Table 3.

Safety Precautions and Contraindications to Physical Activity for Cancer Survivors.

Year	Institute	Safety Precautions and Contraindications
2003/2006/201210,23,26	ACS	Survivors with compromised immune function should avoid public gyms and public pools until their white blood cell counts return to safe levels. Survivors who have completed a bone marrow transplant are usually advised to avoid such exposures for 1 year after transplantation. Survivors experiencing severe fatigue from their therapy may not feel up to an exercise program, and therefore they may be encouraged to do 10 minutes of light exercises daily. Survivors undergoing radiation should avoid chlorine exposure to irradiated skin (eg, from swimming pools). Survivors with indwelling catheters or feeding tubes should be cautious or avoid pool, lake, or ocean water or other microbial exposures that may result in infections, as well as resistance training of muscles in the area of the catheter to avoid dislodgment. Survivors with multiple or uncontrolled comorbidities need to consider modifications to their exercise program in consultation with their physicians. Survivors with significant peripheral neuropathies or ataxia may have a reduced ability to use the affected limbs because of weakness or loss of balance. They may do better with a stationary reclining bicycle, for example, than walking on a treadmill.
201027	ACSM	Beware of fracture risk in patients with breast and prostate cancer who are treated with hormone or androgen deprivation therapy, respectively, or diagnosed with osteoporosis or bone metastases. Women with immediate arm or shoulder problems secondary to breast cancer treatment should seek medical care to resolve those issues before exercise training with the upper body. If an ostomy is present in patients with colon cancer, physician permission is recommended before participation in contact sport and weight training, excessive intra-abdominal pressure should be avoided, and modifications will be needed for swimming and contact sports. In adults with HSCT, care should be taken to avoiding overtraining given immune effects of vigorous exercise. If peripheral neuropathy is present in patients with gynecologic cancer, a stationary bike might be preferable over weight-bearing exercise. Women with gynecologic cancer with swelling or inflammation of the abdomen, groin, or lower extremities should seek medical care to resolve these issues before exercise training with the lower body. Patients with bone metastases may need to alter their exercise program given the increased risk for skeletal fractures. Care should be taken to reduce infection risk in fitness centers for patients who are currently undergoing chemotherapy or radiation treatment or have compromised immune function. Patients with cardiac conditions will require modifications and may require increased supervision for safety.

ACS, American Cancer Society; ACSM, American College of Sports Medicine; HSCT, hematopoietic stem cell transplantation.