Table 3.

Example studies showing beneficial effects of exercise on key toxicities from cancer and its treatment

Toxicity	Exercise mode and dose shown to be effective before treatment	Exercise mode and dose shown to be effective during treatment	Exercise mode and dose shown to be effective after treatment
Fatigue		During chemotherapy: supervised exercise two sessions/week: 30 minutes aerobic exercise at 50–80% maximum workload (12–16 out of 18 for perceived exertion), plus 20 minutes resistance exercise of six large muscle groups with two sets of eight reps at 80% one-rep maximum. Patients were encouraged to be physically active 30 minutes/day for 5 days/week at home.²⁶	Group Gentle Hatha, Restorative, Iyengar yoga for 75–120 minutes/session, two sessions/week for 4–12 weeks with breathing exercises and meditation.^{54,66–68,185} Unsupervised resistance and aerobic training. Resistance training with 10 exercises across large muscle groups at least two sessions/ week at a moderate intensity using provided resistance bands. Patients gradually increased their repetitions to 15, at which point they selected a higher-resistance band. Aerobic training involved walking at a brisk pace (one mile per 20 minutes) and logging steps with a provided pedometer. Patients increased steps by 10% every other week if they achieved their prior goal.
Cardiotoxicity	High-intensity interval cycling (alternating <60% VO_2max and >90% VO_2max) 30 minutes/ session, 3 sessions/week for 4 weeks.²²	During chemotherapy: see Fatigue (above).²⁶ During radiation: unsupervised walking 20–45 minutes/day for 3–5 days/week at 50–70% maximum heart rate for 7 weeks.⁴⁷
Pain		During chemotherapy: supervised aerobic exercise (choice of cycling, treadmill, elliptical, rower, or combination) three sessions/ week for 50–60 minutes/session starting 1–2 weeks before chemotherapy until 3–4 weeks after completion of chemotherapy. Intensity started at 55–60% VO_2max and progressed to 70–75% VO_2max by week 6. Initial duration started at 15–30 minutes/session and progressed to 50–60 minutes/session by week 6.³⁰ During radiation: supervised physical therapy exercises for core strength (abdominals, hips, back) to relieve spinal bone pain.^50,186
Cognitive impairment		During myeloablative chemotherapy: aerobic and resistance training 30–40 minutes/session, five sessions/week for the duration of chemotherapy until blood cell count was normalized. Aerobic training used cycling for 10–20 minutes, with the use of interval training if steady state training intensity is too high. Three resistance exercises over 20 minutes using the main muscle groups (bridging, sit ups, back and arm exercises) for two sets of 16–25 repetitions at 40–60% one repetition maximum.³²	Group Gentle Hatha and Restorative yoga classes, 75–90 minutes/session, two sessions/week for 4–12 weeks.^69,70
Neurotoxicity		During chemotherapy: unsupervised low- to moderate-intensity walking and resistance exercises 7 days/week at 60–85% heart rate reserve and 3–5 out of 10 perceived exertion for 6 weeks during chemotherapy. Walking began at the patient’s pre-chemotherapy steps/day and patients were encouraged to increase by 5–20% each week (patients tracked steps using a provided pedometer). Ten upper- and lower-body resistance exercises progressed in volume to a maximum of four sets of 15 repetitions and progressed in resistance using provided TheraBand resistance bands (red, green, and blue) over 6 weeks.³⁴
Sleep disturbances			Group Gentle Hatha and Restorative yoga for 75– 120 minutes/session, two sessions/week for 4–8 weeks with breathing exercises and meditation.^64,65 Also, walking and resistance exercise detailed in Fatigue (above).
Bone damage		During bone radiation: see Pain (above).^50,186	Tai Chi performed 60 minutes/session, three sessions/week for 12 weeks.⁷⁴
Metabolic toxicity
Psychological distress			Walking 40 minutes/day, three days/week with weekly counseling.⁶¹ Iyengar yoga 90 minutes/session, two sessions/ week for 8–12 weeks.^67,68

Empty cells do not imply that there are no studies that support the use of exercise. VO_2max = aerobic fitness.