Exercise and metastatic breast cancer
Staying physically active after a metastatic breast cancer diagnosis
- Medical Review: Jennifer Ligibel, MD
Exercise has important health benefits and can improve quality of life. If you’ve been diagnosed with metastatic breast cancer, exercise is a powerful tool that can help you keep doing everyday activities and things you enjoy. It can also help reduce treatment side effects, such as fatigue.
Each person with metastatic breast cancer has unique physical fitness needs. If you’ve been diagnosed with metastatic breast cancer, talk with your care team about exercises that work for your diagnosis and treatment plan. This may include:
- Making some adjustments for doing certain types of exercise safely
- Working with an exercise professional, such as a physical therapist or certified cancer exercise trainer
Metastatic breast cancer treatment is not one size fits all, and neither are exercise recommendations. You and your care team can work together to create an exercise plan that’s right for you.
Below, you can learn how exercise can help, how to create a plan, how to find a trainer, and more.
How exercise helps
Exercise has many benefits if you are living with metastatic breast cancer. Exercise can:
- Help increase your energy so you can function better in your daily life and do more of what you enjoy
- Reduce cancer-related fatigue and pain
- Reduce treatment side effects such as lymphedema
- Increase muscle and bone strength and improve balance, which can make daily activities easier and safer
- Decrease anxiety and depression
- Help you sleep better
Exercise can also improve quality of life — a person’s sense of how their diagnosis affects the physical, psychological, and social parts of their lives.
Exercise is so important. It helps keep people strong. Moving more helps. Trying to walk every day is important.
Research on exercise and metastatic breast cancer
The PREFERABLE-EFFECT clinical trial tested the effect of exercise on fatigue and health-related quality of life in 357 people with metastatic breast cancer. Health-related quality of life looks at a person’s sense of well-being and how disease and treatment impact their ability to function.
People in this trial were randomly assigned to one of two groups:
- People who were given general advice to be active, or
- People who underwent 9 months of supervised exercise that included aerobic, strength, and balance training
People in the exercise group worked with a trainer twice a week for 6 months and then attended unsupervised sessions for 3 more months. During the unsupervised part of the study, the researchers asked them to be active for at least 30 minutes every day.
After 6 months, people in the exercise group had:
- Less fatigue, pain, and shortness of breath, and better health-related quality of life
- Better balance and fewer falls
- Improved muscle strength, muscle mass, and physical ability. This result is important because some people who are receiving chemotherapy or hormonal therapy can develop low muscle mass, which is related to poorer outcomes and survival.
Before you try any exercise, it’s important to talk with your doctor about a plan that’s right for you.
Questions to ask your doctor
Before starting any exercise, talk with your doctor. Let your doctor know whether you are generally very active or not very active, the types of exercise you like to do, and if you’re interested in trying any new exercise.
Discuss any symptoms or side effects you may be experiencing, such as:
- Fatigue
- Balance issues
- Bone loss
- Hand-foot syndrome, which may include tingling, burning, rash, or pain on the palms of the hands and/or soles of the feet
- Neuropathy, a burning, numbness, or tingling in the hands or feet that can affect balance
- Pain
- Low blood cell counts, such as anemia or neutropenia caused by chemotherapy
If you have bone metastases, ask your doctor about any individual exercise considerations to reduce the risk of fracture.
If you were diagnosed with a swelling condition called lymphedema after having lymph nodes removed, and you are not already seeing a specialist, ask your doctor for a referral to see one. Exercise is an important part of managing lymphedema.
Questions to ask your doctor:
- Can I continue to do the same exercise routine I was doing before I was diagnosed?
- Do you have any specific concerns about me exercising?
- Are there any adjustments I may need to make to my exercise routine?
- Are there any types of exercise I should avoid? If so, are there alternatives or modifications?
- Is there any risk for exercise-related injury with my diagnosis? How can I reduce that risk?
- Can you give me a referral to a physical therapist or certified cancer exercise trainer who has experience working with people diagnosed with metastatic breast cancer? (This is especially helpful if you are having pain or trouble walking.)
- Are there hospital, community, or online programs or classes you can recommend?
Exercise recommendations for people with cancer
For people with cancer, the American Cancer Society recommends:
- 150-300 minutes (2.5-5 hours) of moderate-intensity exercise a week (examples: walking, bike riding)
- Or 75-150 minutes of vigorous-intensity activity per week (examples: running, swimming, tennis)
- Or a combination of the above
Aim to exercise 2-3 times a week for 30-60 minutes each time. Include exercise that strengthens muscles (examples: weights, exercise bands, push-ups).
This level of exercise is safe for most people with metastatic breast cancer. Still, before you begin any exercise program, it’s important to talk with your doctor about what level of exercise is right for you. If there is cancer in your spine, hips, or brain, for example, work with your doctor and a physical therapist or certified cancer exercise trainer to create an exercise plan that reduces the risk of fracture or falls. Below, you can learn more about finding a trainer.
To get a personalized analysis of your level of exercise, try the EXCEEDS online survey. This survey is part of the American College of Sports Medicine Moving Through Cancer program. The results provide guidance on your exercise needs and abilities. Talk with your doctor about the results as you plan an exercise routine.
“No one benefits from sitting on the couch all day,” says Kathryn Schmitz, PhD, MPH. Dr. Schmitz is professor of malignant hematology and medical oncology at the University of Pittsburgh UPMC Hillman Cancer Center.
Dr. Schmitz suggests working with your care team to identify things you can do that can benefit your health. This can include exercise and nutrition and other things that support health and well-being, such as complementary therapies.
Dr. Ligibel recommends that people move every day, but to not overdo it. “Instead, move in a way that will allow you to be active in upcoming days, too,” she says.
Exercise recommendations for people 65 and older
If you are 65 or older and have metastatic breast cancer, talk with your doctor about any other health issues you have when making an exercise plan. Dr. Schmitz recommends using the EXCEEDS online survey. Review the results with your doctor, and ask for a referral to see a physical therapist or certified cancer exercise trainer who can help you exercise safely.
In 2025, a group of experts made the following recommendations for people with cancer 65 years and older who are working with an exercise professional:
- Include physical and balance tests as part of planning an exercise program.
- Start with exercises for improving balance, flexibility, and strength before moving on to aerobic exercises.
An exercise professional can also help:
- Monitor you for problems such as pain, dizziness, and shortness of breath
- Make sure that the place you exercise is safe and does not have a risk for falls
- Provide guidance on supportive exercise clothing
- Provide nutrition guidance
Work with your doctor to make any adjustments for your individual situation.
Ask the expert: Fitness & exercise
Learn from Certified Oncology Exercise Specialist & Nutrition Coach, Sami Mansfield, about how to incorporate movement into daily life, exercise safely, and move your body, no matter your ability level.
Making exercise adjustments
Metastatic breast cancer and treatment is highly personalized, so your exercise plan should be too. You can work with your care team and/or a physical therapist or cancer exercise trainer to come up with a plan that works for you.
Your unique diagnosis, treatment side effects, and cancer symptoms can sometimes make exercise a challenge. Still, there are many ways to adjust your exercise routine so you can keep doing it.
Below, you can find examples of adjustments to discuss with your doctor.
Lung metastases
If you have lung metastases, your exercise plan will depend on how the cancer affects your lung capacity — the amount of air your lungs can hold. Your care team can test your lung capacity during an office visit.
Lung capacity can be very different from one person to another. Listen to your body and reduce your exercise intensity if you feel out of breath.
Liver metastases
If you have liver metastases and do not experience any symptoms, there are no specific exercise precautions or limitations.
Advanced liver metastasis can include symptoms such as pain, fluid retention, and fatigue. If you are living with advanced liver metastasis, talk with your doctor about a safe, low-intensity workout plan that includes gentle exercises.
Bone metastases
The best way to exercise if you have bone metastases depends on where the metastases are.
Bones that don’t carry much weight are not likely to break during exercise even if they have metastases. In general, the recommended 150 minutes per week of exercise is safe if you have stable bone metastases. Walking is generally safe for everyone with bone metastases.
Still, it’s important to work with your doctor to make any adjustments if you have lesions in bones that carry more weight, including your leg bones, hips, or lower spine. If cancer is in your spine, for example, twisting exercises can increase the risk of fracture. Talk to your doctor or trainer about a safe plan before starting any exercise.
If you are receiving radiation to reduce bone metastases, fatigue is common. Exercise is likely to help with fatigue. There are no special concerns about exercising if you are receiving radiation.
In 2022, a group of experts published a set of recommendations to guide people with bone metastases in planning exercise:
- Talk with your care team, including both your doctor and an exercise professional, to understand the risks and benefits of exercise.
- Work with your care team to confirm any exercise risks. Risk of injury depends on the type, number, size, and location of the bone metastases, the cancer treatments, and your overall health. A CT scan or MRI may be helpful to show bone integrity. Weight-bearing exercise and vitamin D may help with bone density.
- Ask your care team for a referral to see a qualified exercise professional, such as a physical therapist, oncology rehabilitation specialist, or clinical exercise physiologist trained in working with people with cancer.
- Exercise testing, which measures your body’s response to exercise and abilities, may be useful to help plan what exercises you can do or should not do.
- Follow Exercise Guidelines for Cancer Survivors, which emphasize being active.
- Continually monitor your response to exercise and work with your trainer and/or your doctor to make any needed adjustments.
- Exercise should focus on good posture, controlled movement, the location of metastases, and reducing the risk of falls.
Brain metastases
Brain metastases can impact stability, balance, eyesight, and coordination. Small metastases may not require activity limits. But with multiple brain lesions and extensive treatment, falling is a risk, particularly if you’ve had surgery or radiation treatment.
Here are some suggestions:
- If you have brain metastases, a simple exercise plan is best because a complicated plan can feel overwhelming. For many people, a walking program is a good choice.
- People with physical challenges due to brain metastases may benefit from working with a physical therapist.
- If you have brain metastases and you are exercising without professional supervision, chair-based exercise is a good option. Chair-based exercise uses core muscles to support your lower back and improve your posture. Ask your doctor for recommendations. Some people start with body weight only, and then add extra resistance using exercise bands or light weights as it becomes easier to complete more repetitions.
Fatigue
Fatigue, a common side effect of chemotherapy and other treatments, can reduce your available energy. Fatigue can also happen with loss of lean muscle. Loss of lean muscle happens due to inactivity, such as times when you’re not feeling well or you’re recovering from surgeries or treatments.
Research shows that exercise can help improve fatigue. Moderate-intensity aerobic exercise — three times a week for up to 30 minutes each time — can help manage fatigue. Strength exercises may also help.
Neuropathy
Neuropathy — a burning, numbness, or tingling in the hands or feet caused by damage to the nervous system that is a side effect of some treatments — can be painful and affect balance and coordination.
Here are some ways to approach exercise if you have neuropathy:
- With mild neuropathy — some numbness and tingling — you may not need any adjustments but may choose to try different types of activity, such as pool exercise, to take pressure off your feet.
- Ask your doctor, physical therapist, or cancer exercise trainer to check your balance, stability, and walking before beginning exercise.
- If you have neuropathy that causes pain or balance challenges, talk with your doctor about ways to address it before starting to exercise.
- Talk to a physical therapist who knows about cancer treatments and neuropathy. The therapist may be able to help you manage the tingling and improve your balance.
If you have neuropathy, these adjustments may help:
- Use a stationary bike
- Exercise in the pool
- Try yoga
- Use weights with a soft cover or wear soft gloves
- Try exercise bands or weight machines if you are concerned about dropping weights
- Try chair-based exercise
Hand-foot syndrome
Hand-foot syndrome is a skin reaction on the palms of the hands and soles of the feet caused by some cancer medicines, including capecitabine (Xeloda) oral chemotherapy pills. Ask your doctor for advice on exercising with hand-foot syndrome.
You may need to avoid activities that put high levels of stress on your feet or hands, such as long walks or runs and gardening. Ask your care team to refer you to an oncology rehabilitation center and/or a physical therapist with specialty training in oncology. Professionals with this kind of experience may be more helpful than a general fitness trainer.
Chemotherapy side effects such as fatigue, neuropathy, and hand-foot syndrome can affect how you feel and can make strenuous exercise difficult. “Listen to your body. If you are feeling tired after chemotherapy, instead of doing something strenuous, aim to do something more moderate, such as walking for 10 or 15 minutes,” says Dr. Ligibel.
Lymphedema
Lymphedema is a painful swelling condition that can develop in the arm or other body locations after lymph node surgery. Exercise can help relieve symptoms and is generally considered safe and recommended for people with lymphedema.
If you have been diagnosed with lymphedema, ask your doctor about wearing a compression garment during exercise to control swelling and keep lymph fluid moving. Consider working with a physical therapist who specializes in lymphedema or a cancer-certified exercise trainer. Learn about exercising with lymphedema on the Breast cancer and exercise page.
Exercising with a port
If you are receiving treatment through a port — an implantable device usually placed under the chest skin — certain precautions are recommended:
- Avoid swimming to reduce the risk of infection from possible bacteria in the water.
- Use caution when exercising the upper body.
- To avoid damaging the port, be careful about extensive stretching or leaning against equipment.
- Exercising with the lower body is safe if you have a port.
Exercise class with Sami Mansfield, Certified Oncology Exercise Specialist
Join Sami Mansfield, Certified Oncology Exercise Specialist & Nutrition Coach, for an exercise session that’s a mix of posture, mobility, aerobics, strength, and education that’s designed for all skill levels.
Finding exercise programs and trainers
The level of exercise that is best for you may be different for someone else. Below, you can learn about different kinds of programs and trainers, how to find them, and questions to ask.
Types of programs and trainers
If you are not sure about the type of exercise you should do or the best professional to guide you, the American College of Sports Medicine’s EXCEEDS Tool can help. First, you will answer a few short questions. Then, based on the results, you and your doctor can search for and choose the right type of trainer in your area.
Dr. Ligibel suggests starting with a structured program. If you have pain, balance problems, or movement problems, it may help to work with a physical therapist. If you are very mobile, you may benefit from guidance, motivation, an exercise partner to provide support, and an exercise professional to make sure your form is good.
Supervised exercise or a program approved by a trained professional can support your health and help keep you safe. Ask your doctor for a referral.
Trained exercise professionals can include:
- A physical therapist
- An oncology rehabilitation specialist
- A clinical exercise physiologist
- Professionals available through a community-based program such as Livestrong at the YMCA
Cancer rehabilitation (rehab) programs can help you manage how cancer affects you physically and emotionally. Exercise is part of cancer rehab. Many hospitals have cancer rehab programs that include people with metastatic cancer.
Cancer rehab can help make daily activities easier to do. It can also help you manage side effects such as fatigue, pain, balance problems, and neuropathy.
Participating in a cancer rehab program usually requires a referral from your doctor. Check with your health insurance provider to see what services are covered by your plan.
Finding a trainer on your own
Here are some ideas for finding a qualified exercise trainer:
- Ask your care team for a referral to a qualified trainer or physical therapist; this may include participating in a cancer rehabilitation program if your cancer center has one.
- Ask your doctor if joining an exercise clinical trial is a good option for you.
Several organizations certify cancer exercise trainers and offer searchable databases for finding a trainer in your area.
Before searching a database for a trainer, ask your doctor what you should look for in a trainer. Also ask what you should let the trainer know about your diagnosis, treatment, symptoms, side effects, and activity or fitness level.
Here are two databases where you can search for cancer exercise trainers:
Questions to ask a trainer
Here are some questions you can ask a potential trainer:
- Do you have training and experience working with people who have metastatic breast cancer?
- How many people with cancer have you worked with?
- Do you have experience working with people who have bone, liver, lung, or brain metastases?
- Have you worked with people who’ve experienced the side effects I’m experiencing?
- Do you have any national certifications such as from the American College of Sports Medicine?
Online programs
There are many online exercise programs available for people with cancer. Here are two examples:
- 2Unstoppable provides online exercise programs for women with cancer including metastatic cancer. The programs are run by certified cancer exercise specialists.
- The Leonard P. Zakim Center at Dana-Farber Cancer Institute offers free exercise videos through the MyZakim Digital Library and on YouTube.
You can also ask your care team for recommendations.
Clinical trials for exercise
Another way to work with a qualified trainer is through clinical trials that study exercise in people with metastatic breast cancer. Exercise classes in clinical trials may be virtual or in-person. Trials may study things like:
- What kinds of exercise improve physical and mental health
- Exercise to reduce side effects such as fatigue
- Exercise to improve quality of life
- Support to help you stick with an exercise program
Ask your doctor if an exercise clinical trial may be a good option for you. You can search for clinical trials on Metastatic Trial Search.
Pay attention to your body
As you start a new routine, pay attention to how your body feels.
For example, it’s normal to feel a little out of breath during exercise due to heart-rate elevation, but if you feel out of breath during more gentle activities such as yoga or daily tasks, it’s important to tell your doctor. Notice any pain you feel when you’re not moving or pain that is more severe and does not go away within a few days of an intense workout.
If you develop the following signs, stop exercising and ask your doctor:
- New or unusual pain in your chest or head area, or while walking or coughing
- Dizziness or feeling unsteady
- Falls
- Bruising easily
- Fever
- Lymphedema that gets worse with exercise
Finding emotional support
If exercise was a big part of your life before a metastatic breast cancer diagnosis, having to adjust or stop an activity can feel like a major loss.
Talk with your care team, your physical therapist or trainer, a hospital social worker, or someone else with breast cancer for help with difficult feelings and finding alternative activities with similar benefits.
Here are some sources where you can find emotional support:
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Reviewed and updated: April 6, 2026
Reviewed by: Jennifer Ligibel, MD
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