Exercise During Chemo: What The Evidence Says (with EP & PhD Candidate, Brent Cunningham)
Guest: Brent Cunningham — Exercise Physiologist, PhD candidate in Exercise Oncology
Host: Dan Rothenberg — Scope Sports Injury & Exercise Clinic, Back 2 Your Best Podcast
When you’re facing cancer, so much feels outside your control. Exercise is one lever you can pull—safely and meaningfully—when it’s tailored to you. In this episode, I sat down with exercise physiologist and researcher Brent Cunningham to unpack the latest on exercising before, during, and after chemotherapy.
Why exercise matters in cancer care
Think in three buckets:
- Prevention & pre-treatment: Being active lowers risk for several cancers and builds a “functional reserve” before treatment.
- During treatment: Exercise can improve treatment tolerance, help maintain strength and fitness, and reduce delays or dose reductions.
- Survivorship: It supports recovery from side-effects, rebuilds capacity, and helps people return to life, sport, and work.
What kind of exercise helps?
- Aerobic training improves cardiorespiratory fitness—especially relevant when treatments have potential cardiotoxic effects.
- Resistance training protects muscle mass, strength, and power—key for daily function and offsetting treatment-related muscle loss (e.g., cachexia).
- Intensity matters: Moderate to higher efforts often deliver more benefit—but auto-regulation is critical. On low-energy days, you can still train at an “8/10 effort” relative to how you feel that day. Output changes; intent remains.
Auto-regulation: meeting your body where it is
Brent’s PhD focuses on day-to-day adjustment of training based on symptoms, fatigue, and readiness. Practical levers include:
- Reducing volume (e.g., 2 sets instead of 4) when fatigue is high
- Adjusting load, reps, rest to match daily capacity
- Using RPE to anchor intensity without forcing fixed numbers
What a session can look like
- Whole-body strength work + aerobic intervals (moderate–vigorous, as tolerated)
- Added focus where needed: balance (for peripheral neuropathy), bone health (impact/progressive loading when safe), and power (e.g., getting out of a chair faster)
- Technique is individualized: “fit the exercise to the person, not the person to the exercise.”
Recovery, side-effects & safety
- Cancer-related fatigue isn’t fixed by rest alone; dose training so it doesn’t wipe you out for days.
- Consider treatment specifics:
- Taxane-based chemo → higher risk of peripheral neuropathy (falls/balance).
- Anthracyclines → possible cardiac impact; monitor aerobic intensity thoughtfully.
- Hormone therapies → watch bone health and adaptive capacity.
- Bone metastases → load selection and positions matter (see UBC Bone Metastases Exercise Hub).
- Radiation skin changes → adjust surfaces/pressure.
Training around infusion days
Highly individual. Some patients train the same day as infusion; others need 1–2 days either side. There’s early research exploring light–moderate exercise during infusions to enhance drug delivery via improved blood flow to the tumour microenvironment—promising, but still emerging.
Supervision vs DIY
Supervised exercise often yields better outcomes, especially early. Over time, build self-efficacy so you can continue independently or in cost-effective groups. In Australia, ask your GP about a Chronic Disease Management Plan (Medicare-subsidised allied health visits).
Where to find support
- Start with your cancer-specific organisation (e.g., Cancer Council, Myeloma Australia) for local services.
- Professionals: see ESSA’s position statement
Need help getting started?
At Scope (Ipswich), we tailor rehab and strength programs for people navigating chronic pain or returning to life after it. If you’re ready for a plan that gets you back 2 your best—book a chat about our Back 2 Your Best Rehab Program.
