Safety Considerations, Contraindications, and Symptom Management During Exercise
Absolute versus relative
Absolute contraindications include acute febrile illness or suspected infection, unstable angina, decompensated heart failure, uncontrolled arrhythmia, severe symptomatic aortic stenosis, acute pulmonary embolism or deep vein thrombosis, and severe untreated anemia. Relative contraindications require judgment and modification: uncontrolled hypertension, electrolyte abnormalities, high-grade neuropathy, marked thrombocytopenia, bone pain from metastases, and recent chest radiotherapy.
Daily symptom work
Fatigue: cut volume before cutting intensity. Pain: change position and avoid loading painful sites. Dyspnea: use intervals, pacing, and breathing exercises. Neuropathy: balance training, sturdy footwear, avoid extreme temperatures. Lymphedema: compression per therapist guidance and gradual progression. Nausea: avoid large meals before exercise. Diarrhea: emphasize hydration. Immunosuppression: avoid crowded spaces and clean equipment.
Bone metastases: avoid high-impact, twisting, and heavy loading over affected sites. Ostomies and catheters: secure the device, avoid direct pressure, empty before exercise. Stop the session for chest pain, dizziness, new dyspnea, palpitations, confusion, or desaturation.
Trap
Numeric thresholds for platelets, hemoglobin, and neutrophils differ by institution; a memorized universal cutoff is a classic distractor.
Worked example
A client on chemotherapy reports a temperature of 38.3°C and chills. No exercise; urgent medical contact.
Rule of thumb
Modify by symptom, not by diagnosis label - and when a safety question is unresolved, the session waits.