Gentle Movement on Low-Energy Days

Some days there is no version of exercise that sounds possible. The stairs look like a project. The idea of a walk is faintly insulting.

This page is for those days. It is not a training plan, and nothing here needs shoes, equipment, or leaving the house.

Cancer-related fatigue does not behave like ordinary tiredness. NCI reports that more than 80 percent of people having chemotherapy or radiation experience it. It also advises telling your doctor if you are still very tired even after resting or sleeping, which tells you how often rest alone falls short.

The counterintuitive part is what helps. NCI states that exercise, including walking, may help people with cancer feel better and have more energy during and after treatment. Not a cure, and not on every day. But the instinct to wait until you feel stronger before moving usually leaves you waiting a long time.

The Physical Activity Guidelines for Americans put the same idea more bluntly: some physical activity is better than none, and adults who sit less and do any amount of moderate-to-vigorous activity gain some health benefits.

ACS suggests that if you feel very tired, try 10 minutes of light exercise each day and build up from there. It also says plainly that even a few minutes of activity each day will help you.

Ten minutes does not have to be one block. Three lots of three minutes across a day is a legitimate way to reach it, and on a bad day it is the only way.

The guidelines add something worth holding onto. Adults with chronic conditions who cannot meet the standard targets should be regularly active according to their abilities. Your abilities today are the correct measure. Not last month's.

Pick the tier that matches the day, not the one that matches your self-image.

Tier one: from a bed or chair. Ankle circles and ankle pumps. Shoulder rolls, forward and back. Slow neck turns. Opening and closing the hands. Marching in place while seated. Standing up from the chair and sitting back down, a few times, using the armrests if you need them. Two minutes of this is not nothing, especially for circulation.

Tier two: around the house. Stand up every time an advert comes on. Walk to the far end of the hallway and back once an hour. Take the stairs once, deliberately, instead of avoiding them. Do one household task standing rather than sitting. Put the kettle on and walk while it boils.

Tier three: out the door. A ten-minute walk, or two five-minute walks. Around the block, or to the end of the street and back. Stop when you planned to stop rather than when you are exhausted, because that is what makes tomorrow possible.

NCI names three specifically: qigong, tai chi, and yoga have been found to reduce fatigue.

All three are slow, low-impact, and can be adapted for a chair. Many cancer centers run classes, and a hospital-run class is safer than a video, because the instructor knows what a port is and what a recent surgery means.

Ask whether your center offers one. Ask specifically for a class aimed at people in treatment.

The most common pattern in cancer fatigue is not doing too little. It is doing everything on a good day and losing the next two.

NCI's energy conservation advice is the antidote: choose the activities that are most important to you and do them when you have the most energy. Everything else waits, gets delegated, or does not happen.

Two habits make this practical. Stop while you still have something left, rather than at empty. And spread demanding tasks across the week instead of stacking them on the one morning you feel human.

The rest of NCI's fatigue advice is about removing friction.

• Sleep on a regular schedule, and if you nap, keep it under an hour so night sleep is not damaged.
• Drink plenty of water, and limit caffeine and alcohol.
• Eat many small meals through the day rather than three large ones, which is easier when appetite is poor.
• Move the movement to your best hour. NCI advises doing what matters most when you have the most energy, and your best hour is the one you notice, not a set time of day.

If pain, nausea, or breathlessness is what stops you, that is a treatment problem rather than a motivation problem. Say so, because those are treatable.

ACS advises always checking with your health care team before starting an exercise program, and several situations change the answer.

• Higher infection risk. You may need to stay away from public gyms and crowds until your risk returns to normal.
• A port or catheter. Avoid strength work using the muscles around it, which could dislodge it.
• Cancer in the bone, or osteoporosis. Use caution with heavy weights or anything that stresses the bones.
• Numb feet or poor balance. ACS notes a higher risk of falls, so stay on flat ground and keep a hand on something.
• During radiation therapy. Check with the radiation team before swimming.

Add the obvious ones: a fever, active vomiting or diarrhea, new chest pain, or feeling faint. Those are days to rest and call, not days to push.

Some things on this list will not wait. Call 911 or go to an emergency department if you have chest pain, or if you faint or nearly faint. And if you are in treatment, call your doctor immediately for a temperature of 100.4°F (38°C) or higher — that is the threshold CDC names as a sign of infection, and CDC says infections during cancer treatment can be life threatening and need urgent medical attention. The rest below can go to your team in normal hours.

Tell your team if:

• 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.
• The fatigue arrived suddenly or got much worse over a few days.
• You are breathless walking across a room, or your heart races on standing. Anemia is common and treatable.
• You feel dizzy on standing (chest pain and fainting go to the emergency department, as above).
• One leg becomes swollen, red, warm, or painful. That needs same-day assessment.
• You are low or hopeless most of the day. Depression and fatigue feed each other, and both respond to treatment.

• Is anything treatable driving this fatigue, such as anemia, thyroid problems, or low mood?
• How much activity is safe for me this week, given my counts?
• Can you refer me to physical therapy or a cancer exercise program?
• Does the center run chair yoga, tai chi, or qigong for people in treatment?
• Which symptoms mean I should stop exercising and call you?
• Is my pain or nausea controlled well enough for me to move at all?

Read next: Exercise During Cancer Treatment, Exercise With Neuropathy: What to Ask, Returning to Exercise After Cancer Surgery, Getting Back to Daily Activity After Treatment, and What to Expect at an Infusion Center.

• https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
• 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