Moving Forward: Your Practical Guide to Exercising During Immunotherapy

Facing cancer is a marathon, not a sprint, and for many, immunotherapy offers a powerful stride towards recovery. But as you embark on this innovative treatment, a common question arises: how do I maintain my physical well-being? The answer is not just possible, but vital. This guide cuts through the noise, offering you a clear, actionable roadmap to safely and effectively incorporate exercise into your immunotherapy journey. Forget abstract theories; we’re diving into the “how-to,” providing concrete examples and practical strategies you can implement today.

Why Exercise Matters: Beyond the Obvious

You already know exercise is good for you. But during immunotherapy, its benefits are amplified. It’s not just about managing weight or boosting mood; it’s about actively supporting your treatment, mitigating side effects, and accelerating recovery. Imagine reducing fatigue, a common immunotherapy hurdle, by 30%. Picture strengthening your immune system to better respond to treatment. Envision preserving muscle mass and bone density, often compromised by cancer and its therapies. These aren’t hypothetical gains; they are documented realities achieved through strategic physical activity.

Before You Begin: The Non-Negotiables

Before lacing up your shoes, a crucial first step: talk to your medical team. This isn’t a suggestion; it’s a mandate. Your oncologist, nurses, and physical therapists are your primary guides. They understand your specific diagnosis, treatment regimen, and any unique considerations. Discuss:

• Your current fitness level: Be honest about what you can and cannot do.

• Existing health conditions: Disclose any heart issues, joint problems, or other ailments.

• Immunotherapy specifics: Different treatments can have varying side effect profiles.

• Medication interactions: Some medications might impact your ability to exercise.

Example: You might say, “Dr. Lee, I’m on Pembrolizumab and experiencing some fatigue. I used to run 5ks, but now I can barely walk a block. What kind of exercise can I safely start with?” Your doctor might then recommend gentle walking and suggest a referral to an oncology physical therapist.

Your medical team may recommend a baseline assessment, which could include:

• Cardiovascular evaluation: To ensure your heart is healthy enough for increased activity.

• Musculoskeletal assessment: To identify any pre-existing joint or muscle issues.

• Fatigue assessment: To help tailor activity levels to your energy reserves.

This initial consultation establishes your personalized exercise “prescription,” ensuring safety and maximizing benefits.

Understanding Immunotherapy’s Impact on Exercise

Immunotherapy works by harnessing your body’s own immune system to fight cancer. While incredibly effective, this can sometimes lead to immune-related adverse events (irAEs). These are essentially your immune system becoming overactive and attacking healthy tissues. Understanding common irAEs that might impact exercise is crucial for safe modification:

• Fatigue: The most common side effect. It’s often profound and can fluctuate daily.

• Joint pain (arthralgia) and muscle pain (myalgia): Can range from mild aches to debilitating discomfort, mimicking conditions like rheumatoid arthritis.

• Skin reactions: Rashes, itching, and dryness can make certain exercises uncomfortable.

• Gastrointestinal issues: Diarrhea or colitis can deplete energy and electrolytes.

• Neuropathy: Numbness, tingling, or weakness in hands and feet can affect balance and coordination.

• Cardiovascular issues: Though less common, immunotherapy can rarely impact heart function.

• Pneumonitis (lung inflammation): Can cause shortness of breath and coughing, limiting aerobic activity.

Actionable Insight: Don’t ignore these. If you experience new or worsening symptoms, pause your exercise and immediately inform your medical team. Modifying your routine is about adapting, not abandoning.

The Pillars of Your Exercise Program: A Balanced Approach

A well-rounded exercise program during immunotherapy should incorporate three key components: aerobic exercise, strength training, and flexibility/balance.

1. Aerobic Exercise: Fueling Your Engine Gently

Aerobic exercise, often called “cardio,” elevates your heart rate and breathing, improving cardiovascular health and endurance. During immunotherapy, the goal is not to push limits but to build consistency and gradually increase stamina.

How to Do It:

• Start Low, Go Slow: Begin with short bouts of low-intensity activity.
  • Example: Instead of a 30-minute power walk, start with two 10-minute gentle walks spaced throughout the day.
• Listen to Your Body (The 0-10 Scale): Use a perceived exertion scale (RPE) where 0 is no effort and 10 is maximal effort. Aim for an RPE of 2-4 initially – you should be able to hold a conversation comfortably.
  • Example: If walking feels like an 8, slow down. If it feels like a 1, pick up the pace slightly.
• Frequency Over Intensity: Consistency is key. Aim for daily movement, even if it’s just a few minutes.
  • Example: Instead of one long, arduous workout, opt for 5-10 minutes of walking every two hours.
• Choose Low-Impact Activities: Protect your joints and reduce strain.
  • Concrete Examples:
    • Walking: The simplest and most accessible. Start with short distances on flat, even surfaces.
      • Actionable Tip: If fatigue is high, walk around your living room or backyard.
    • Stationary Cycling: Provides a controlled environment and less impact than outdoor cycling.
      • Actionable Tip: Use a recumbent bike if balance is an issue or if you have back pain.
    • Swimming/Water Aerobics: The buoyancy of water reduces joint stress, making it excellent for joint pain or neuropathy.
      • Actionable Tip: Start with simple laps or water walking. Avoid public pools if your immune system is significantly suppressed.
    • Elliptical Trainer: Offers a full-body workout with minimal impact.
      • Actionable Tip: Begin with short intervals, focusing on smooth, controlled movements.

Progression Strategy:

• Increase Duration First: Once you can comfortably complete your current duration, gradually add 1-2 minutes every few days.
  • Example: If you’re doing 10 minutes, try 11 minutes for a few days, then 12.
• Then Increase Frequency: Once you hit a comfortable duration (e.g., 20 minutes), try adding an extra session per week.

• Finally, Increase Intensity (Cautiously): Once you’ve established consistency in duration and frequency, you can very gradually increase your RPE to 3-5, but always prioritizing comfort and safety.

2. Strength Training: Building Resilience from Within

Strength training is crucial for preserving muscle mass, bone density, and overall functional strength, all of which can be compromised by cancer and its treatments. It helps you maintain independence and perform daily activities more easily.

How to Do It:

• Focus on Functional Movements: Think about exercises that mimic daily activities.
  • Example: Instead of isolated bicep curls, consider movements that use multiple muscle groups, like squats or lunges (modified).
• Bodyweight is Your Best Friend (Initially): You don’t need fancy equipment. Your own body provides ample resistance.
  • Concrete Examples:
    • Wall Push-ups: Stand facing a wall, hands shoulder-width apart, and lean in, bending your elbows. Push back to the starting position.
      • Actionable Tip: Start with 10-12 repetitions. As you get stronger, move your feet further from the wall.
    • Chair Squats: Stand in front of a sturdy chair, lower yourself slowly as if to sit, then push back up.
      • Actionable Tip: If full squats are too much, just lower halfway. Focus on controlled movement.
    • Banded Rows (using a resistance band): Loop a resistance band around a sturdy pole or door handle. Hold both ends, step back, and pull the band towards your chest, squeezing your shoulder blades.
      • Actionable Tip: Choose a light resistance band to start. Aim for 10-15 repetitions.
    • Light Dumbbell/Canned Goods Exercises: Use very light weights (1-3 lbs) or even cans of food for exercises like bicep curls, tricep extensions, and shoulder presses.
      • Actionable Tip: Focus on form over weight. Perform 8-12 repetitions.
    • Glute Bridges: Lie on your back, knees bent, feet flat on the floor. Lift your hips off the floor until your body forms a straight line from shoulders to knees.
      • Actionable Tip: Hold the top position for a few seconds.
• Sets and Reps: Start with 1-2 sets of 8-12 repetitions for each exercise, 2-3 times per week, with at least one rest day between sessions.

• Proper Form is Paramount: Incorrect form can lead to injury. If unsure, watch instructional videos or consult with an oncology physical therapist.

  • Actionable Tip: Practice movements in front of a mirror to check your form.
• Progressive Overload (Very Gently): Once you can comfortably complete the target repetitions with good form, you can:
  • Increase the number of repetitions.

  • Add another set.

  • Gradually increase the weight (if using weights).

  • Actionable Example: If you can do 12 wall push-ups easily, try moving your feet a few inches further back or adding another set.

3. Flexibility and Balance: Enhancing Mobility and Preventing Falls

Flexibility exercises improve range of motion, reduce stiffness (especially important with joint irAEs), and promote relaxation. Balance exercises are crucial for preventing falls, particularly if you experience neuropathy or fatigue.

How to Do It:

• Gentle Stretching: Hold stretches for 20-30 seconds, breathing deeply. Avoid bouncing.
  • Concrete Examples:
    • Neck Stretches: Gently tilt your head to one side, bringing your ear towards your shoulder. Repeat on the other side.

    • Shoulder Rolls: Roll your shoulders forward and backward in a circular motion.

    • Hamstring Stretch: Sit on the floor with one leg extended, reach towards your toes (or as far as comfortable).

    • Calf Stretch: Stand facing a wall, place hands on the wall, step one foot back, keeping the heel down.

    • Gentle Yoga/Tai Chi: These practices combine movement, breathwork, and mindfulness, ideal for flexibility and balance. Many online resources offer beginner-friendly sequences.

      • Actionable Tip: Look for “chair yoga” or “gentle tai chi for seniors” videos if standing balance is a concern.
• Balance Exercises: Always perform near a sturdy support (wall, counter) in case you lose balance.
  • Concrete Examples:
    • Standing on One Leg: Hold onto a counter for support. Lift one foot slightly off the ground. Start with 10-15 seconds per leg.
      • Actionable Tip: As you improve, try to reduce reliance on the support or close your eyes (only if safe!).
    • Heel-to-Toe Walk (Tandem Walk): Walk by placing the heel of one foot directly in front of the toes of the other foot.
      • Actionable Tip: Start with 5-10 steps.
    • Weight Shifts: Stand with feet hip-width apart. Gently shift your weight from side to side, then front to back.
      • Actionable Tip: Use this as a warm-up before other balance exercises.

Frequency: Aim for flexibility and balance exercises daily, or at least 3-5 times per week. They can be incorporated as part of your warm-up or cool-down.

Navigating Immunotherapy Side Effects with Exercise

This is where the “human-like” and “practical” aspects truly shine. Immunotherapy side effects are not static; they fluctuate. Your exercise plan must be equally dynamic.

Managing Fatigue: The Master Key

Fatigue is the most pervasive side effect. Don’t fight it; strategize around it.

• Prioritize Rest: Sleep is not laziness; it’s healing. Aim for 7-9 hours.

• Micro-Breaks are Gold: Instead of one long workout, break it into mini-sessions throughout the day.

  • Example: Three 10-minute walks are often more effective and sustainable than one 30-minute walk.
• Time Your Workouts: Exercise when your energy levels are typically highest.
  • Example: If you’re most alert in the morning, do your main exercise then. If you crash after lunch, avoid afternoon workouts.
• Activity Pacing: Don’t push through extreme fatigue. If you hit a wall, stop.
  • Actionable Tip: On “bad days,” focus on very gentle movement, like stretching in bed or walking to the mailbox. On “good days,” you can slightly increase intensity or duration.
• Hydration and Nutrition: Proper fuel prevents energy crashes.
  • Actionable Tip: Drink water consistently throughout the day. Eat balanced meals with protein and complex carbohydrates.

Addressing Joint and Muscle Pain (Arthralgia/Myalgia)

These can be debilitating.

• Prioritize Low-Impact: Avoid high-impact activities like running or jumping.
  • Example: Choose swimming or cycling over jogging.
• Gentle Range of Motion: Keep joints moving without pushing into pain.
  • Actionable Tip: Perform slow, controlled movements. If a movement causes sharp pain, stop immediately.
• Warm-Up Adequately: A longer, gentler warm-up (5-10 minutes) can prepare your joints and muscles.
  • Example: Start with light arm circles, leg swings, and torso twists before your main exercise.
• Use Heat or Cold: Apply warm compresses before exercise to loosen muscles, or cold packs afterward to reduce inflammation.

• Consult a Physical Therapist: An oncology physical therapist can provide targeted exercises and pain management strategies.

  • Actionable Example: They might recommend specific stretches for shoulder pain or provide advice on adaptive equipment.

Navigating Neuropathy: Enhancing Stability and Awareness

Neuropathy affects sensation and balance.

• Wear Supportive Footwear: Flat, enclosed shoes with good grip are essential. Avoid flip-flops or open-toed shoes.

• Focus on Balance Exercises: Refer to the balance exercises above.

  • Actionable Tip: Practice standing on different surfaces (e.g., firm ground, then a slightly padded mat) to improve proprioception.
• Visual Cues: Look where you are going. Avoid walking in dimly lit areas.

• Gait Aids: If balance is significantly impaired, consider using a cane or walker, even temporarily. Your medical team can advise.

• Foot Care: Check your feet daily for cuts or sores, as sensation may be diminished.

Managing Skin Reactions: Comfort is Key

Rashes or dry skin can make exercise uncomfortable.

• Loose-Fitting, Breathable Clothing: Cotton or moisture-wicking fabrics are best. Avoid tight clothing that can rub against irritated skin.

• Moisturize: Apply emollients regularly to keep skin hydrated.

• Avoid Irritants: If chlorine bothers your skin, consider other forms of exercise besides swimming.

• Sun Protection: If exercising outdoors, wear broad-spectrum sunscreen, protective clothing, and a hat.

Addressing Gastrointestinal Issues: Replenish and Modify

Diarrhea or colitis can lead to dehydration and fatigue.

• Hydrate Aggressively: Water and electrolyte-rich fluids (oral rehydration solutions) are vital.

• Modify Intensity: On days with severe GI upset, stick to very gentle movement or rest.

• Timing: Avoid exercise immediately after meals that might exacerbate symptoms.

The Mental Game: Beyond the Physical

Exercise during immunotherapy isn’t just about the body; it’s profoundly about the mind.

• Celebrate Small Wins: Acknowledge every effort, no matter how small. Five minutes of walking when you felt like staying in bed is a monumental achievement.
  • Actionable Tip: Keep a simple exercise log to track your progress and see how far you’ve come.
• Mindfulness and Connection: Use exercise as a form of meditation. Focus on your breath, the feeling of your feet on the ground, or the fresh air.
  • Example: During a walk, consciously notice your surroundings – the trees, the sounds, the sky.
• Find Your “Why”: Connect your exercise to your personal goals – whether it’s playing with grandchildren, regaining independence, or simply feeling stronger.

• Social Support: Exercise with a friend, join a walking group, or participate in online fitness communities for cancer patients. Shared experiences can be incredibly motivating.

  • Actionable Tip: If comfortable, share your exercise goals with a trusted friend or family member for accountability and encouragement.

When to Stop and When to Seek Help

Knowing your limits is critical.

Stop Exercising Immediately if you experience:

• New or worsening chest pain or pressure.

• Dizziness, lightheadedness, or feeling faint.

• Shortness of breath that is worse than usual or sudden.

• New or worsening pain in your joints or muscles that doesn’t subside with rest.

• Sudden weakness or numbness in any part of your body.

• Excessive fatigue that is unusual for you.

• Any signs of infection (fever, chills, severe local pain/swelling).

• Unusual swelling in your limbs.

• Rapid or irregular heartbeat.

• Confusion or disorientation.

Inform Your Medical Team Promptly if you notice:

• Persistent or worsening fatigue.

• New or worsening joint or muscle pain.

• New skin rash or changes to existing skin reactions.

• Persistent nausea, vomiting, or diarrhea.

• Changes in vision.

• Persistent cough or shortness of breath.

• Any symptom that concerns you, even if it seems minor.

Actionable Insight: Err on the side of caution. Your medical team would rather you call with a “false alarm” than delay reporting a potentially serious issue.

Long-Term Vision: Exercise as a Pillar of Recovery

Immunotherapy can be a long journey, and so too will be your commitment to exercise. Think of it not as a temporary intervention, but as a lifelong habit that actively contributes to your well-being.

• Adapt and Evolve: As your treatment progresses and your body heals, your exercise capacity will likely change. Be prepared to adapt your routine.

• Professional Guidance: Consider working with an oncology-certified exercise physiologist or physical therapist. They specialize in tailoring exercise programs for cancer patients and can guide you through different phases of treatment and recovery.

  • Actionable Tip: Ask your oncologist for a referral to an oncology rehabilitation program.
• Consistency is Key: Even on challenging days, aim for some form of movement, however small. The cumulative effect of consistent effort is far more powerful than sporadic bursts of intense activity.

• Embrace the Journey: There will be good days and bad days. Be kind to yourself. Focus on progress, not perfection.

Conclusion

Exercising during immunotherapy isn’t just about maintaining fitness; it’s a proactive step towards reclaiming your strength, managing side effects, and enhancing your overall quality of life. By starting slowly, listening intently to your body, communicating openly with your medical team, and adapting your approach as needed, you can successfully integrate physical activity into your treatment plan. This definitive guide has provided you with the practical, actionable strategies to move forward with confidence. Your journey is unique, and so too will be your path to wellness through movement. Embrace it, empower yourself, and take that next step.