Is hiking safe for people with cancer? Practical guidance and precautions

Hiking is often safe and can be beneficial for many people living with or after cancer, especially when tailored to current health, treatment stage, and energy levels. Light-to-moderate outdoor walking is commonly encouraged to help reduce cancer‑related fatigue and improve quality of life. ^[1] Major cancer organizations recommend staying active and avoiding inactivity, with a general target of about 150 minutes of moderate aerobic activity per week when feasible, adapted to your condition. ^[2] If you are in treatment or recently completed it, hiking plans should be individualized with your care team to account for infection risk, blood counts, side effects, and medication considerations. ^[3]

---

Why hiking can help

• Fatigue relief: Gentle exercise like walking can increase energy and reduce cancer‑related fatigue, which often does not improve with rest alone. ^[1]
• Physical function: Regular activity supports mobility, strength, and mood during and after treatment. Guidance for cancer survivors favors consistent moderate activity across the week, adjusted to tolerance. ^[2]
• Mental health: Nature exposure and rhythmic movement can lower stress and improve sleep, which are commonly affected during treatment. Outdoor aerobic choices such as walking are highlighted as accessible and helpful. ^[4]

---

When to postpone hiking

• Neutropenia (low white blood cells): If your absolute neutrophil count is very low (often below about 500 cells/mm³), your infection risk is high and extra precautions or temporary activity limits are advised until counts recover. ^[5] Infection risk typically peaks 7–12 days after chemotherapy doses, so plan activity cautiously during this window. ^[6]
• Fever or signs of infection: A temperature at or above 100.4°F (38°C) warrants medical assessment, and outdoor activity should be deferred. ^[5]
• Severe anemia, extreme fatigue, or uncontrolled symptoms: If you are breathless at rest, dizzy, or have chest pain, pause hiking and check with your clinician. Programs for activity during and after treatment recommend scaling intensity down during periods of high fatigue or treatment‑related symptoms. ^[7]
• Open wounds or high bleeding risk: If your platelets are low or you are at bleeding risk, uneven terrain may be unsafe; discuss with your team before hiking. General advice during low counts includes avoiding activities that increase injury or infection exposure. ^[8]

---

Core precautions for safer hiking

Plan conservatively

• Start short and easy: Choose flat, well‑maintained trails and increase distance gradually as energy allows. Activity guidelines emphasize returning to daily movement and building to moderate intensity over time. ^[2]
• Go with a buddy: Having someone with you helps with pacing, safety, and support if symptoms arise. Outdoor exercise is encouraged with attention to sensible spacing and safety practices. ^[4]

Protect against infection

• Avoid crowds and sick contacts: Pick less busy trails and keep physical distance from others, especially during periods of lower immunity. ^[4]
• Hand hygiene: Carry alcohol‑based sanitizer; clean hands before eating and after touching shared surfaces like gates or railings. ^[3]
• Timing matters: If you receive chemotherapy, plan hikes outside the highest‑risk days (commonly days 7–12 after infusion) when possible. ^[6]

Manage fatigue and energy

• Use the “talk test”: Aim for a pace where you can talk but not sing; this indicates moderate intensity appropriate for many survivors. ^[9]
• Rest and refuel: Take frequent breaks, hydrate, and eat small snacks; fatigue improves with gentle, consistent effort rather than pushing hard. ^[1]
• Listen to symptoms: If you feel unusually weak, dizzy, or short of breath, stop and reassess; resume on an easier route next time. Activity should be tailored and scaled during periods of high fatigue. ^[7]

Sun and skin protection

• Sun sensitivity: Some cancer therapies and common medicines increase sun sensitivity; effects can persist after treatment. Use broad‑spectrum sunscreen, protective clothing, hat, and sunglasses, and avoid peak UV hours. ^[10]
• Skin care: Check feet for blisters, keep skin clean and dry, and treat minor cuts promptly to reduce infection risk. People with lowered immunity should avoid exposures that increase infection risks from breaks in skin. ^[8]

Altitude, temperature, and terrain

• Altitude: Higher elevations can worsen breathlessness and fatigue; start at low elevations and progress slowly. Guidance emphasizes choosing routes that match current stamina and health status. ^[2]
• Heat or cold: Extreme temperatures add strain; pick mild weather, layer clothing, and carry extra water. Outdoor exercise is feasible with sensible adjustments and separation from others. ^[4]
• Stable footing: Uneven trails can raise fall risk if you have neuropathy, weakness, or balance issues; consider trekking poles and supportive footwear. Activity recommendations favor safe, manageable exercise modes. ^[2]

Medication and treatment considerations

• Photosensitizing drugs: Antibiotics (e.g., doxycycline), certain anti‑inflammatories, and many cancer therapies can increase sun sensitivity use strict sun protection and discuss timing with your clinician. ^[10]
• Blood counts: If told you have neutropenia or low platelets, follow your team’s precautions closely and adjust or delay hiking as advised. ^[5] In low white count periods, avoid gardening or soil handling, and minimize infection exposures. ^[8]

---

Practical hiking checklist

• Check with your care team if you are in active treatment, have low counts, or new symptoms; ask about the best timing and intensity. ^[3]
• Pick an easy, familiar route and let someone know your plan and expected return time. ^[2]
• Carry essentials: water, snacks, sun protection, hand sanitizer, a charged phone, and any urgent medications. ^[4]
• Use supportive shoes and consider poles if balance or neuropathy is an issue. ^[2]
• Monitor during the hike: pace by the talk test; stop for fever, chest pain, severe shortness of breath, dizziness, or bleeding, and seek care if needed. ^[9]

---

How to start if you’re new

• Begin with 10–15 minutes of gentle walking on flat paths, 3 days per week, and add 5 minutes as tolerated until you reach your comfortable goal. ^[9]
• Integrate light strength work (like simple bodyweight moves) on non‑hiking days to support joints and balance. Including strength training at least 2 days per week is broadly advised for survivors. ^[2]
• Expect variability: Energy can fluctuate during treatment; adjust day by day and celebrate consistency over intensity. Even small amounts of regular activity are beneficial and preferable to inactivity. ^[2]

---

Bottom line

Hiking especially easy, well‑paced walking outdoors can be a safe and helpful form of exercise for many people living with cancer, provided you tailor it to your current health and follow sensible precautions. Focus on infection prevention, sun protection, pacing for fatigue, and route safety, and coordinate with your oncology team if you have low counts or are in active treatment. ^{[4] [5]} With these steps, most people can enjoy the physical and mental benefits of time on the trail. ^{[1] [2]}