Moderate exercise while on chemotherapy is safe and reduces fatigue, helps people finish their planned doses, and may protect the heart and nerves.
More than a hundred randomised trials, summarised in Cochrane reviews and the 2019 ACSM roundtable, show that supervised aerobic and resistance exercise during chemotherapy reduces cancer-related fatigue, preserves cardiorespiratory fitness and muscle, improves quality of life and, in several trials (for example PACES in breast cancer), increases the proportion of patients completing chemotherapy at full dose. Signals for reduced chemotherapy-induced neuropathy and cardiotoxicity exist but are from smaller trials. No trial has shown harm from moderate exercise in patients with stable blood counts. Home-based and remotely supervised formats retain most of the benefit for fatigue.
Exercise counteracts the deconditioning and inflammatory cascade of cytotoxic treatment, maintains muscle protein synthesis, and improves perfusion and mitochondrial function in heart and peripheral nerve.
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