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  • Carol Michaels

Cancer Related Fatigue

Cancer Related Fatigue

Cancer related fatigue is the most common and distressing side effect experienced by cancer survivors. The severity and length of the fatigue depends on the type of cancer, treatments and overall the heath of the patient. Cancer related fatigue differs significantly from fatigue that is not cancer related. It can also last for years after treatment is finished.

Resting or a good night’s sleep usually does not relieve cancer related fatigue. Some words used to describe the fatigue are: tired, exhausted, washed out, wiped out, weak, and no energy. Fatigue may make it difficult to participate in the activities that one enjoys and in performing basic home tasks.

This article discusses the possible causes of cancer related fatigue and the methods that have proven to be successful in fighting fatigue.

Causes of Fatigue

· Chemotherapy - Fatigue may be worse after a session of chemotherapy. There may be a pattern of fatigue.

· Chemo brain or brain fog- Chemotherapy, radiation, and hormonal therapy can cause changes in a cancer survivor's mental function. It can be extremely frustrating. The mental energy needed to do simple tasks can be exhausting.

· Inflammation caused by cancer treatments.

· Surgery.

· Pain can increase fatigue and pain meds cause fatigue.

· Radiation.

· Hormone imbalance.

· Medication.

· Low thyroid levels.

· Low blood pressure.

· Anemia.

· Electrolyte imbalance.

· Malnutrition or poor nutrition.

· Dehydration.

· Lack of sleep.

· Emotional issues- Depression, Anxiety and Stress.

Management of Fatigue

Lifestyle Changes:

Cooking- learn how to save energy-sit while cooking

Childcare-get help

Work-try to work from home, ask for help from colleagues, take breaks and avoid rush hour

Track fatigue to determine patterns

Schedule needs according to your energy pattern

Be active during the time of day when you feel most energetic

Exercise (see below)

Plan time to rest


Do things that you enjoy

Pace yourself. A slow to moderate pace uses less energy than hurrying.

Do what you enjoy but do a bit less

Sleep Hygiene


Cancer treatments can decrease appetite and fatigue may decrease appetite leaving your client tired and weak. Chemotherapy and immunotherapy make things taste differently and upset the stomach so they should try smaller more frequent meals and make sure to drink. Radiation can upset the stomach and inflame the intestinal tract and part of the intestinal track may be removed for some cancers.

Emotional Health:

Stress and anxiety can be helped by acupuncture, massage, yoga, qui gong, reiki, and relaxation techniques


Inactivity and the cancer treatments cause muscles to get smaller and the body to function less efficiently leading to inactivity which result in even more fatigue. The good news is fatigue can often be ameliorated by a good exercise program. It can help to reduce fatigue, pain, and increase endurance and the ability to tolerate of cancer treatments.

But when some people hear the word exercise, they might immediately think about a difficult gym class or boot camp. Exercise is probably the last thing on the mind of a cancer survivor after a cancer diagnosis. Cancer-related fatigue is the type of fatigue that continues to be felt even after resting and may deter a cancer survivor from embarking on an exercise program. They might know that they should exercise but do not know what to do. You can help, encourage, and motivate your client to engage in physical activity. The NFPT Cancer Recovery course will give you the information needed to work safely with your client. An exercise specialist can help design a properly tailored program.

Recent studies have indicated that even during chemotherapy, exercise may increase fitness and energy levels, improve mood, and help patients tolerate cancer treatments. Exercise during treatments can increase strength and aerobic capacity, improves joint flexibility, elevate mood, and assist with resumption of regular activities and work demands. A good fitness program will help your client to improve mood and help recovery.

Your client may feel lethargic at times during chemotherapy and/or radiation cycles. If a patient feels lethargic then decrease the intensity of the exercise. Allowing the body time to heal or to rest is important. It is best to be conservative when determining the time, type, and intensity of any exercise activity. The cancer patient should listen carefully to their body when engaging in physical activity and act accordingly. and a physician should be consulted before starting an exercise program.

Tips You Can Use:

The following are some tips we use in our Cancer Recovery Fitness program to help our clients overcome and exercise safely when they are not working with a trainer, even when they are fatigued:

§ Walking, even if it is limited to around the house.

§ Perform breathing, stretching, and balance exercises on the high fatigue days.

§ Exercise with a friend.

§ Listening to music.

§ Break up an exercise session into smaller sessions.

§ Be physically active at the times when they have the most energy.

§ Changing exercise routines will minimize boredom.

§ Keeping a journal.

§ Understanding their limitations by listening to their body.

§ Using common sense. Knowing when to rest.

§ Exercise to tolerance.

§ Stay hydrated. Drink before, during and after exercise

We also recommend that a cancer patient have both short term and long-term exercise goals. Select an activity and set an achievable goal. Goals should be able to be adapted to changes in work, health, and family situations. A cancer survivor should slowly add exercise to their daily activities and find something that works with their lifestyle.

Goals should be specific and realistic. Goals could include for example, weight-loss and increased muscle mass. If flexibility is an issue, the goal may be to improve the range of motion. Other goals might be to become stronger, have a good quality of life, better mood, or to decrease the chance of recurrence.

Cancer survivors should follow a systematic and progressive plan. Exercise starts with a warm-up and ends with a cool down. Begin with deep breathing. Stretch daily using relaxation breathing. We add strength training to a program after a client has achieved an acceptable range of motion, posture and obtained medical clearance. Exercise can improve cancer related fatigue, mobility, strength, stamina, and overall quality of life.

Make it a point to communicate with your client’s healthcare team. This way you can fully understand the health issues of the client as it relates to exercises and gives you the ability to relay movement concerns that you have discovered.

A personal trainer should be ready to modify cancer exercise routines when their clients are fatigued. If complicated exercises are introduced, it may cause the client to drop out and increase their stress levels. Each cancer survivor has unique health issues and the fitness professional must make sure that they progress gradually. It is important for a cancer survivor to adhere to a routine and not give up on the days they are not feeling their best. Always tell them to listen to their body and to understand the difference between some muscle fatigue and a health concern. Tell your client how proud you are that they are being physically active and always create a warm encouraging environment.


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