Moving More

Expert recommendations

Both medical groups and integrative experts provide recommendations for Moving More. Learn more about the approaches and meanings of recommendations: Integrative Oncology Programs and Expert Guidelines ›

Recommendations from medical groups

Recommendations for people with cancer are listed here, while recommendations for health professionals treating survivors and people with cancer are in Are you a health professional? ›

ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention ›

ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention presents information to help cancer survivors and their families make informed choices related to nutrition and physical activity, with these specifics:

•  Achieve and maintain a healthy body weight throughout life
• Be physically active.
• Adults should engage in one of the following:
  •  150-300 minutes of moderate intensitya level that get you moving fast enough or strenuously enough to burn off three to six times as much energy per minute as you do when you are sitting quietly; examples include brisk walking (4 mph), mowing a lawn with a walking power mower, or tennis doubles physical activity per week (achieving or exceeding the upper limit of 300 minutes is optimal)
  •  75-150 minutes of vigorousa level that gets you moving fast enough or strenuously enough to burn off more than six times as much energy per minute as you do when you are sitting quietly; examples include jogging at 6 mph, bicycling 14-16 mph, or playing basketball physical activity
  • An equivalent combination of both moderate and vigorous activity
• Children and adolescents should engage in at least 1 hour of moderate- or vigorous-intensity activity each day.
• Limit sedentary behavior, such as sitting, lying down, and watching television, and other forms of screen-based entertainment.

American Cancer Society nutrition and physical activity guideline for cancer survivors ›

• Avoid obesity and maintain or increase muscle mass through diet and physical activity.
• Engage in regular physical activity, with consideration of type of cancer, patient health, treatment modalities, and symptoms and side effects.

American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control ›

Findings: 

1. Physical activity is beneficial for the prevention of several types of cancer including breast, colon, endometrial, kidney, bladder, esophageal, and stomach. 
2. Minimizing time spent in sedentary behavior may also lower risk of endometrial, colon and lung cancers. 
3. Physical activity is associated with higher risk of melanoma, a serious form of skin cancer. 
4. Physical activity before and after a cancer diagnosis is also likely to be relevant for improved survival for those diagnosed with breast and colon cancer; with data suggesting that postdiagnosis physical activity provides greater mortality benefits than prediagnosis physical activity.

Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable ›

Anxiety

1. A dose of moderate-intensity aerobic training three times per week for 12 weeks or twice weekly combined aerobic plus resistance training for 6 to 12 weeks can significantly reduce anxiety in cancer survivors during and after treatment. 
2. Based on sufficient evidence, it does not appear that resistance training alone reduces anxiety.

Bone health

1. A 1-year supervised program of combined moderate-vigorous intensity resistance plus high-impact training (exercise that generates ground reaction forces above three to four times body weight) performed 2 to 3 days per week is the most consistently efficacious modality of exercise to improve bone health.
2. Aerobic training, particularly walking, does not appear to provide a sufficient stimulus to improve bone outcomes.
3. There is insufficient evidence to determine if resistance training alone improves bone outcomes.

Depressive symptoms

1. Moderate-intensity aerobic training performed three times per week and for at least 12 weeks or twice weekly combined aerobic plus resistance training lasting 6 to 12 weeks can significantly reduce depressive symptoms in cancer survivors during and after treatment. 
2. Based on sufficient evidence, resistance training alone does not seem to be effective for this outcome.

Fatigue

1. For training programs that last at least 12 weeks, engaging in moderate-intensity aerobic training three times per week can significantly reduce cancer-related fatigue both during and after treatment. 
2. Moderate-intensity combined aerobic plus resistance training sessions performed two to three times per week or twice weekly moderate-intensity resistance training may also be effective, and the latter particularly in prostate cancer. 
3. The effect of exercise was strongest for moderate- to vigorous-intensity exercise, whereas the effect for low-intensity training was weak

Health-related quality of life

1. Combined moderate-intensity aerobic and resistance exercise performed two to three times per week for at least 12 weeks results in improvements in health-related quality of life both during and after treatment. 
2. The benefit of combined aerobic plus resistance training programs appears more potent than programs consisting of only aerobic or resistance training

Lymphedema

1. For resistance training, a general progressive program focused on large muscle groups performed two to three times per week, with the principle of “start low, progress slow” is safe when supervised by a fitness professional.
2. To date, there is insufficient evidence to draw conclusions for aerobic exercise. In general, aerobic exercise seems to be safe, with no significant increase in the number of lymphedema-related adverse events reported in studies investigating aerobic exercise.

Physical function

1. Moderate-intensity aerobic training, resistance training or combined aerobic plus resistance training performed three times weekly for 8 to 12 weeks can significantly improve self-reported physical function.
2. Supervised exercise appears to be more effective than unsupervised or home-based interventions, although unsupervised programs may be effective in older cancer survivors.

Sleep

1. Mixed evidence for overall sleep quality, indicating either a positive effect of walking or no effect of exercise.
2. Strong evidence that moderate to vigorous intensity aerobic training is associated with better overall sleep quality in the general population.
3. Moderate-intensity aerobic training, particularly walking, three to four times per week, for 30 to 40 min per session over 12 weeks is recommended.

Insufficient evidence to make a recommendation for these effects:

AICR cancer prevention recommendations related to physical activity:

• Break up long periods of sitting with frequent activity breaks.¹American Institute for Cancer Research. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. February 2018. Viewed August 6, 2018.
• Aim for a minimum of 150 minutes of moderate or 75 minutes of vigorous physical activity a week. For cancer prevention and weight control, higher levels of activity provide more benefit. Work toward achieving 45 to 60 minutes of moderate-intensity physical activity daily. Going beyond 60 minutes daily provides additional health benefits.²American Institute for Cancer Research. Cancer Prevention Recommendations. From World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: A global Perspective.Continuous Update Project Expert Report 2018. Viewed April 24, 2019.

Reducing cancer risk:

• Strong evidence linked highest versus lowest physical activity levels to reduced risks of bladder, breast, colon, endometrial, esophageal adenocarcinoma, renal, and gastric cancers, with risk reductions ranging from about 10% to 20%.
• A 25% reduction in lung cancer risk with highest versus lowest levels of physical activity, but the authors could not rule out influences of tobacco use and therefore considered the association is less certain.
• Limited evidence suggested an association between increased physical activity and decreased risks of blood, head and neck, ovary, pancreas, and prostate cancers.
• No grade could be assigned for brain cancer.
• Limited evidence of no effect of physical activity on risk of thyroid or rectal cancer.

Other benefits of regular physical activity:

• Regular physical activity not only reduces the risk of clinical depression but reduces depressive symptoms among people both with and without clinical depression.
• Regular physical activity reduces symptoms of anxiety, including both chronic levels of anxiety as well as the acute feelings of anxiety.
• Physical activity improves physical function among individuals of all ages, enabling them to conduct their daily lives with energy and without undue fatigue.
• A single bout of moderate-to-vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep, reduce anxiety symptoms, and improve cognition on the day that it is performed.

Initiating/maintaining adequate levels of physical activity can reduce cancer-related fatigue in post-treatment survivors.

Recommendations for physical activity: Performing a variety of types and intensities of physical activity which includes:

• Moderate to vigorous aerobic physical activities such that there is an accumulation of at least 150 minutes per week
• Muscle strengthening activities using major muscle groups at least twice a week
• Several hours of light physical activities, including standing

Recommendations for sedentary time: Limiting sedentary time to 8 hours or less, which includes:

• No more than 3 hours of recreational screen time
• Breaking up long periods of sitting as often as possible

Conclusions from the 2015 evidence review:

• A growing evidence base indicates that physical activity has potential value at all stages of cancer care.
• Preliminary evidence suggests that following an exercise program before treatment (prehabilitation) leads to increased cardiorespiratory fitness, fewer complications after surgery and shorter hospital admissions.
• Stronger evidence demonstrates that exercising while undergoing cancer treatment helps to preserve cardiorespiratory and muscular fitness, and to control cancer-related fatigue.
• Similarly, promising evidence indicates that after completion of treatment, undertaking an exercise program leads to increased cardiorespiratory and muscular fitness, reduced fatigue and improved body composition and well-being.
• Preliminary evidence associates regular physical activity after a cancer diagnosis with lower risk of recurrence or disease progression.
• For patients under palliative care, preliminary evidence suggests that exercise is feasible and may help maintain physical function, control fatigue and improve bone health.

NCCN Guidelines for Patients®: Survivorship Care for Healthy Living, 2020 ›

Guidelines include these recommendations:

• Physical activity and exercise recommendations should be tailored to individual survivor’s abilities and preferences
• Physical activity for cancer survivors:
  • Overall volume of weekly activity should be at least 150–300 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity or equivalent combination spread out over the course of the week.
  • 2 to 3 sessions per week of strength/resistance training that include major muscle groups
  • Stretch major muscle groups at least 2 days per week on days that other exercises are performed
• Engage in general physical activity daily (such as taking the stairs, parking in the back of a parking lot). Physical activity includes exercise, daily routine activities, and recreational activities
• Avoid prolonged sedentary behavior (such as sitting for long periods)
• Set incremental goals for physical activity.

NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 2.2022 ›

People in active treatment or after treatment: maintain an optimal level of activity to manage cancer-related fatigue

People approaching the end of life: optimize level of activity

Recommendations:

• For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.
• Most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate intensity physical activity, such as brisk walking.
• Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.
• The benefits of physical activity far outweigh the possibility of adverse outcomes.

Integrative programs, protocols, and approaches

These program from integrative medicine expert recommend making Eating Well an anticancer lifestyle practice.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions such as insulin resistance.

Topics for which physical activity is recommended:

Keith Block, MD

Dr. Block recommends these approaches for those undergoing chemotherapy treatment, with advanced disease, or experiencing cachexiaweakness and wasting of the body due to severe chronic illness:

• Reduce your emphasis on aerobic exercise.
• Emphasize interval training (repeated short sessions of aerobic-type exercise)
• Emphasize strength or resistance training
  • Use light weights or isometrics
  • Use short sessions repeated several times daily
• Emphasize systems such as yoga, Pilates, qigong or tai chi that increase flexibility
• Do not overexercise, for this produces inflammation and increases cortisol, which is linked to cancer growth and spread

Lorenzo Cohen, PhD, and Alison Jefferies, MEd

Jeremy Geffen, MD

Dr. Geffen developed a healing program based on what he calls The Seven Levels of Healing. It is a program of body, mind, heart, and spirit for healing and transforming the whole person.

Gerald M. Lemole, MD; Pallav K. Mehta, MD; and Dwight L. McKee, MD

Barbara MacDonald, ND, LAc

Ornish Diet and Lifestyle Modification Program (for prostate cancer)

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

David Servan-Schreiber, MD, PhD

Traditional medicine systems

Traditional Chinese and Ayurvedic medical systems see each individual as composed of the primary elements of nature, in varying degrees. After carefully determining your basic composition and your current state of balance (or imbalance), a traditional medicine professional may prescribe Moving More to bring your elemental energies into alignment.

Learn more about traditional medical systems and how to find practitioners ›

Other expert assessments

Current Oncology Reports

An expert review of evidence suggests that physical activity “might have a potential role in alleviating cancer-related fatigue.”³David A, Hausner D, Frenkel M. Cancer-related fatigue-is there a role for complementary and integrative medicine? Current Oncology Reports. 2021 Nov 7;23(12):145.

Naturopathic physicians

A 2018 survey identified exercise as one of the most frequently identified interventions used by members of the Oncology Association of Naturopathic Physicians for lung and gastroesophageal cancer care.⁴Seely D, Ennis JK, McDonell E, Zhao L. Naturopathic oncology care for thoracic cancers: a practice survey. Integrative Cancer Therapies. 2018 Sep;17(3):793-805.

Donald Abrams, MD