Exercises That Improve Quality of Life With Metastatic Breast Cancer

While physical activity may not be the first thing on your mind when living with metastatic breast cancer, moving your body can help improve symptoms and give your mental and physical health a boost.

“One of the most common misconceptions I hear is that people with metastatic breast cancer should avoid exercise,” says Kayla Wei, OTD, an oncology rehab occupational therapist and the manager of rehabilitation at City of Hope Orange County in Irvine, California. “While rest is important, appropriate physical activity can help people feel and function better throughout their cancer journey, including during active treatment.”

From walking to lifting weights to doing yoga, there are a number of ways to incorporate movement into your treatment plan.

Types of Exercise for Metastatic Breast Cancer

A wide variety of exercises offer health benefits for people with metastatic breast cancer.

“In general, I encourage patients to think about exercise as a combination of aerobic activity, strength training, flexibility work, and mindful movement,” Dr. Wei says. “The right mix depends on a person's diagnosis, symptoms, treatment plan, and fitness level, but most people can benefit from incorporating some form of each.”

Aerobic Activity

• Increased metabolism
• Improved blood circulation
• Increased immunity
• Reduced symptoms, including fatigue, anxiety, and depression
• Improved quality of life

Walking is often one of the easiest and most accessible forms of cardiovascular exercise, says Wei.

“The goal is to start with 10 to 15 minutes of walking three or four days a week and building gradually,” says Jessica Scott, PhD, the director of the exercise oncology program and an associate attending at Memorial Sloan Kettering Cancer Center in New York City.

• Jogging
• Swimming
• Cycling
• Running
• Dancing
• Gardening
• Jumping rope
• Playing sports

Your surgeon may temporarily restrict activities such as swimming immediately after surgery until incisions are fully healed, says Nasim Chowdhury, MD, the medical director of cancer rehabilitation at Weill Cornell Medicine and an attending physician at NewYork-Presbyterian in New York City. “However, patients should not be fearful of returning to exercise once medically cleared,” he says. “Remaining active is one of the most important things that patients can do for their long-term health.”

Strength Training

Strength training can help counteract the muscle loss and weakness that can occur with metastatic breast cancer and its treatment, Wei says.

Dr. Chowdhury says that for individuals receiving hormone therapy, resistance training becomes especially important because some treatments can contribute to bone loss and osteoporosis.

Wei suggests starting with simple strength-training exercises such as going from sitting in a chair to standing, wall push-ups, body-weight squats, and resistance-band exercises. “Many patients don't need a gym membership or heavy weights to benefit,” she says. “In general, I encourage strength training two or three times per week, with adjustments as needed based on a person's symptoms, recovery, and physical abilities.”

Stretching

Stretching can be especially important for people who have had surgery or radiation, which may contribute to tightness and reduced range of motion in the chest, shoulders, and arms, Wei says. “Gentle stretching can help improve flexibility, comfort, posture, and everyday function,” she says.

Wei recommends easy movements like shoulder rolls, chest stretches, and wall walks.

“I generally advise patients to stretch after their muscles are warmed up and to focus on gentle movement and deep breathing, rather than pushing through pain,” Wei says. “If a particular stretch causes significant discomfort, it's worth discussing with a rehabilitation specialist.”

Mindful Movement Practices

Yoga and tai chi may be particularly beneficial for balance, coordination, and fall prevention, Chowdhury says. “This can be especially valuable for individuals experiencing balance impairments from chemotherapy-induced nerve problems,” he says.

Can Exercise Help With Weight Management for Metastatic Breast Cancer?

“Weight gain is common during and after breast cancer treatment due to a combination of factors, including reduced physical activity, treatment-related metabolic changes, and hormonal therapies,” Dr. Scott says. “Unfortunately, excess weight is associated with poorer outcomes across the breast cancer continuum.”

Maintaining a healthy weight improves mobility, enhances the response to rehabilitation, and reduces the risk of lymphedema-related symptoms, Chowdhury says. “Overall, combining weight management with exercise provides synergistic benefits, improving pain and physical function,” he says.

• Reduced Risk of Mortality Maintaining a healthy weight through regular physical activity is associated with longer survival.
• Reduced Chronic Inflammation Excess body fat promotes a pro-inflammatory state linked to cancer progression. Exercise helps lower inflammatory biomarkers.
• Improved Insulin Sensitivity Elevated insulin levels have been linked to poorer breast cancer outcomes, and physical activity helps regulate blood sugar and reduce insulin resistance.
• Preservation of Lean Muscle Mass Resistance training helps maintain muscle while reducing body fat.
• Improved Energy and Reduced Fatigue Supporting a healthy weight and improving cardiovascular fitness helps reduce cancer-related fatigue, a common side effect of treatment.

How to Select and Start a Routine

People with metastatic breast cancer should think through a few steps when selecting and starting a new workout routine.

Start Where You Are

“Cancer treatment often interrupts exercise routines,” Chowdhury says. “Similar to any prolonged hiatus from physical activity, patients should expect to restart gradually.”

Scott says, “Starting with aerobic exercise like walking is a great way to start and build up to including resistance training.”

A practical approach is to pay attention to how your body feels while doing basic activities like walking, climbing stairs, and carrying groceries.

“If an activity leaves someone feeling exhausted for the rest of the day, that may be a sign to scale back,” Wei says. “Gradually increasing activity is usually safer and more sustainable than doing too much too soon.”

If you’re not sure where to start, you might want to seek professional help. “Consider working with a cancer exercise specialist such as an ACSM-certified cancer exercise trainer or an oncology-trained physiotherapist who can build a program around your specific medical situation,” Scott says.

Choose Exercises You Enjoy

Experts recommend choosing activities you enjoy and are likely to continue doing. “The best exercise program is one that is safe, realistic, and sustainable,” Wei says. “A routine that someone can maintain consistently is usually more beneficial than an ambitious plan that's difficult to stick with.”

If you’re starting out, she recommends focusing on increasing your physical activity overall. “Park a little further away, take a stroll while talking to a friend, make a goal to stand up at least two or three times an hour,” she says.

Chowdhury says that the most important principle is to start somewhere. “Even small amounts of physical activity provide meaningful health benefits, and consistency is more important than intensity during the initial stages of returning to exercise,” he says.

Getting Started

Before people with metastatic breast cancer start a new exercise program, Wei recommends the following:

• Discuss exercise plans with your oncology team.
• Consider whether surgery, radiation, chemotherapy, or other treatments create any temporary limitations.
• Start slowly and increase activity gradually.
• Wear supportive footwear and comfortable clothing.
• Stay hydrated and avoid exercising in extreme heat.
• Pace yourself by incorporating rest breaks during sessions, slowly increasing exercise duration over time, and allowing ample time for recovery between sessions.
• Stop and seek medical guidance if concerning symptoms develop.

Modifications

You may need to make modifications to your routine based on your treatments and overall health.

“Patients with balance impairments may benefit from safer aerobic activities such as walking, treadmill training with support, stationary cycling, or supervised exercise programs,” Chowdhury says. “Activities requiring significant balance such as outdoor cycling or skiing may be more challenging depending on the severity of symptoms.”

Some people may need to temporarily reduce intensity because of fatigue, while others may need to adapt exercises because of surgery, lymphedema, neuropathy, or bone issues, Wei says.

“Someone experiencing neuropathy may benefit from activities that reduce fall risk,” she says. “The goal is not to avoid activity altogether but to find safe ways to keep moving. Individualized exercise recommendations can help make that possible.”

A cancer physiatrist, physical therapist, or occupational therapist can help you figure out which exercises and modifications are right for you.

When to Push, When to Stop

Sticking to a routine is important to reap the many benefits of exercise, but pay attention to any signs that your body needs a break.

“In general, it's appropriate to skip exercise during acute illness or fever, severe sleep deprivation affecting safety, or deep exhaustion that is distinct from the mild fatigue that often improves with movement,” Scott says. “Rest is also warranted during periods with changes in blood counts or severe nausea or vomiting.”

Lightheadedness may be a sign of dehydration, overheating, or low blood sugar. “Patients should stop, rest, hydrate, and only resume activity once symptoms have completely resolved,” Chowdhury says.

If a particular exercise consistently causes pain or symptom flare-ups, that activity should be modified or temporarily avoided until symptoms improve, Chowdhury says. “Rest is not a setback; it is an important part of the recovery process,” he says.

That said, skipping exercise doesn't always have to mean complete inactivity. “On days when a full workout isn't realistic, some people may still benefit from gentle movement such as stretching or a short walk,” Wei says. “The goal is finding the right balance between movement and recovery.”

Contact your care team if you experience persistent symptoms after exercise, worsening swelling in an arm or leg, or signs of infection such as fever.

“In general, if something feels significantly different from what they normally experience during physical activity, it's worth discussing with a medical professional,” Wei says.

Chowdhury advises stopping exercise immediately and seeking medical attention if you experience any of the following:

• Chest pain
• Chest pressure
• Significant shortness of breath
• Sudden weakness on one side of the body
• Facial drooping
• Confusion
• Difficulty speaking
• Lack of coordination

These symptoms may signal a stroke or another neurological emergency that requires immediate treatment.