Precautions and Contraindications

Please find below common precautions and contra-indications to exercise for people with cancer.

Absolute Contra-indications:

  • Unstable angina, arrhythmia, hypertension or heart failure
  • Acute embolus/infarct, acute systemic infection with fever
  • Dissecting aneurysm
  • Acute myocarditis or pericarditis

Discontinue exercise if there are adverse cardiorespiratory signs or symptoms: moderately severe angina, dizziness or pre-syncope, cyanosis or pallor – Call for urgent medical assistance

Relative Contra-indication
Gain physician clearance
Exercise modification
Platelets
<20 × 109/L
• Functional mobility exercises only
• Minimise fall or impact risk
• Emphasise normal breathing (avoid Valsalva manoeuvre) monitor bruising and bleeding
Haemoglobin
<80 g/L
• Low to moderate intensity only
White blood cell
<2•0 × 109/L:
• Avoid group exercise
• Light to moderate intensity exercise only
• Reinforce importance of sanitisation and hand-washing
• Clean all equipment before use
Neutrophils
<1•5 × 109/L
• Avoid group exercise
• Light to moderate intensity exercise only
• Reinforce importance of sanitisation and hand-washing
• Clean all equipment before use
Blood glucose
<5•5 mmol/L
• Recommend 5–30 g carbohydrate consumption before exercise
Resting Blood pressure
Systolic blood pressure >200 mmHg or diastolic blood pressure >110 mmHg after two measurements, 5 min apart
• Seek medical review and clearance
• If medically cleared - monitor for signs and symptoms
• Repeat blood pressure measurements frequently during session
Resting heart rate
120 bpm after two measurements, 5 min
• Seek medical review and clearance
• If medically cleared - exercise as tolerated
• Monitor closely
Resting O2 saturation
≤88%
• Discontinue exercise if desaturation to this level occurs during a session
• 88-94% Exercise as tolerated, monitor signs and symptoms of fatigue and exertion, repeat SpO2
Sudden or severe pain, swelling or dysfunction• Avoid exercise of the affected region
• Doctor’s clearance required to resume exercise of the affected region or if general exercise exacerbates symptoms
Recent surgical intervention• Adhere to post operative surgical instructions
regarding movement and lifting restrictions
• Monitor wound healing and dressings

Source: Adapted from Santa Mina et al. Lancet Oncol 2018

Printable Safety Reference Guide for Exercise for People with Cancer