Mesothelioma | Safe Exercise Guidelines


Mesothelioma is a debilitating form of lung cancer caused by asbestos exposure. Around 70 to 80% of cases are associated with occupational exposure, particularly in industrial trades as well as employment in old buildings (schools and homes).

In my work as an exercise physiologist in both cardiac and pulmonary rehab settings, I’ve worked with a lot of patients with very complicated medical histories, including various types of cancers.

Mesothelioma, by nature of its effects on lung tissue, results in muscle loss and fatigue which can greatly reduce overall quality of life.

Benefits of exercise for mesothelioma patients

If you’re a mesothelioma survivor, you’d certainly agree that any therapy that does not include drugs would be desirable. Exercise offers a viable alternative that, if properly prescribed, can have a multitude of benefits, including:

  • Reduced fatigue and exhaustion, higher energy levels – exercise helps improve your body’s chemistry and physiology in ways that provide you with more stamina.
  • Improved physical function – exercise increases valuable muscle mass (or reduces the loss muscle) which can help improve your ability to perform activities of daily living and maintain your independence.
  • Boosts immune system – exercise is known to induce a number of changes in the body that make us more resistant to illness.
  • Improve appetite – exercise has a stimulatory effect on your appetite.
  • Lower stress levels – exercise helps you mitigate stress hormones and neurotransmitters that contribute to your feeling anxious and edgy.
  • Better self image – exercise makes you feel good about yourself through enhancements in your brain chemistry.
  • Improved balance – exercise not only builds muscle, but it helps you to maintain your balance, particularly from performing activities that challenge your body.

Pre-exercise checklist 

If you’re attending a mesothelioma cancer centre for treatment, you should speak with your health management team for exercise advice that is specific to your situation.

From an exercise physiologist’s perspective, here are some pre-exercise considerations to bear in mind.

  • Get medical clearance – it is always important to get clearance from your doctor before starting an exercise regimen. Everyone is different, so ask your doctor questions to ensure that exercise will be safe and effective for your unique situation.
  • Be medically stable – we know exercise is good for you, but if you’re not medically stable or have any specific contraindications, then exercise could potentially worsen your health.
  • Be stable on your medications – safety first. If you’ve had a lot of recent changes in your medications, talk to your doctor about how they might impact your ability to exercise. Some medications can interact with exercise in ways which might cause you to feel dizzy or pass out.
  • Have no open wounds – if you have any open wounds, then it’s important to have wound care procedures in place if you’re going to be in a gym. You want to minimise your risk of infections which could set you back.

Bottom line: before you start exercising, talk to your doctor about any mesothelioma-specific considerations which might impact your ability to exercise. Complications could affect your exercise prescription so you’ll want to be prepared so you can exercise as safely as possible.

Safe exercise for mesothelioma patients

We can break physical movement down into two types: 1) activities of daily living; and 2) structured exercise.

Activities of daily living

Activities of daily living (ADLs) refer to the daily incidental movement you must perform to simply get through life. In the face of cancer, it can sometimes be a real challenge to get though even the most basic ADLs.

Reassure yourself that it’s normal to feel tired and lethargic given the circumstances but know that, little by little, you will be able to regain your movement and independence.

ADLs might include things like household chores such as washing the dishes, doing the laundry, or walking to the corner shop for veggies.

Sometimes you’ll be required to lift objects, but be careful to ease into it. You might try lifting 2 to 4.5 kg (5 to 10 lbs) to start and, if this feels ok and you have approval from your doctor, you may try increasing the load a bit. In general, be aware of any activities that require lots of pushing or pulling.

Overhead lifting such as putting dishes in the cupboard or even brushing your teeth might make you feel a bit tired, as it forces your body to push blood upwards against gravity.

Climbing stairs and steps can leave you feeling exhausted, so try a graduated approach where you climb one flight of stairs, stopping when you feel tired. As your tolerance improves, try two flights of stairs. As you return to health, you’ll be able to climb all the stairs without stopping.

Structured exercise

Structured exercise, on the other hand, includes purposeful movement with the intention of improving your health and fitness.

Which exercise is best? The one you enjoy most! For many people, walking is both functional and enjoyable and is well-tolerated. Riding a bike, swimming, or lifting weights (with approval). But be sure to avoid sham infomercial exercise gadgets.

Aerobic exercise

Aerobic exercises engage the large muscles of the body, are rhythmic in nature, and can be maintained continuously for a long period of time.

Because, mesothelioma affects the lungs, which can make aerobic exercise particularly difficult, it is important to work to your tolerance and gradually increase durations and intensities as you’re able.

Graduated mesothelioma aerobic exercise program

A graduated exercise plan can slowly help you improve your exercise tolerance. The logic is that, in the early weeks of your recovery, you will perform a shorter intervals for more times throughout the day. As you become stronger, you will progress to longer intervals for fewer times per day until you’re able to do one long bout of continuous aerobic exercise.

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The above example is not a rigid, set-in-stone program, but is just a template that you will have to modify to your level of health and fitness. Speak with your doctor and/or medical management team to determine the optimum starting point.

Strength training

Strength training refers to weight lifting or resistance training. It can be safely performed in properly risk-stratified mesothelioma patients who are stable and medically-managed.

  • Frequency – start off with lifting 2 to 3 sessions per week. This will allow you time in between workout days for recovery.
  • Intensity – start off with light weights until you receive the green light from your doctor or rehabilitation team. Progress at a slow and steady pace to minimise delayed onset muscle soreness.
  • Duration – start off with short duration sessions of approximately 15 to 20 minutes. See how your body tolerates this and then progress from there. Be careful not to overdo it since “marathon sessions” can leave you sore and exhausted which might discourage you.
  • Types of strength training – contrary to popular belief, you don’t have to “pump iron” by lifting barbells and dumbbells. Calisthenics (body weight), resistance bands, and exercise machines all offer viable resistance training options as well.

You have a couple options for easing into weight training. You can do a full-body routine or you can break up the routine to work different body parts on different days.

If feasible, I would advise working with a clinical exercise physiologist or physical therapist with knowledge and experience in helping cancer patients. They can help you create a customised workout plan unique to your physical abilities, likes and dislikes, and the effects your medications might have on your exercise prescription.

Flexibility, movement, and breathing exercises

Exercises that combine strength and flexibility include yoga, Pilates, and Tai Chi. If you’ve been debilitated from treatment, then these forms of movement can help you maintain your range of motion and also promote a sense of calm and relaxation. Inform your instructors of your mesothelioma so they can help adjust and tailor exercises to you.

Is exercise safe? Risks and precautions

While exercise is known to have countless health-promoting effects, excessive exercise is a challenge to the body and can actually work against you by driving down your immune system and increase your shortness of breath.

As a general rule, it is advisable to avoid or minimise performing extremely high-intensity, high-impact, long-duration exercises (unless you are specifically cleared to do so by your doctor).

Medications can have side effects or interactions which might make exercise more difficult for you. Speak to your doctor about their effects on the exercise response.

See your doctor if you experience any signs or symptoms while performing low to moderate-level exercise or you start to notice a deterioration in your fitness levels.

Take home message

Properly prescribed exercise, along with healthy eating and stress management, is an important cornerstone in recovering and living with mesothelioma. Work closely with your medical management team to ensure that exercise is as safe as possible and will improve your health, well-being, and quality of life.

Other resource pages

  1. American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors (link)
  2. Exercising Promotes Healing for Cancer Patients (link)
  3. Top 5 Benefits of Exercise for Mesothelioma Patients (link)
  4. Custom Mesothelioma Exercise Plan May Improve Quality of Life (link)
  5. Fitting Exercise into Your Treatment Schedule (link)

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