.

Balance. The guidelines specifically say older adults should do multicomponent activity that includes balance training as well as aerobic and muscle-strengthening work. This matters more if treatment left you with numb feet.

ACS is practical about starting from a low base: if you feel very tired, try 10 minutes of light exercise each day and build up from there. It also notes that even a few minutes of activity each day will help you.

A workable pattern looks like this. Start where you can finish comfortably, not where you think you should be. Hold the same amount for a full week before increasing it. Add a small amount, perhaps five minutes, to a few sessions rather than all of them. Add strength work once the walking feels routine, starting with body weight or light resistance.

Expect setbacks that are not your fault. A cold, a bad scan week, or a rough night resets you by a few days, not to zero.

Activity guidelines say nothing about the things people actually want back. These need specific answers from your team, not general ones.

Ask about work, and ask about a phased return rather than a date. Ask about driving, particularly if you are on medicines that affect alertness. Ask about lifting, with a number attached, if you had surgery. Ask about swimming pools, hot tubs, and public gyms, which come with infection questions. Ask about travel and flying. Ask about sex, which almost nobody raises and most teams are used to discussing.

Vague answers are worth pushing on. "Take it easy" tells you nothing about whether you can lift a toddler.

Cancer rehabilitation exists and is chronically underused. Say the words directly.

A physical therapist rebuilds strength, range of motion, and balance. An occupational therapist works on the actual tasks of your day, including energy conservation, which is a real technique rather than a slogan. If you had lymph nodes removed, a certified lymphedema therapist is a specific referral worth asking for.

NCI's fatigue guidance also points to energy conservation as a strategy: choose the activities that matter most to you and do them when you have the most energy.

ACS is clear that you should always check with your health care team before starting an exercise program. Several situations change the advice.

• Cancer in the bone, or osteoporosis. Use caution with heavy weights or exercises that stress the bones.
• Numb feet or balance problems. ACS notes this puts you at higher risk for falls, so choose stable surfaces and hold on when you need to.
• A port or catheter in place. Avoid strength training using the muscles in that area, which could dislodge it.
• Higher infection risk. You may need to stay away from public gyms and crowds until your risk returns to normal.
• Radiation therapy and swimming. Check with the radiation team before getting in a pool.

Start with the exceptions. Chest pain, sudden or unusual breathlessness, or an irregular or racing heartbeat means stopping and calling 911 or going to an emergency department — not waiting for the clinic to open. The same goes for fainting. Everything else on this list is a call to your team.

• You feel very weak and tired even after resting or sleeping, or you cannot do your normal activities. NCI names this specifically as something to report.
• You feel dizzy or unsteady during or after exercise.
• New or worsening bone pain appears, or pain in one spot that activity makes worse.
• One arm or leg swells, or feels heavy, full, or tight. That can be lymphedema and it is easier to treat early.
• A calf becomes swollen, red, warm, or painful. That needs same-day assessment.
• Your temperature reaches 100.4°F (38°C) or higher.

• What are my activity limits right now, with numbers rather than adjectives?
• Can I be referred to cancer rehabilitation, physical therapy, or occupational therapy?
• How long should I expect this fatigue to last, and what would make you investigate it?
• Should anything be checked before I start strength training, such as bones or heart?
• What is a realistic phased return to work in my case?
• Which late effects should I watch for, and who monitors them?

Read next: Survivorship, What to Expect at a Survivorship Visit, Your Survivorship Care Team, Walking Plan After Chemotherapy, and Breathing and Relaxation Before Cancer Appointments.

• https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• https://www.cancer.org/cancer/survivorship/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection