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To support strength during cancer treatment, work with your oncology team on an eating plan that fits your symptoms and nutrition needs, and ask what kinds of activity are appropriate for your current health and abilities. Adequate food and exercise can help support function, but neither guarantees that muscle loss can be prevented: cancer-related cachexia can cause muscle and weight loss even when someone is eating well.
Why strength and muscle can change during treatment
Cancer and its treatment can affect appetite, taste, smell, swallowing, digestion, and the ability to absorb enough nutrients. Nausea, vomiting, constipation, diarrhea, dry mouth, mouth or throat sores, and feeling full quickly can also make it harder to eat. These effects differ by treatment and from person to person, even among people receiving the same treatment. The National Cancer Institute (NCI) describes these treatment-related eating challenges in its nutrition guidance and side-effect overview.
When a person does not get or absorb enough nutrition, malnutrition can contribute to weakness and loss of muscle and fat. Cancer cachexia is a wasting syndrome that can also cause weakness and loss of weight, fat, and muscle. It may happen even when someone is eating adequately, so muscle loss is not always a sign that a person simply needs to eat more.
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Some people need extra calories and protein during treatment. The amount and approach should be individualized: ask the oncology team for a referral to a registered dietitian, who can consider the cancer, treatment, symptoms, nutrition status, and other health needs. NCI notes that extra calories and protein can help some people maintain strength and cope with treatment side effects, but a universal protein target is not appropriate for everyone.
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Try practical adjustments for low appetite or early fullness
- Try five or six smaller meals or snacks instead of relying on a few large meals.
- When you can eat, choose foods with more calories and protein, and eat protein-rich foods first.
- Ask your dietitian whether adding calories or protein to foods you already tolerate makes sense for you.
- If solid food is unappealing or difficult, consider soups, smoothies, milkshakes, or juices. A blender can make smoothies easier to prepare, but it is optional.
- If drinking with meals makes it harder to eat, try having most fluids between meals, unless your care team has given you different fluid instructions.
These are general options, not a substitute for help with persistent eating problems. NCI’s nutrition guidance recommends discussing ongoing difficulty maintaining food intake or weight with the care team. Depending on the situation, the team may discuss nutrition support such as tube feeding or IV nutrition; these are clinical decisions, not self-directed steps.
Tell the team when eating problems persist
Contact your care team about difficulty eating, unplanned weight changes, swallowing problems, persistent nausea or vomiting, diarrhea, or concerns about dehydration. Nutrition screening and dietitian assessment can help the team identify and address nutrition risk. Do not assume a symptom is simply an unavoidable part of treatment; side effects vary, and the team can advise you about options for your circumstances.
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Choose activity to fit your health and treatment
NCI summarizes strong evidence that moderate-intensity aerobic training and/or resistance exercise during and after treatment can reduce fatigue, anxiety, and depressive symptoms, and improve quality of life and physical function. That evidence supports discussing activity as part of care; it does not establish one ideal program for every patient or guarantee that exercise will prevent muscle loss.
The two forms of activity have different emphases. Which, if either, is appropriate depends on the person’s functional ability, preferences, treatment effects, and health considerations.
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| Approach | What it emphasizes | What to discuss with the care team |
|---|---|---|
| Aerobic activity | Moderate-intensity aerobic training is among the approaches NCI says has strong evidence for benefits including less fatigue and improved physical function. | Ask what activity, intensity, and duration fit your current ability and treatment effects. |
| Resistance exercise | Resistance exercise is also among the approaches NCI says has strong evidence for benefits including less fatigue and improved physical function. | Ask whether resistance exercise is suitable and whether you need supervision or adaptations. |
| Aerobic and resistance exercise | NCI’s summary includes aerobic training and/or resistance exercise; it does not name one combination as best for everyone. | Discuss how to balance the approaches around your preferences, symptoms, and functional status. |
NCI also reports strong evidence that exercise training is safe for people who have or may develop breast-cancer-related lymphedema. For several other specific outcomes—including preventing cardiotoxicity or chemotherapy-induced peripheral neuropathy, and improving nausea, pain, falls, cognitive function, sexual function, or treatment tolerance—NCI says evidence is insufficient. Exercise should not be presented as a proven way to prevent or treat those problems. See the NCI physical activity fact sheet.
Understand the general activity targets
The U.S. Department of Health and Human Services’ 2018 Physical Activity Guidelines for Americans recommend that adults aim for 150 to 300 minutes of moderate-intensity aerobic activity each week, or 75 to 100 minutes of vigorous aerobic activity, or an equivalent combination, plus muscle-strengthening activity at least two days a week. These are general adult public-health targets summarized by NCI—not a personal exercise prescription for someone receiving active cancer treatment. Your care team can help decide whether and how they apply to you. NCI’s fact sheet explains the evidence and summarizes the guidelines.
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Plan activity and nutrition with your care team
- Describe your starting point. Tell your oncology team about your treatment, symptoms, other health conditions, and any changes in what you can eat or do. Exercise needs to account for factors such as age, cancer type and stage, treatment side effects, and other health considerations. In an NCI interview published October 16, 2019, Kathryn Schmitz, Ph.D., M.P.H., co-chair of the American College of Sports Medicine expert panel, said: “To prescribe a safe and effective exercise program, the patient’s age, type and stage of cancer, treatment side effects, and other health considerations should be evaluated first.” Read the NCI interview.
- Ask for the right support. Ask whether a registered dietitian can help with food intake or weight concerns, and whether an appropriately qualified exercise professional can help adapt activity to your functional ability and treatment effects.
- Agree on an approach you can adjust. Discuss activity type, intensity, duration, and supervision, along with what to do if symptoms or abilities change. A plan should reflect your preferences as well as your clinical circumstances.
- Check before adding supplements or restrictive diets. Ask the oncology team before taking vitamins, minerals, herbs, or other supplements, or starting a restrictive diet. NCI warns that some supplements can change how cancer treatment works and says no diet trend or supplement has been proven to slow, cure, or prevent recurrence of cancer. NCI’s supplement guidance provides more detail.
Follow food-safety advice that fits your treatment
Some cancer treatments weaken immune defenses, which can make food safety especially important. NCI advises cooking foods to safe temperatures, scrubbing raw fruits and vegetables, and using separate utensils, plates, and cutting boards for meat and produce. Follow your oncology team’s food-safety advice, particularly if treatment effects or blood counts raise additional concerns. NCI’s nutrition guidance covers these precautions.
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Questions to take to your next appointment
- Could treatment or my symptoms be affecting my nutrition, and can I speak with a registered dietitian?
- What should I do about my current eating or weight concerns, including swallowing difficulty or persistent nausea, vomiting, or diarrhea?
- What kinds of activity are suitable for me now, and do I need supervision or adaptations?
- Are there food-safety precautions, supplements, or dietary changes I should avoid or follow during my treatment?
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