Starting exercise safely
Starting exercise safely
Before starting any gym or exercise programme consult your oncologist and ideally a physiotherapist or clinical exercise physiologist experienced in cancer care. They can review:
- Sites of bone metastases (e.g., spine, ribs, pelvis, femur)
- Bone stability (to avoid fractures)
- Blood counts (especially hemoglobin and platelets)
- Pain control and fatigue level
Sometimes your team may refer to a bone scan or MRI to guide you on which areas to protect.
If you have any bone metastases, certain movements should be avoided or modified:
| Site of metastasis | Movements to avoid | Safer options |
|---|---|---|
| Spine | Heavy lifting, twisting, forward flexion (e.g., crunches, deadlifts) | Light resistance bands, seated machines, recumbent cycling |
| Pelvis/femur | Impact activities (running, jumping), heavy leg press or squats | Stationary bike, pool walking, gentle leg extensions |
| Ribs | Upper-body twisting, push-ups, chest flys | Light resistance bands, gentle wall push-ups |
In general avoid high-impact and high-load exercises, and stop immediately if there is new or sharp pain.
Start slowly, aiming for consistency over intensity. A safe, balanced plan includes:
Aerobic (2-4x/week)
- Walking, stationary cycling, or swimming
- Start with 10–15 min and progress toward 30 min at light–moderate effort
(You should be able to talk while exercising)
Resistance (1-2x/week)
- Use machines rather than free weights for stability
- Focus on major muscle groups, light–moderate load (e.g., 8–12 reps, 1–2 sets)
- Avoid training near metastatic sites
Flexibility and balance (most days)
- Gentle stretching and balance exercises are encouraged
- Avoid ballistic (bouncing) stretches, twisting or bending through the spine and overhead or weight-bearing stretches that load affected bones
Watch for warning signs to stop exercise
- Sudden or sharp pain
- New bone pain or swelling
- Dizziness, chest pain, or breathlessness out of proportion
- Fatigue that lasts more than a day
If any of these occur, pause and contact your medical team.
And finally, a few other things to consider include:
- Making sure you are consuming enough protein
- Staying hydrated
- Managing fatigue (short bouts of exercise may be better tolerated)