You may have been given medicine or therapies that target your cancer cells, but did you know that some cancer treatments also can damage your heart and blood vessels? This is called cardiotoxicity. The most common forms of cardiotoxicity include:
- Cardiomyopathy and heart failure (heart muscle is damaged so that it can’t pump or receive blood normally)
- Coronary artery disease (major sources of blood supply to the heart are damaged)
Your risk of cardiotoxicity depends on the treatments you receive (type and dosage). It also depends on certain risk factors — some of which you can’t control, and some you can.
Risk factors that can’t be controlled include your sex, age, and family history. Some examples of controllable risk factors are inactivity, obesity, and smoking. You are more likely to develop cardiotoxicity after a cancer diagnosis if you:
- Are overweight
- Smoke
- Have diabetes, high blood pressure or high cholesterol
- Don’t exercise regularly
- Already have heart disease
The good news is that exercise can help control your risks. Use this condition center to learn about the benefits of exercise for patients with cancer, what questions you should ask your care team, and how to get started.
Benefits of Exercise
Studies in cancer patients have shown that regular exercise or physical activity can help prevent deaths from cardiovascular disease (CVD). For example, survivors of breast cancer and Hodgkin’s lymphoma who did at least 150 minutes per week of physical activity had a 23% and 51% reduction in cardiovascular events respectively compared with those who did less.
This research suggests that you do not need to be running marathons to benefit from exercise!
What is Physical Activity?
Physical activity is defined as anything that makes you move your body and burns calories, such as gardening or playing a sport.
What is Exercise?
Exercise is a type of physical activity that is planned and structured. It aims to improve or maintain your physical fitness and health.
Although exercise is good for most people, how you exercise will depend on some factors, such as your health, goals and overall fitness level.
What Increases Your Risk?
You may need to check with your doctor before starting an exercise program. Whether you need to talk to your health care team can depend on several factors including:
- Your cancer history
- Your cancer treatments (chemotherapy and chest radiation)
- Your non-cancer medical history
- Other factors
Cancer History
It’s important to consider your history of cancer before starting or restarting an exercise program.
Do you have early stage disease or are you living with advanced disease?
The goals of someone living with (or recovering from) early stage disease will likely be different from those of someone living with advanced disease. Also, certain exercises — such as high intensity aerobic exercise or resistance exercise — may not be safe for everyone, especially if you are living with advanced disease.
Has your cancer spread to your bones or nervous system?
Exercise may still be safe for people living with advanced disease, even if your bones or nervous system have been affected. However, it is important to speak to your doctor and an exercise specialist before exercising to ensure you lower your risk of falls and fractures!
Cancer Treatments
Before starting to exercise, the types of cancer treatments — whether you had surgery and what type of therapy you may have had — also should be considered.
If you received surgery:
❱❱ How long ago did you have surgery? If less than 3 or 4 months ago, it may not be safe for you to begin all types or intensities of exercise. Ask your surgeon or oncologist if it is safe for you to start reintroducing exercise into your life.
❱❱ Did you have major or minor surgery? More invasive surgeries take longer to heal than less invasive ones. Check with your surgeon to make sure it is safe for you to start to exercise again.
❱❱ Did you have lymph nodes removed? If so, and if the nodes were in or near the arms (shoulders) or legs (pelvis), you may be at higher risk for swelling of the arms or legs (lymphedema). Although lymphedema can be prevented and treated, it can’t be cured. If you had any lymph nodes removed as part of your cancer treatment talk with your surgeon or health care provider before starting to exercise.
❱❱ Do you have other surgery-related considerations? Patients in the process of, or who recently completed, reconstructive procedures need to be careful not to irritate the affected area to avoid infections. If you are in having, or recently had, a reconstructive procedure, check with your surgeon before starting to exercise.
❱❱ Have you had an ostomy? The major concerns around exercising with an ostomy include infection and herniation risks. An ostomy is a surgical procedure done to help the body remove waste when your digestive system is not working properly. An ostomy bag worn outside the body collects the waste. If you are living with an ostomy, you should avoid contact sports and water sports. However, you may be able to do other exercises safely, for example brisk walking and cycling. You also should avoid exercises that cause high levels of abdominal strain and obtain medical clearance before doing resistance exercise.
If you received chemotherapy, hormone therapy, or a targeted therapy:
❱❱ Is the treatment linked to higher risk of cardiotoxicity? If so, ask your provider whether it is safe to begin exercise. Make sure there is a plan to monitor your heart health during and after treatment. If you had more than one such treatment, be sure to ask about possible combined risks for the treatments you are receiving or received.
❱❱ How much of the medication did you receive, and how long were you taking it? In many cases, cardiotoxicity risk adds up over time. The more medication you receive, or the longer you are taking the medication, the greater the risk. If you are concerned about your risks, talk to your oncologist to learn more about your treatment options.
If you received radiation therapy:
❱❱ What area of the body was affected? Radiation may hurt your heart, lungs, blood vessels, nerves, and bones. Speak with your radiation oncologist to learn more about your radiotherapy-related risks.
❱❱ How much radiation therapy did you receive? The amount of radiation therapy you receive or received also influences your cardiotoxicity and exercise risks. Again, speak with your radiation oncologist to learn more. Are your blood counts stable?
❱❱ Some treatments can affect components of your blood, such as red blood cells, white blood cells, platelets, or plasma volume. These levels can influence your safety and ability to exercise. If you are on — or recently completed — treatment, it’s a good idea to check with your oncologist to see if your blood counts are in a safe range before exercising.
Non-Cancer History
In addition to your cancer history and treatments, your non-cancer health history is also important to keep in mind before starting an exercise program.
Have you been diagnosed with or are you living with a chronic health condition other than cancer?
If you have a preexisting or uncontrolled heart condition or cardiovascular disease, you need to check with your doctor to make sure it is safe for you to exercise.
Does heart disease run in your family?
If so, make sure you tell your oncologist at your next health visit.
Other Factors
Other health considerations may factor into whether you start an exercise program.
Your pre-cancer activity level or fitness.
The more active and physically fit you were before your cancer diagnosis, the more you may be able to do after a cancer diagnosis. However, this is not always the case. Make sure you ask your oncologist if it’s safe for you to return to your pre-diagnosis exercise program.
Your current condition and energy levels.
Energy conservation is important — especially if you are feeling fatigued. Although it is important to challenge yourself, it is similarly important not to over-do it!
How to Exercise
In general, the exercise guidelines for cancer patients and survivors are similar to the guidelines for the general public. According to the Office of Disease Prevention and Health Promotion, you should:
1. Be active
2. Perform aerobic exercise
- New to exercise? Work up to or perform either 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity aerobic physical activity each week.
- Regular exerciser? Try increasing your moderate-intensity physical activity to 300 minutes or your vigorous-intensity physical activity to 150 minutes each week.
3. Perform resistance exercise
- Perform moderate-to-high intensity, muscle-strengthening exercises (body weight, dumbbells, or resistance bands) that involve all the major muscle groups at least two days per week.