Low-intensity exercise

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Low-intensity exercise

Common Names

  • Walking
  • Swimming
  • Biking
  • Rowing
  • Dance
  • Resistance training
  • Low-intensity aerobics
  • Movement practices like tai chi and yoga

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


What Is It

Activities done at a comfortable pace such as walking, swimming, biking, rowing, dance, resistance training, using an elliptical machine, other low-impact aerobics, or mind-body movement practices like tai chi, qigong, and yoga can be considered low-intensity exercise. Some formats may even have specific training goals, like working within 50% of your maximum heart rate for a set time to improve stamina.

Although most data are on moderate to vigorous activity, several studies show that low-intensity exercise can also improve many aspects of health and well-being such as mood, mobility, and cardiorespiratory fitness. It also helps reduce fatigue and pain, slow functional decline, and has the added benefit of reducing risk for injury. Certain types of low-intensity exercise like tai chi and yoga have also been shown to reduce fall risk and improve sleep quality in cancer survivors.

Low-intensity exercise can be an important bridge to meeting American Cancer Society recommendations of at least 150 minutes of moderate-intensity aerobic exercise and 2–3 days of resistance training per week, to help improve quality of life, maintain independence, increase blood flow, and reduce muscle wasting. And any of the above-mentioned activities can be performed at more intense levels later, as physical conditioning gradually improves.

Continued practice and patience as well as choosing activities that you enjoy can help you stick to your exercise regimens. Importantly, cancer patients should check with their healthcare professionals about what they can do, what to avoid, and to get appropriate referrals to help maintain or improve physical activity levels. It’s also important to listen to your body. Exercising with cancer fitness experts and others who have like-minded goals can also help keep up your physical activity safely.

How It Works

Because low-intensity exercise is low-impact, it avoids stress on the joints while still providing therapeutic benefits that come from deeper breathing, coordinating movements, and other forces like weight and resistance. Although it may take longer to see results with low-intensity over high-intensity exercise for things like weight loss or physical conditioning, these activities have important added benefits like reducing risk for injury and helping to improve mobility, stamina, and stability. For example, because resistance training increases strength, it improves balance which reduces fall risk.

Purported Uses

Anxiety and mood
In patients receiving chemotherapy, home-based low-intensity exercise improved anxiety and mood, especially in those who had worse symptoms at baseline.

Balance
Regular practice of yoga and tai chi have been shown to improve balance.

Fall and fracture risk
Activities including walking and tai chi have been shown to reduce fall and fracture risk.

Fatigue
In a study of cancer survivors, light-intensity activity improved fatigue, cardiorespiratory fitness, and physical functioning, while slowing functional decline.

Heart health
Regular physical activity is known to benefit heart health, and emerging evidence also shows light-intensity activity can reduce heart disease risk. Although more study in this area is needed, it highlights the fundamental importance of maintaining regular activity.

Pain and treatment-related symptoms
Clinical trials of yoga and tai chi indicate these practices are useful for reducing pain and inflammation. In a randomized trial of breast cancer patients undergoing chemotherapy, both a low-intensity home-based program and moderate-to-high-intensity exercise improved fitness and functioning, and reduced nausea and pain versus usual care.

Reducing cancer risk
A meta-analysis determined that both light and high-intensity exercise significantly reduced breast cancer risk, although high-intensity exercise was slightly more protective.

Sleep
Regular practice of yoga and tai chi have been shown to improve sleep quality.

Special Point
  • Low-intensity exercise is always low-impact, meaning it minimizes how much stress you put on your joints. However, not all low-impact exercise is low-intensity. For example, low-impact high-intensity cardio works the heart at a higher rate while still avoiding joint stress.
  • Even seasoned athletes regularly use low-intensity exercise to reduce injury risk and prepare the body for more intense activity.
Is It Safe

Low-intensity exercises are generally safe and appropriate for most fitness levels, with the added benefit of reducing risk for injury and improving recovery time. Patients with joint pain, balance problems, or injuries can particularly benefit from low-intensity forms of exercise. Still, cancer patients who are undergoing active treatment or have just had surgery should check with their healthcare provider to determine when to safely resume activity and which types of exercises are safe to perform.

Who Can Provide this Service

In addition to physical rehabilitation, hospitals may offer online videos, workshops, or continuing courses with clinical fitness specialists to help patients safely maintain or return to regular activity. These experts may focus on particular areas of concern such as regaining shoulder mobility after surgery, safely increasing flexibility and heart rate, or addressing muscle weakness. Some videos may also demonstrate multiple levels of the same exercise so that both a person who cannot stand and another person who needs more weight resistance can benefit from the same demonstration.

Where Can I Get Treatment

MSK offers exercise classes at all levels for our patients and caregivers. Free introductory courses to get started can be found on our MSK YouTube Channel. We also offer single and series workshops focusing on specific types of exercise and mind-body practices. And our online membership program, Integrative Medicine at Home, offers low-cost virtual classes to help support the recovery and well-being of cancer patients everywhere.

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For Healthcare Professionals

Clinical Summary

Activities done at a comfortable pace such as walking, swimming, biking, rowing, dance, resistance training, using an elliptical machine, other low-impact aerobics, or mind-body movement practices like tai chi, qigong, and yoga can be considered low-intensity exercise. Some formats may even have specific training goals, like working within 50% of your maximum heart rate for a set time to improve stamina.

Large cohort studies indicate that regular physical activity including light-intensity activity reduces risks for heart disease, death, and fractures, including hip fractures (1) (2). Even as few as 4400 steps daily was significantly related to lower mortality rates compared with 2700 steps daily, with no clear relation to intensity (3). Other epidemiological studies indicate that after adjustment for total daily steps, greater step intensity was not significantly associated with lower mortality (4). In addition, higher amounts of leisure-time physical activity in later adulthood were associated with lower mortality, suggesting that midlife is not too late to start exercising (5). For older adults with low levels of physical functioning, low-intensity exercise can also help reduce fall risk (6) (7) . In addition, clinical trials of yoga and tai chi indicate these practices are useful for improving sleep and reducing inflammation and pain (8) (9) (10) (11) (12).

Several studies have evaluated the benefits of low-intensity exercise or light physical activity for cancer survivors. In a trial of patients receiving chemotherapy, a home-based walking and resistance training program improved anxiety and mood, especially among those who had worse symptoms at baseline (13). In addition, light-intensity activity improved fatigue, cardiorespiratory fitness, and physical functioning, while slowing functional decline among cancer survivors (14) (15).

Studies have also compared benefits across different exercise intensities. In a randomized trial, both a low-intensity home-based program and moderate-to-high-intensity exercise during chemotherapy resulted in significantly better fitness and physical functioning, less nausea and pain, and earlier returns to work than usual care (16). In another study, although high-intensity exercise had larger long-term effects than low-to-moderate intensity exercise among cancer survivors, some measures like hand-grip strength and lower body muscle function were not significantly different between groups (17). In addition, a meta-analysis determined that both light- and high-intensity exercise significantly reduced breast cancer risk, although the latter was slightly more protective (18).

Even as most evidence has focused on moderate to vigorous activity for cancer prevention, low-intensity exercise can be an important bridge to American Cancer Society recommendations of at least 150 minutes of moderate-intensity aerobic exercise and 2–3 days of resistance training per week, to help maintain independence, improve blood flow, and reduce muscle wasting, fall risk, and injury (19) (20).

Continued practice and patience as well as choosing preferred, more enjoyable activities can help patients stick to their exercise regimens. Importantly, cancer patients should receive guidance from their healthcare professionals about what they can do, what to avoid, and appropriate referrals to help maintain or improve physical activity levels. Patients should also be encouraged to develop awareness of and listen to their body. Exercising with cancer fitness experts and others who have like-minded goals can also help patients keep up physical activity safely.

Purported Uses
  • Anxiety
  • Balance
  • Fall prevention
  • Cancer risk
  • Fracture risk
  • Fatigue
  • Heart health
  • Mood
  • Pain
  • Sleep
  • Treatment-related symptoms
Mechanism of Action

Most studies have focused on moderate to vigorous physical activity (PA), so research on mechanisms behind low-intensity exercise is limited but emerging. In a large prospective cohort of older women, light PA measured by accelerometry was associated with a dose-responsive, independent reduced risk of CHD and CVD events (1). Biological plausibility for these associations have also been suggested by a large cross-sectional study in race- and ethnically-diverse older women, where even after adjustment for intensity and other confounders, lighter intensity PA was still associated with benefits in cardiometabolic markers such as high-density lipoprotein, triglyceride, glucose, C-reactive protein, BMI, and waist circumference (21). In addition, both high- and low-to-moderate intensity exercise can induce benefits on peak oxygen uptake and strength due to the increase in daily activities (17). Regular PA may also attenuate age-related reductions in bone mineral density and improve range of motion and balance to reduce both fall and fracture risk (2).

Mechanisms by which yoga, tai chi, and qigong confer benefits have also been elucidated, and include increased blood flow to the brain, release of endogenous dopamine, reductions in blood pressure, and other therapeutic benefits that come from deeper breathing, coordinated movements, and forces like weight shifting and resistance to improve awareness, postural control, balance, stamina, and strength (see respective monographs).

Contraindications

Although low-intensity exercises are generally safe and appropriate for most fitness levels, cancer patients who have just had surgery or are in active treatment should check with their healthcare provider to determine when to safely resume activity and which types of exercises are safe to perform.

Adverse Reactions

Low-intensity exercises are generally safe and appropriate for most fitness levels, with the added benefit of reducing risk for injury and improving recovery time. Patients with joint pain, balance problems, or injuries can particularly benefit from low intensity forms of exercise.

Practitioners and Treatments

In addition to physical rehabilitation, hospitals may offer online videos, workshops, or continuing courses with clinical fitness specialists to help patients safely maintain or return to regular activity. These experts may focus on particular areas of concern such as regaining shoulder mobility after surgery, safely increasing flexibility and heart rate, or addressing muscle weakness. Some videos may also demonstrate multiple levels of the same exercise so that both a person who cannot stand and another person who needs more weight resistance can benefit from the same demonstration.

MSK offers exercise classes at all levels for our patients and caregivers. Free introductory courses to get started can be found on our MSK YouTube Channel. We also offer single and series workshops focusing on specific types of exercise and mind-body practices. And our online membership program, Integrative Medicine at Home, offers low-cost virtual classes to help support the recovery and well-being of cancer patients everywhere.

References
  1. LaCroix AZ, Bellettiere J, Rillamas-Sun E, et al. Association of Light Physical Activity Measured by Accelerometry and Incidence of Coronary Heart Disease and Cardiovascular Disease in Older Women. JAMA Netw Open. Mar 1 2019;2(3):e190419.
  2. LaMonte MJ, Wactawski-Wende J, Larson JC, et al. Association of Physical Activity and Fracture Risk Among Postmenopausal Women. JAMA Netw Open. Oct 2 2019;2(10):e1914084.
  3. Lee IM, Shiroma EJ, Kamada M, et al. Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med. May 29 2019;179(8):1105-1112.
  4. Saint-Maurice PF, Troiano RP, Bassett DR, Jr., et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. Mar 24 2020;323(12):1151-1160.
  5. Saint-Maurice PF, Coughlan D, Kelly SP, et al. Association of Leisure-Time Physical Activity Across the Adult Life Course With All-Cause and Cause-Specific Mortality. JAMA Netw Open. Mar 1 2019;2(3):e190355.
  6. Morgan RO, Virnig BA, Duque M, et al. Low-intensity exercise and reduction of the risk for falls among at-risk elders. J Gerontol A Biol Sci Med Sci. Oct 2004;59(10):1062-1067.
  7. Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. Feb 9 2012;366(6):511-519.
  8. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. Sep 10 2013;31(26):3233-3241.
  9. Mustian KM, Sprod LK, Janelsins M, et al. Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep problems, Depression, Pain, Anxiety, and Physical Dysfunction: A Review. Oncol Hematol Rev. 2012;8(2):81-88.
  10. Irwin MR, Olmstead R, Carrillo C, et al. Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. J Clin Oncol. Aug 10 2017;35(23):2656-2665.
  11. Irwin MR, Olmstead R, Breen EC, et al. Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial. J Natl Cancer Inst Monogr. Nov 2014;2014(50):295-301.
  12. Qin J, Zhang Y, Wu L, et al. Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). Sep 2019;98(37):e17099.
  13. Loh KP, Kleckner IR, Lin PJ, et al. Effects of a Home-based Exercise Program on Anxiety and Mood Disturbances in Older Adults with Cancer Receiving Chemotherapy. J Am Geriatr Soc. May 2019;67(5):1005-1011.
  14. Kampshoff CS, Chinapaw MJ, Brug J, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study. BMC Med. Oct 29 2015;13:275.
  15. Blair CK, Morey MC, Desmond RA, et al. Light-intensity activity attenuates functional decline in older cancer survivors. Med Sci Sports Exerc. Jul 2014;46(7):1375-1383.
  16. van Waart H, Stuiver MM, van Harten WH, et al. Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. J Clin Oncol. Jun 10 2015;33(17):1918-1927.
  17. Kampshoff CS, van Dongen JM, van Mechelen W, et al. Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors. J Cancer Surviv. Jun 2018;12(3):417-429.
  18. Hardefeldt PJ, Penninkilampi R, Edirimanne S, et al. Physical Activity and Weight Loss Reduce the Risk of Breast Cancer: A Meta-analysis of 139 Prospective and Retrospective Studies. Clin Breast Cancer. Aug 2018;18(4):e601-e612.
  19. Rock CL, Thomson C, Gansler T, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin. Jul 2020;70(4):245-271.
  20. American Cancer Society. Physical Activity and the Cancer Patient. Available at: https://www.cancer.org/treatment/survivorship-during-and-after-treatmen…. Accessed May 5, 2021.
  21. LaMonte MJ, Lewis CE, Buchner DM, et al. Both Light Intensity and Moderate-to-Vigorous Physical Activity Measured by Accelerometry Are Favorably Associated With Cardiometabolic Risk Factors in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study. J Am Heart Assoc. Oct 17 2017;6(10).
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