From Your Navigator

Fighting Back Fatigue

When the body is healing, energy is directed toward repairing the cells that have been damaged by surgery, chemotherapy, or radiation; this often leads to an energy deficit described as fatigue and weariness.
October 2015 Vol 1 No 5
Deborah Christensen, MSN, APRN, AOCNS, HNB-BC
Oncology Nurse Navigator
St. George, UT

You may have heard the term “bone tired,” and it seems a fitting description of the fatigue that goes hand in hand with most cancer treatments. However, without personal experience, it is hard to understand just how limiting cancer treatment–related fatigue can be.


Normal body functions and physical healing require energy. Energy is needed for the heart to beat, brain to think, and lungs to breathe. When the body is in a state of health and is well-fed, there is a surplus of energy that can be used for daily activities, such as shopping or going on a long walk with the dog.

When the body is healing, energy is directed toward repairing the cells that have been damaged by surgery, chemotherapy, or radiation; this often leads to an energy deficit described as fatigue and weariness. The good news is that there are several ways to fight back fatigue during and after cancer therapy.


Although it may not seem to make much sense, napping or staying in bed does not relieve treatment-related fatigue. The truth is, studies have shown that the very best way to fight fatigue is to get up and move.

Muscles require energy to move, and at the same time, muscle movement preserves muscle mass. Said differently, “use it or lose it.” Inactivity leads to muscle loss, which, in turn, leads to fatigue. Low blood counts, depression, pain, and sleep disorders also contribute to fatigue. Your cancer care team will be able to guide you in just how much, and what type of physical activity is right for you during treatment, so be sure to ask for their recommendations.

Nutrition is also central to creating energy balance and reducing fatigue. Think of food as medicine. Loss of appetite, taste changes, and nausea during cancer treatment can thwart a person’s best efforts for getting enough calories. The bottom line is that the body will break down muscle for the energy it needs to heal and conduct the day-to-day bodily functions. Not consuming enough calories creates that downward spiral of muscle loss, weakness, and fatigue.


It is much harder to get out of a deep hole than it is to fall in. Similarly, regaining energy after cancer treatment is completed can be a slow and challenging task, so it helps to remember that small gains mean that you are headed in the right direction—up. And although it’s easy to get discouraged, some strategies can help fortify your determination to keep your chin up, and keep moving ahead.

Movement is just as important after treatment is completed as it is during treatment. The American Cancer Society recommends walking at a comfortable pace for a total of 20 minutes daily on most days of the week. Walking sessions can be broken down into shorter segments—2 10-minute sessions or 4 5-minute sessions. The important thing is to be consistent. Just do it.

In addition to walking, muscle-strengthening exercises are recommended to help increase strength and replace muscle that was lost during treatment because of inactivity and poor nutrition.

A strategy that physical therapists and trainers recommend is to make small increases in the amount of resistance or time in motion, and write down your progress. A few examples of small increases include:

  1. Increase walking time by 1 minute every session
  2. Add small amounts of resistance to your routine (half-pound to 1-pound increments)
  3. Increase walking distance a little at a time (add 1 block or one-quarter mile to your walk, or increase the number of steps you take over time)
  4. Keep an ongoing log of progress. It’s hard to argue that progress is not being made when the numbers say otherwise

Above all, develop realistic expectations. Remember that each small gain is movement in the right direction.


Research in treatment-related fatigue supports each of the following interventions:

  • Keep moving. Move as much and as often as you are able, being careful not to overexert. If you find you are more fatigued after walking for 10 minutes, reduce it to 5 minutes and start progressing from there. Remember, cancer treatment is not a sprint; it’s a marathon. Train slowly and consistently
  • Food is medicine. Balanced nutrition coupled with adequate calorie intake can restore energy balance, making it easier to get up and get moving
  • Fatigue can lead to depression and hopelessness. Movement has been shown to increase the “feel good” hormones in the body. It’s a win/win situation
  • Document your progress and set realistic expectations, keeping in mind that you can generally do more than you think you can; but in the same sense, don’t cause a setback by overexerting yourself. Set a pace that is right for you

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