How To Get Stronger After Cancer: The Principle of Progressive Overload in Strength Exercise

Strength training is an important tool for those going through a cancer diagnosis to help improve overall health and quality of life. One principle of strength training is called 'progressive overload', a key strategy to build strength and enhance functional capacity. When it comes to those who have received a primary cancer diagnosis, the application of this principle can significantly improve physical function, combat fatigue, and support recovery.

What is Progressive Overload?

Progressive overload is a fundamental concept in exercise physiology. It refers to the gradual increase of stress placed on the body during exercise to continually challenge muscles and stimulate growth and adaptation. The basic premise is simple: to become stronger, your body needs to be pushed beyond its current capabilities, but in a controlled, gradual manner. Without adequate overload, progress plateaus.

In strength training, this principle can be implemented by increasing:

1. Resistance (Weight): Gradually adding weight to your lifts.

2. Reps (Repetitions): Increasing the number of repetitions per set.

3. Sets: Adding more sets to a workout.

4. Frequency: Training more often throughout the week.

5. Time under Tension: Slowing down the tempo of lifts to increase muscle engagement.

   
   

Why is Progressive Overload Important for Cancer Survivors?

For individuals who have received a primary cancer diagnosis, especially those recovering from treatment, progressive overload can have profound benefits on both physical and mental well-being. While it may seem daunting to begin strength training after your diagnosis or treatment, it’s important to understand how it helps:

1. Combatting Muscle Weakness and Fatigue

Cancer treatments such as chemotherapy and radiation therapy can cause muscle wasting, fatigue, and weakness. These side effects often leave individuals feeling drained and less physically capable. Progressive overload, when applied gradually and in a tailored manner, helps rebuild muscle strength and combat fatigue by stimulating muscle growth and improving endurance.

A study conducted by the American Cancer Society found that strength training can be an effective countermeasure against cancer-related fatigue (CRF),[1] a common issue for cancer survivors. By gradually increasing the intensity of resistance exercises, individuals can restore muscle mass and reduce overall feelings of tiredness, ultimately leading to better energy levels.

2. Improving Bone Health

Cancer treatments, particularly chemotherapy and hormone therapies, can impact bone density, leaving individuals at greater risk of osteoporosis. Progressive overload strengthens bones by enhancing bone mineral density. As muscles adapt to heavier loads, the mechanical stress transferred to bones stimulates bone-building processes, promoting healthier bones.

3. Boosting Mental Health

Physical activity, especially strength training, is linked to improved mental health, and this is particularly crucial for people navigating the emotional and psychological effects of cancer. The progressive challenge of strength training provides a sense of accomplishment, increasing self-esteem and confidence. In addition, the release of endorphins during exercise can combat anxiety and depression, which are common emotional responses during cancer recovery.

4. Enhancing Functional Capacity

Cancer treatments can impact an individual’s ability to perform daily tasks. Progressive overload helps to improve functional strength, making everyday activities—like carrying shopping, climbing stairs, or lifting objects—easier. By focusing on compound movements (like squats, deadlifts, or presses), individuals can gain strength in the muscles used in daily life, leading to improved independence and mobility.

How to Safely Implement Progressive Overload in Strength Training for Cancer Survivors

While progressive overload is essential for progress, it’s crucial that the approach be individualised and done with caution. Cancer survivors may have unique health considerations, such as compromised immune function, fatigue, or joint issues, that require adjustments. Here's how to apply progressive overload safely:

1. Start Slow and Build Gradually

After treatment, the body may be deconditioned, and starting with too much weight or volume can lead to injury. It's vital to begin with low resistance and work on proper form. Once strength begins to return, the load can be gradually increased by 2-5% each week. This can be done by adding small increments of weight or adding a rep or two to each set.

2. Focus on Form and Technique

Before increasing the intensity of a workout, it’s essential to perfect the form to avoid injury. This is particularly important for people with cancer, as treatments may have affected coordination or balance. A specialist cancer trainer or physio can ensure exercises are performed safely and effectively.

3. Prioritise Rest and Recovery

Recovery is key to avoiding overtraining and injury. For people with cancer, it’s essential to listen to the body and not push too hard too quickly. Adequate sleep, hydration, and nutrition play a huge role in ensuring muscles repair and grow. Rest days between workouts allow the body to adapt and build strength effectively.

4. Monitor Fatigue Levels

Cancer survivors often experience fluctuations in their energy levels. It’s important to monitor fatigue and adjust the intensity of training accordingly. Some days, you might feel energised, while other days fatigue might set in. The principle of progressive overload should be flexible, allowing adjustments based on how the body is feeling on any given day.

Example Strength Exercise Program Using Progressive Overload After Cancer

We cover cycles of progressive overload in our LIVE classes. It is also included in our breast cancer program. Here’s an basic example of a beginner strength training program that incorporates progressive overload:*

Weeks 1-4: Foundation Building

• Exercise: Squat, Push-up (or Wall Push-up), Dumbbell Row

• Sets/Reps: 2-3 sets of 8-10 reps

• Rest: 1-2 minutes between sets

• Weight: Light resistance (e.g., body weight or light dumbbells)

• Focus: Perfecting form and technique, building a foundation

Weeks 5-8: Introducing Overload

• Exercise: Squat, Push-up, Dumbbell Row, Glute Bridge

• Sets/Reps: 3-4 sets of 8-12 reps

• Rest: 1-2 minutes between sets

• Weight: Increase resistance by 5-10% from previous weeks

• Focus: Gradually increasing intensity, challenging muscles

Weeks 9-12: Continued Progression

• Exercise: Squat, Push-up, Dumbbell Row, Deadlift

• Sets/Reps: 4-5 sets of 8-12 reps

• Rest: 1-2 minutes between sets

• Weight: Increase resistance by another 5-10%

• Focus: Continuing to overload the muscles, tracking progress

Weight progression

Progressive overload is a cornerstone of effective strength training, offering benefits beyond just muscle growth. For cancer survivors, it can help combat fatigue, improve strength, and increase independence, all while fostering mental well-being. With a careful, individualised approach, progressive overload allows cancer patients to safely rebuild their strength and quality of life, one step at a time.

*Before starting any exercise program, it’s essential to consult with a oncology team or a certified fitness professional, especially when recovering from cancer treatments. They can guide you in creating a personalised program that takes into account your unique health situation.

Ultimately, the key is gradual, consistent progress—small, incremental changes that lead to lasting improvements in strength, mobility, and health.

References: 1. Ernst M, Wagner C, Oeser A, Messer S, Wender A, Cryns N, Bröckelmann PJ, Holtkamp U, Baumann FT, Wiskemann J, Monsef I, Scherer RW, Mishra SI, Skoetz N. Resistance training for fatigue in people with cancer. Cochrane Database of Systematic Reviews 2024, Issue 11. Art. No.: CD015518. DOI: 10.1002/14651858.CD015518. Accessed 27 March 2025.