Exercise with blood cancer: leukaemia, lymphoma and myeloma, low blood counts and transplants

Safe for most people

Being active is safe for most people with blood cancer, before, during and after treatment. Let your team know your plans: they'll tell you what to adjust for your blood counts and treatment.

Sources 1, 2, 3

It probably eases tiredness

In a Cochrane review of 18 trials, aerobic exercise probably eased tiredness (moderate certainty) and may slightly ease low mood. It made no difference to survival either way.

Source 4

No agreed safe blood count

Advice is moving from stopping exercise when counts are low to adapting it. Your cancer team sets your limits; Anthony Nolan suggests speaking to your doctor and not exercising if your platelets are below 20.

Sources 5, 6

Low white cells: avoid crowds. Low platelets: avoid knocks

With low white cells, avoid busy gyms, pools and spas. With low platelets, avoid contact and high-impact sports, and choose activities where you won't fall or get knocked.

Sources 7, 3, 2

Myeloma bone disease: low impact, no heavy lifting

Myeloma UK recommends walking, swimming and cycling, and advises against high-impact exercise, contact sports and heavy lifting. Stop and tell your team about new or increasing pain.

Sources 8, 9, 10

Know the warning signs

Call your 24-hour number straight away if your temperature reaches 37.5°C or goes below 36°C, if you feel unwell even with a normal temperature, or if you have unexplained bruising or bleeding. With myeloma, suddenly losing feeling in your legs or control of your bladder or bowels is a 999 call.

Sources 11, 12, 13

What blood cancer is

Blood cancer affects blood cells. It includes leukaemia, lymphoma and myeloma, and related conditions called myelodysplastic syndromes and myeloproliferative neoplasms. More than 40,000 people a year are diagnosed in the UK and more than 310,000 are living with it, and around 4 in 10 people are 75 or over when they're diagnosed.

Source 14

Fast and slow types

Some types grow fast (acute), others slowly (chronic). The commonest are large B-cell lymphoma, chronic lymphocytic leukaemia, myeloma, essential thrombocythaemia and acute myeloid leukaemia, and 5-year survival ranges from over 80% for some types to 22% for acute myeloid leukaemia.

Source 14

The blood counts that change what's safe

• White cells (neutrophils) fight infection. Chemotherapy lowers them most 7 to 14 days after treatment, and they usually recover before the next cycle.
• Platelets help your blood clot. When they're low, you bruise and bleed more easily. After chemotherapy they're often lowest 7 to 10 days later and take 2 to 3 weeks to recover.
• Red cells carry oxygen. When they're low (anaemia), you feel very tired, breathless and dizzy, and you may need a transfusion.

Sources 15, 12, 16

Myeloma and the bones

Myeloma is a cancer of plasma cells in the bone marrow. It weakens the surrounding bone, most often in the middle or lower back, the ribs and the hips, so bones can break more easily. 70% to 80% of people with myeloma have bone pain, 50% to 60% have fractures and 2% to 3% have spinal cord compression. Bone pain is often worse when you move and eased by lying down.

Sources 17, 18, 9, 16

Treatment

Treatments include chemotherapy, targeted medicines, steroids, radiotherapy and stem cell (bone marrow) transplants, using your own cells or a donor's. After a transplant you stay in your own room until it works, and recovery can take up to a year. Donor transplants can cause graft versus host disease (GvHD), which can affect the skin, gut, lungs, muscles and joints. Slow-growing types, such as chronic lymphocytic leukaemia, may be watched at first without treatment (watch and wait), and being active then can help you prepare for treatment if you need it.

Sources 19, 20, 21, 22, 2, 3

Who the evidence is about

Most people in the trials had acute leukaemia, lymphoma or myeloma, and 8 of the 18 trials in the Cochrane review were around stem cell transplants, mostly with walking programmes. Myeloma trials are small, and charity advice fills much of the gap.

Sources 4, 23, 24

Tiredness: probably helpsEmerging evidence

In a Cochrane review of 18 trials (1,892 people), aerobic exercise probably eased tiredness by a small amount (9 trials, 826 people; moderate certainty) and might slightly ease low mood (low certainty). Its effects on quality of life and physical functioning were unclear.

Source 4

Survival: no difference either wayEmerging evidence

Exercise made no difference to the risk of dying (low-certainty evidence). It's for how you feel and function, not a treatment for the cancer.

Source 4

Around a stem cell transplant: mixed resultsMixed evidence

Across 27 studies (2,432 people), exercise around a bone marrow or stem cell transplant improved walking distance (about 29 metres further in 6 minutes), quality of life and tiredness by modest amounts, and shortened hospital stays by about 2 days, more so after donor transplants. Other reviews found gains in walking and leg strength but not consistently in tiredness or quality of life, with low-certainty evidence.

One trial in 105 people having donor transplants found less tiredness and better fitness. But the two largest single trials found no benefit: 18 weeks of supervised high-intensity training after an own-cell transplant (109 people) did no better than usual care, in which many people had physiotherapy, with no difference a year later; and brief self-directed training before a transplant (711 people) changed nothing.

Sources 25, 26, 27, 28, 29, 30, 31

LymphomaEmerging evidence

In 122 people with lymphoma, 12 weeks of supervised cycling improved physical functioning, quality of life and tiredness, without interfering with treatment or how well it worked.

Source 32

Acute leukaemiaEmerging evidence

In 9 trials (314 people), exercise improved fitness and strength, but not tiredness, anxiety, low mood or quality of life.

Source 33

Without a transplantEmerging evidence

In 15 studies of people who weren't having a transplant, exercise improved walking and fitness, but not tiredness or quality of life compared with the control groups.

Source 34

MyelomaMixed evidence

In 20 studies (1,032 people), exercise was feasible, but its effects on fitness, strength, tiredness, quality of life and pain were small and not statistically clear. Another review of 7 studies (563 people) found it safe, with no serious and 4 minor problems reported, and 5 trials found no effect on quality of life.

Sources 23, 24, 35

Myeloma bone diseaseEmerging evidence

In 12 exercise studies (346 people), 69% to 86% had myeloma bone disease. Exercise appeared safe when people with an unstable spine, spinal cord compression or a high risk of fracture were left out, but the studies reported problems poorly.

Source 36

Where treatment carries the evidenceStrong evidence

Chemotherapy, targeted medicines, radiotherapy and transplants treat the cancer. Exercise is there to help you feel and function better alongside them.

Sources 19, 4

No agreed safe numberEmerging evidence

A 2025 review of 47 papers found most set a platelet cut-off for exercise, but the numbers varied widely, from under 10 to under 50, and the evidence is moving away from stopping exercise towards adapting it. Bleeding caused by exercise was rare where it was reported.

Source 5

Low platelets

Choose activities where you won't fall or get knocked: start with gentle seated or standing exercises, stretches and walking, and as your platelets recover, add brisk walking, step-ups and gentle strength work with bands. Avoid contact and high-impact sports such as football and rugby. Anthony Nolan suggests speaking to your doctor and not exercising if your platelets are below 20.

Sources 2, 3, 6, 7

What physiotherapists useEmerging evidence

One Canadian physiotherapy guideline, written for professionals, adapts exercise to the platelet count: very limited activity below 15, gentle exercise without resistance from 15 to 20, light resistance from 20 to 40, and gentle aerobic exercise such as a static bike above 40, with nothing vigorous below 50 (the same numbers your blood test results show). It notes the count is an imprecise guide to bleeding, and that weeks of bed rest cause decline. One study used resistance tubing instead of dumbbells at counts of 10 to 20. These are for your team to use, not rules to follow on your own.

Sources 16, 5

Low white cells (neutropenia)

Avoid busy places such as gyms, pools and spas, or go at quiet times and wipe equipment down, or exercise at home or outdoors. Blood Cancer UK says outdoor, well-ventilated and less crowded activities are lower risk, and that hard exercise or shouting indoors spreads airborne viruses more. The risk is higher in the 6 to 12 months after a transplant, especially a donor one.

Sources 7, 15, 3, 37, 2

Gardening

When your immunity is low, Macmillan advises avoiding compost heaps, dead leaves and building dust, which can carry a mould called aspergillus.

Source 15

Anaemia

With severe anaemia you may manage only everyday activities: rest when you need to until it improves. Contact the hospital if you're very tired, breathless or dizzy, and find out what's causing breathlessness before you exercise. Our anaemia guide has more.

Sources 7, 12, 2

Days to skip

Don't exercise if you have a fever, diarrhoea or vomiting, new bone, neck or back pain, chest pain, an irregular heartbeat, sudden weakness, or recent dizziness or fainting.

Sources 6, 3

Signs of infection can be mild

With blood cancer, an infection can cause only mild symptoms, you can have one without a fever, and paracetamol, steroids and aspirin can hide a fever. If you feel unwell, skip exercise and get advice.

Source 11

What Myeloma UK advisesStrong evidence

Myeloma UK: "You should avoid strenuous exercises like weightlifting or contact sports such as rugby. Gentle forms of exercise such as walking, swimming, cycling, gentle aqua-aerobics, gentle gym work, yoga and tai chi are good." Its bone disease guide says low-impact exercise is generally recommended, and high-impact exercise such as running, tennis or contact sports usually isn't.

Sources 8, 9

Myeloma UK's top tips

Keep mobile with regular gentle exercise, ask for a physiotherapist, avoid over-exertion and heavy lifting, and know the signs of spinal cord compression.

Source 9

Twisting and bending forward: our reading

Our reading, from advice for cancer in the bones and the physiotherapy guideline, is to leave out twisting and repeated or loaded forward bending if myeloma affects your spine, unless your team says they're safe. Cancer Research UK says avoid twisting the spine with cancer in the bones, such as yoga twists, the rowing machine and golf or tennis swings. Macmillan says avoid repeated bending forward, such as toe touches and sit-ups. The Canadian guideline says twisting, bending forward, reaching overhead, pushing, pulling and lifting weights can cause or worsen fractures in the spine.

Sources 38, 7, 39, 16

Myeloma Australia adds

Activities with a high risk of falls, such as skating and skiing; lifting weights without an exercise physiologist's or physiotherapist's guidance; and possibly golf, because of the twisting swing.

Source 40

Bone lesions don't rule exercise outStrong evidence

The Canadian guideline says bone lesions aren't an absolute bar to exercise, but advises avoiding high impact and extreme or twisting movements, following back-care principles, and using walking aids or braces where advised.

Source 16

Myeloma UK's home programme

Learn each exercise with a physiotherapist first. Do them about 3 times a week, not on 2 days in a row, starting with 5 of each and building gradually: "if it hurts then don't do it". Wear supportive laced shoes, hold a chair for balance work, stop to rest if you're breathless, and stop straight away and tell your team about new or increasing pain.

Source 10

Not the osteoporosis programme

The impact and heavy lifting in our osteoporosis guide aren't for myeloma bone disease. Light strength and balance work, planned with a physiotherapist, is.

Sources 9, 10

Steroids and numb feet

Steroids can weaken your muscles, making stairs, lifting and reaching overhead harder: tell your team. Myeloma and its treatments can cause numb or tingling feet, which affects balance, so hold a counter for balance work; a static bike may be safer than cycling outside.

Sources 20, 18, 3

High impact: with bone disease or low platelets

Myeloma UK, Macmillan and Lymphoma Action advise against high-impact exercise and contact sport with myeloma bone disease, other cancer in the bones or low platelets. In our catalog, leave out:

• Jumping jacks, skipping, pogo hops, jump squats, burpees and box jumps.
• Heel drops, which are done for bone strength in osteoporosis.
• Shuttle runs, and treadmill jogging and running.

Sources 9, 8, 7, 3

Twisting and bending forward: with myeloma in the spine (our reading)

Our reading of the advice for cancer in the bones and the physiotherapy guideline, unless your team says they're safe:

• Twists: the supine spinal twist, half lord of the fishes, revolved chair pose, the Pilates saw, kettlebell windmills and the rowing machine. Keep thoracic rotation small, or leave it out.
• Forward bending: sit-ups, the Pilates roll-up, Jefferson curls and standing toe touches.

Sources 38, 7, 16, 39

Heavy and overhead lifting

Myeloma UK advises against heavy lifting and strenuous weightlifting, so leave out barbell deadlifts and back squats, kettlebell swings and overhead presses unless a physiotherapist has planned them with your team.

Sources 8, 9, 16

Getting down to the floor

With very low platelets or if you're unsteady, practising getting down to the floor and back up can wait until your team agrees (our suggestion, from the advice to avoid falls).

Source 2

Contact sport with an enlarged spleen

Leukaemia and some other conditions can enlarge the spleen. Avoid contact sports while it's enlarged, because a knock could make it burst.

Source 41

In hospital

One NHS (National Health Service) hospital's leaflet for people in their own room after a transplant suggests sitting out of bed for meals, washing and dressing yourself, and gentle exercises spread through the day at about 3 on a scale of 0 to 10: ankle pumps, thigh and buttock squeezes, deep breathing, arm raises, knee straightening, walking or marching, sit-to-stands and the ward bike. Wear a mask when you're allowed out of your room. Leukaemia Care suggests starting with 5 minutes of walking and building towards 30.

Sources 42, 2

At home

The international roundtable on exercise and cancer encourages exercise at home after a transplant: light, short and often, adjusted day by day, building up slowly. Anthony Nolan suggests aiming for 20 to 30 minutes of moderate activity a day, in chunks of 3 to 5 minutes if you need to, strength and balance exercises at least twice a week, and getting up every 30 minutes. The NHS says recovery can take up to a year: increase exercise slowly, starting with short walks.

Sources 39, 6, 21

Gyms and pools

Wait until your immune system has recovered before going back to a public gym, and check with your team before being around other people. Anthony Nolan says strenuous exercise waits until your immune system and energy have recovered. Don't swim while you have a central or PICC (peripherally inserted central catheter) line.

Sources 39, 6, 7

Graft versus host disease

GvHD can make your joints swollen and your arms and legs hard to move: tell your care team. Call them too if breathing gets difficult, you start wheezing or exercise gets harder.

Source 22

Lines

With a central or PICC line, don't swim, and avoid vigorous upper-body exercise that could move the line. Pain or swelling in the arm, shoulder or chest on that side can be a clot: call your team.

Sources 7, 43

Sun

Your skin may be more sensitive to the sun after a transplant, so cover up when you exercise outdoors.

Source 21

Goals

Leukaemia Care says even after a stem cell transplant you may only need a short break from activity. Once your strength is back, Anthony Nolan suggests goals such as parkrun, the NHS Couch to 5K programme or the British Transplant Games (running isn't for myeloma bone disease, because of the impact).

Sources 2, 6, 9

Pace it

Avoid boom and bust: don't overdo it on good days, rest is important too, and something is better than nothing.

Sources 1, 2

Build up slowly

Lymphoma Action suggests building up from 10 to 15 minutes on 3 days a week, adding 10 to 15 minutes over time, with a gentler day between harder ones. It can take a year or two to get back to your previous fitness.

Source 3

Exercise and tirednessEmerging evidence

Aerobic exercise probably eases tiredness in blood cancers (moderate certainty). Our cancer guide covers fatigue in more detail.

Source 4

Watch and wait, or before treatment

If you feel well, aim for the UK guidelines: 150 minutes of moderate activity a week, plus strength exercises twice a week. Before a transplant, getting fitter (prehabilitation) is often recommended.

Sources 2, 3, 6

During chemotherapy cycles

Little and often, more on better days, and gentle or nothing in the days your counts are lowest or you feel unwell. Avoid busy gyms and pools when your white cells are low, and contact or high-impact sport when your platelets are low.

Sources 7, 2, 3

In hospital or isolation

Short sessions spread through the day at about 3 out of 10 effort, and walking from 5 minutes towards 30.

Sources 42, 2

The first months after a transplant

At home: light, short and often; 20 to 30 minutes of moderate activity a day, in chunks; strength and balance twice a week; no public gyms until your immune system recovers.

Sources 39, 6

Later recovery

Blood Cancer UK suggests starting with 5 or 10 minutes of walking and building up to 20 to 30 minutes of activity a day, plus muscle strengthening twice a week. It can take a year or two to get your fitness back.

Sources 1, 3, 6

With myeloma bone disease, at any stage

Walking, swimming or cycling, and Myeloma UK's home exercises about 3 times a week, planned with a physiotherapist. No high-impact exercise, contact sport or heavy lifting.

Sources 8, 10, 9

Infection: call your 24-hour number straight away

Most teams advise checking your temperature if you feel unwell, and getting advice if it reaches 37.5°C or goes below 36°C. With blood cancer, symptoms can be very mild, and you can have an infection without a fever. Call the number you were given if you have:

• A high or low temperature, feeling hot or cold, or feeling generally unwell.
• A sore throat, a cough with green mucus, or a headache or stiff neck.
• Frequent watery poo, being sick, or feeling dizzy or faint.
• Red, hot or swollen skin, burning or stinging when you pee, or pain, redness or fluid around a central line.
• New pain anywhere.

Sources 11, 15

If you can't get through

If you're having treatment and can't get through to your number, call 999 or get someone to drive you to A&E. If you're not having treatment, call your GP or team, or 111.

Source 11

Sepsis: call 999

Call 999 if you have:

• Slurred speech or confusion.
• Extreme shivering or muscle pain.
• Not passing any urine in a day.
• Severe shortness of breath.
• A feeling that it's the worst you've ever felt.
• Skin that's mottled or discoloured.

Sources 44, 11

Call 999

Call 999 (911 in the US) if any of these happen, and don't drive yourself to A&E:

• You have chest pain that feels tight or like squeezing on your chest.
• You have chest pain that spreads to your arms, neck or jaw.
• You're having severe difficulty breathing: you're gasping, choking or not able to get words out.
• Your lips or skin are pale, blue or grey. On brown or black skin, this may be easier to see on the palms of the hands.
• Difficulty breathing comes on suddenly, or you have pain in your chest or upper back: these can be signs of a blood clot in the lungs.
• Someone has passed out and is not responding normally.

Sources 45, 46

Bruising and bleeding

Contact the hospital straight away on your 24-hour number for unexplained bruising or bleeding: nosebleeds, bleeding gums, heavy periods, blood in your pee or poo, or tiny red, brown or purple spots that may look like a rash (they can be harder to see on black or brown skin).

Source 12

Myeloma: bone pain and spinal cord compression

Stop straight away and tell your team about new or increasing pain; sudden, severe pain can mean a broken bone. Spinal cord compression is an emergency: get medical advice immediately for back pain with numbness, weakness or tingling in your legs or arms, problems walking, or problems passing urine or opening your bowels. The NHS says call 999 if you:

• Suddenly lose feeling in your arms or legs, or can't walk or stand.
• Suddenly feel confused.
• Suddenly can't control when you poo or pee.

Sources 10, 9, 13

Myeloma: high calcium

Thirst, feeling sick, constipation, confusion, weakness or tiredness can be signs of high calcium: tell your team.

Source 9

A burst spleen: go to A&E

Pain behind your left ribs with tenderness, dizziness and a fast heartbeat after a knock, even weeks later, can mean a ruptured spleen: go straight to A&E.

Source 41

After a transplant

Call your care team now for a high temperature or other signs of infection, signs of a clot, sudden breathlessness or chest pain, or difficulty breathing, wheezing or finding exercise harder. Tell them about swollen joints or difficulty moving your arms and legs.

Source 22

Lines

Pain or swelling in the arm, shoulder or chest on the side of your line can be a clot, and redness, heat, swelling or pain around it can be an infection: call your team.

Sources 43, 44

On steroids

Tell your team about muscle weakness. Contact the hospital if you feel thirsty all the time, pee more and feel more tired, which can mean high blood sugar.

Source 20

Skip exercise and speak to your doctor

Anthony Nolan lists:

• Very low blood counts, platelets below 20, or problems with clotting.
• New pain in your bones, neck or back, or severe, persistent headaches.
• Chest, arm or jaw pain, or an irregular heart rate.
• Feeling or being sick, diarrhoea, or a fever.
• Sudden muscle weakness, recent joint pain or swelling, or recent dizziness or fainting.

Source 6

If you're struggling

Long treatment, isolation and uncertainty can wear you down. If you're thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988. Blood Cancer UK's support line is 0808 2080 888, Leukaemia Care's helpline is 08088 010 444, Lymphoma Action's helpline is 0808 808 5555, and Myeloma UK's Infoline is 0800 980 3332.

Sources 47, 48, 49, 11, 2, 3, 8

"Rest is safest during blood cancer treatment"Strong evidence

Being active is safe for most people before, during and after treatment, and aerobic exercise probably eases tiredness. Leukaemia Care says even after a stem cell transplant you may only need a short break from activity, and weeks of bed rest cause decline.

Sources 1, 2, 3, 4, 16

"With low platelets you mustn't move at all"Emerging evidence

Advice is moving from stopping exercise to adapting it: gentle activity with a low risk of falls or knocks is suggested. Very low counts (Anthony Nolan: platelets below 20) are a reason to speak to your doctor and not exercise, and your team sets your limits.

Sources 5, 2, 6

"Walking is bad for myeloma bones"Strong evidence

Myeloma UK recommends low-impact exercise such as walking, swimming and cycling. It's high-impact exercise, contact sport and heavy lifting that aren't recommended.

Sources 8, 9

"Heavy lifting builds bone, so it's good for myeloma bone disease"Strong evidence

That's osteoporosis advice. With myeloma bone disease, Myeloma UK advises against heavy lifting and strenuous weightlifting, and physiotherapists avoid loaded bending, twisting and heavy overhead pushing where the spine is affected. Light strength work, planned with a physiotherapist, is encouraged.

Sources 8, 9, 16, 10

"You can't exercise for a year after a stem cell transplant"Strong evidence

Recovery can take up to a year, but the NHS says to increase exercise slowly, starting with short walks. Guidelines encourage light, short, frequent exercise at home, and Anthony Nolan suggests building to 20 to 30 minutes of moderate activity a day, in chunks if you need to.

Sources 21, 39, 6

"Exercise can stop blood cancer coming back"Mixed evidence

There's no evidence that it does: the Cochrane review found no difference in survival either way (low certainty). Exercise helps tiredness, fitness, strength and mood alongside treatment.

Source 4

"If you haven't got a temperature, it can't be an infection"Strong evidence

With blood cancer, signs of infection can be mild, you can have an infection without a fever, and paracetamol, steroids and aspirin can hide one. If you feel unwell, skip exercise and get advice.

Source 11