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Exercise and keeping active

British Transplant games

After a stem cell transplant, keeping active can help you both physically and emotionally. Making exercise a part of your daily routine is a great way to combat fatigue and rebuild your strength and balance.

On this webpage, we will look at the different types of exercise you can do at all stages of your recovery, starting with your first few days in hospital. It will focus on the following topics:

You can also read this information in our An essential guide to diet and physical activity booklet. Order a copy on our Order or download publications webpage.

Being physically active is great for alleviating stress. Exercising in some way every day really helps me to level myself and bring myself back down. It helps me to say to myself, 'You're really lucky you're still here.'

Ashling, who had a stem cell transplant to treat acute myeloid leukaemia (AML). You can read her story on our blog.

Getting active after transplant

Stem cell transplants and the associated medication can cause side effects such as:

  • stiff joints
  • achy and weak muscles
  • reduced bone density
  • fatigue and tiredness.

This can affect your energy and fitness levels, as well as your ability to complete everyday tasks.

The good news is that being more active can help you cope better before, during and after your transplant.

Being more active is good for you. It can:

  • boost your mood and wellbeing
  • reduce extreme tiredness (fatigue)
  • improve your strength and fitness
  • prevent osteoporosis (bone thinning)
  • reduce your risk of heart disease and some cancers.

Top tip: We have lots more information and support on fatigue and stem cell transplant on our Managing fatigue webpage and in our booklet: Managing fatigue after a stem cell transplant.

Other people who have had a stem cell transplant say that being active also helps reduce their stress. Being active with others can also help combat loneliness, but be sure to check with your transplant team to make sure it’s safe for you to be around others after transplant.

Before your transplant

It’s normally safe to exercise before your transplant. Building up your fitness is often recommended as it can help with your recovery after transplant. This is part of prehabilitation (prehab). Your hospital might have a prehab programme for you. If not, ask your medical team about it. They should still be able to offer advice.

Gentle exercise such as walking, using an exercise bike, or dancing can improve your stamina and strength. Exercises like yoga, Pilates and tai chi can strengthen muscles, make you more flexible and help you relax, which could also be good for your mental health.

Early recovery

It’s important and normally OK to continue doing some exercises while you’re still in hospital or recovering at home. Not being active will cause muscle weakness, leading to increased fatigue.  Check with your transplant team or physiotherapist if you’re not sure what you’re able to do.

What is a physiotherapist?

Physiotherapists are experts in finding the best ways for people going through a transplant to be active. This may involve exercise programmes or advice on everyday activities. If you need physiotherapy while you are in hospital, the physiotherapist will come and see you on the ward. Otherwise, you can ask your GP or transplant team to refer you.

Top tips:

  • If your transplant team agrees, you could try exercises in your hospital room – even in your bed or chair.
  • Walking and moving regularly will help. For example, getting up every day to have a shower and sitting out of bed.
  • Even doing very gentle exercises or stretches can help with your circulation. This is important especially when you don’t feel like getting up and moving around the room.
  • Exercise can help break the day up and give you a sense of routine while you are in hospital
  • Break down activities into small chunks with some rest in between.

Being in isolation immediately after the transplant was soul destroying, and opportunities for exercise were very limited. However, when I had to go outside of my room for an x-ray, I persuaded the porter I could walk to the appointment. What a difference this short journey made to my wellbeing, with both my mental and physical condition benefitting enormously.

Dave, who had a stem cell transplant after being diagnosed with myelodysplastic syndromes (MDS) and then acute myeloid leukaemia (AML)

Exercising safely

It’s normally safe for most people to do some light to moderate exercise during recovery. This level of exercise means that you will increase your breathing rate, but you should still be able to talk.

More strenuous exercise should wait until your immune system has recovered and your energy levels have improved.

If you’re still going to hospital for issues related to your transplant, or you have other health problems, check with your medical team, or a physiotherapist or occupational therapist about what is safe for you to do. They will be able to advise on how to progress based on your own fitness levels and how you are recovering.

What is an occupational therapist?

Occupational therapists provide practical support to help you do the activities that matter to you. It is normal to feel fatigued during and following treatment. You should slowly start to resume your daily routine, but recognise you may need help with some activities of daily living. Occupational therapists can help to manage this by giving you tips on how to save your energy and pace yourself, or by providing aids and adaptations.

Speak to your doctor and avoid exercise if you have any of the following:

  • Very low blood counts
  • New pain in your bones, neck or back
  • Severe, persistent headaches
  • Low platelet count (below 20) or problems with blood clotting
  • Pain in the chest, arm or jaw
  • Irregular heart rate
  • Feeling or being sick, or diarrhoea (runny poo)
  • Fever (a sign of infection)
  • A sudden weakness in your muscles
  • Recent pain or swelling in your joints
  • Recent dizziness or fainting

Keeping active for long-term recovery

Whatever your fitness level before your transplant, exercise can be tricky if you haven’t done much for a while. It’s normally a good idea to start small.

Remember:

Recovery is different for everyone and you may encounter setbacks along the way. Don’t let this dishearten you.

If and when you are ready, try building activity into your daily routine. As a general guide, aim to:

  • cut down the amount of time you spend sitting down if you can – if you’re watching TV, resting in bed or working at a computer, get up every 30 minutes and move around if possible 
  • do 20-30 minutes of moderate activity daily, like short walks, housework or using a static bike – you can break it down to chunks of 3-5 minutes if you need to
  • try activities to keep your muscles strong at least twice a week 
  • try activities that can improve your balance and reduce your risk of falling at least twice a week.

We Are Undefeatable and Macmillan Cancer Support have lots of other activity ideas. 

Having a goal to help you get going is paramount. Even if that goal is: by three days’ time I will be able to hang out all the washing or walk to the end gate.

Joanna, who had a stem cell transplant to treat acute myeloid leukaemia (AML)

Stay motivated

Doing something is always better than doing nothing. On the days that you aren’t feeling motivated to go for your walk or complete an exercise programme, something as little as doing 30 seconds of marching on the spot can make a big difference.

How to build up your activity levels

  • Create some short term and long term goals. Make them realistic and achievable.
  • Keep track of your activities for one week, either in a diary, on your phone or using an app.
  • Pick one activity you can do now. Do this every day and start small. For example, walk to the end of the garden, march on the spot, or try a one-minute exercise.
  • Increase how often you do this activity over weeks or months. Try it twice a day instead of once.
  • Increase how long you do it over weeks or months. Try it for 10 minutes instead of five.
  • Increase how hard you work when you’re doing it.

Don't be just satisfied with saying, 'Oh I'll do the same as I did last week.' Always try to do that little bit more. Whether it be walking, or walking up the stairs, go that little bit further. 

Dave, who had a stem cell transplant to treat myelodysplastic syndromes (MDS). You can listen to his story in our video below.

Types of exercise

It’s good to do a bit of each of these four different types of exercise. Speak to your transplant team about any types of exercise you should avoid.

Aerobic

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Good for:

  • increasing your breathing and heart rate
  • keeping your heart, lungs, and circulatory system healthy.

Try:

  • walking
  • cycling
  • running
  • dancing
  • an aerobics class
  • team sports like football.

Balance

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Good for:

  • improving the muscles that help you balance and can help prevent falls.

Try:

  • yoga and tai chi
  • simple exercises like standing on one leg.

Resistance

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Good for:

  • making your muscles stronger.

Try:

  • lifting weights
  • using a resistance band
  • everyday activities like carrying shopping.

Flexibility

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Good for:

  • lengthening your muscles
  • improving movements in your joints.

Try:

  • yoga
  • tai chi
  • Pilates.

Getting support

Speak to your transplant team or GP if you have any concerns about exercise, or are interested in getting a referral for physiotherapy. They could also help with accessing exercise classes for free, or at a reduced cost.

Your GP may be able to give you an exercise referral for reduced-cost sessions with a specialist instructor.

Some gyms have programmes for people who have had cancer or other illnesses.

Your local hospital and support centres, such as Maggie’s or Macmillan Cancer Support, will also have more information.

Your local council will have a list of leisure centres, community centres and activities near you.

One thing that changed so much for me were parkruns. It was a breath of fresh air for me, it gave me motivation. I saw a lot of ill people doing it. So, I really recommend it when your strength is back a bit, as they are all over the country.

Alex, who had a stem cell transplant in 2016. You can read his story in our blog.

Five ways to make physical activity a habit

1. Do what you love

It’s easier to stick to something you enjoy that doesn’t take much effort or planning. You don’t have to join a gym or an exercise class. What about going for a walk, dancing at home to music, or gardening?

2. Make activity a routine

See if you can build more activity into your daily life. You could try:

  • walking instead of taking the bus or driving
  • using the stairs instead of the lift
  • carrying your shopping home
  • doing some cleaning or DIY
  • practise your balance while waiting for the kettle to boil or brushing your teeth.

3. Set clear goals

It helps to write down some specific goals and plan for what might get in the way. For example: ‘I will go for a walk every day after breakfast. If it’s raining, I will do an exercise video indoors instead.’

Use our My Transplant Tracker App to track your progress.

4. Build in rest and relaxation

Getting a good night’s sleep, and making time to rest and unwind, can help with your recovery and reduce tiredness. You could try relaxation exercises, massage or meditation.

Mind has some useful relaxation tips.

5. Set yourself a challenge

Having something to work towards can be good motivation. You could try the NHS Couch to 5k programme or parkrun to get into running, or train for the British Transplant Games.

I felt exhausted all the time. You don't expect to find it hard to just stay upright while you're waiting for the kettle to boil! When I got home I found that I couldn't get up the stairs. It was a shock, but I didn't give up, I set myself goals and I pushed myself. One step at a time.

Sarah, who had a stem cell transplant. You can listen to her story in the video below.

Sarah's story

Information published: 15/11/23
Next review due: 15/11/26

Related links

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