March 28, 2025
Survival To Strength FATIGUE
BY: Clare Poulose, RN, MSN, Cancer Exercise Specialist, PA & Lymphedema Cert.
Coming up in April: Strength training, bone metastasis and lytic lesions
I am too tired to get stronger
In the research, cancer-related fatigue (CRF) is the most common and persistent sympton and side effect experienced by people who have had a cancer diagnosis. This is consistent with my experience as an oncology nurse and cancer exercise specialist.
Yet, to counter fatigue, it is important to use your muscles as much as you can, in balance with rest and good nutrition/hydration. This balance will improve strength and stamina, and provide both physical and emotional benefits. We will talk about strategies to cope with fatigue while still doing your best to be physically active.
Always get medical clearance before participating in any physical activity. If you are experiencing fatigue, discuss this with your provider to receive medical treatment as needed. This is an important safety measure!
There are many causes of CRF. In most cases there are several causes.
Using this list of Possible Contributing Factors for Cancer Related Fatigue, review the possible reasons that you are tired with your healthcare provider.
- Pain
- Anxiety, Depression, Sleep Dysfunction
- Nutritional Imbalances, Hydration and Electrolyte Imbalances
- Decreased Physical Strength, Decreased Physical Stamina
- Anemia, Infection, Lymphedema, and other Medical Conditions
- Medications
- Cancer Treatments
- Cancer Itself
Take precautions.
- If you have diarrhea, make sure you are hydrated, and your electrolytes are OK.
- If you have balance trouble, make sure you take fall precautions.
- If you have lymphedema or an ostomy, wear a supportive garment.
We will talk more about these in April and May 2025.
Fatigue that is related to treatment.
With some treatments, fatigue gets better and worse depending on the week in the treatment cycle.
Some weeks you may spend a few days on the couch, nauseated and working on staying hydrated. Plan time to rest. Once a day try breathing exercises, light range of motion such as slow ankle and knee circles, and shoulder sets (scapula sets), as this may help your energy level and even help with nausea.
Another week you might have less fatigue, but it creeps up on you mid or late day. When you have limited energy - prioritize. How do you want to spend your energy?
- Set aside 20-30 minutes for physical activity a few days a week. A short bout of exercise might give you back some energy. It will also slow the unwanted effects of inactivity.
- Pick movement that you enjoy. Walk the dog or do restorative yoga with a friend.
- For strength work, I recommend:
Breathing exercises
Posture/light core and slow range of motion
A minute of balance practice
3 different strength movements: 1 set:10 reps light resistance each
Brief concentration to complete an exercise with good form can help counter both emotional and physical fatigue. Take a momentary break from everything to focus on one correct movement. Brief concentration has cognitive, emotional and psychological benefits!
Later weeks your energy might improve.
- Plan time to do more. When you are six weeks out from surgery, three weeks since the last chemo, or on a holiday from targeted therapy, you may start to feel less tired. That is when you should try to be more active but not do too much. (See Test How You Feel below). I don't mean to be discouraging!
- Remember: You are still healing, and that takes energy.
- If you have not done an activity for a while, hold back a little. Gradually add.
- If you have never done an activity, hold back a little. Gradually add.
- Be patient! Careful consistency with planned rest/recovery time is important.
Fatigue that is related to cancer itself.
You may be living with active disease that is under check with treatment.
You may be living with active disease and not taking treatment anymore.
Try to schedule physical activity for the most likely time that you feel more energy.
Your energy may go up and down throughout the day. You may notice that late mornings are your best time, or maybe afternoons after a nap.
Appointments often involve walking, sitting and standing. You may need to rest afterwards.
What are your goals?
Maybe you want to be able to walk down the aisle with your son at his wedding next month, or kayak next spring. Maybe you want to stay independent in your apartment as long as possible.
Plan physical activity that will help you reach your goals. Prioritize your energy for this.
Whether fatigue is related to treatment or to cancer itself: Test How You Feel
Say you decide on Tuesday and Thursday mornings you will work on strength and balance. First start with breathing and light posture. This might let you know if Yes, that feels OK.
Then you can try some slow range of motion/core exercises. How much you do depends on how you feel. Some days you will be able to do more than you thought, and that feels pretty good! Sometimes you will stop a little early. That's OK.
You gain and maintain strength by the combination of rest, nutrition/hydration and physical activity.
Doing what you can, without overdoing it, is the balance. This is the balance to help you be as strong and healthy as possible.
Use your muscles, be as physically active as you can. With a balance of rest, nutrition and movement, you can increase your energy, offset some unwanted effects of inactivity, and counter cancer related fatigue.
References
Mitchell, SA, Hoffman, AJ, et al. Putting Evidence Into Practice: An Update of Evidence-Based Interventions for Cancer-Related Fatigue During and Following Treatment. Supplement to Clinical Journal of Oncology Nursing. 2014:18:6:38-58
National Cancer Institute, Updated November 6, 2024, Fatigue (PDQ) Health Professional Version
https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue/fatigue-hp-pdq Last accessed Feb 27, 2025
National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Cancer Related Fatigue. Version 2.2025-January 14,2025. Last accessed February 27, 2025
