Fighting Prostate Cancer With Exercise (Part 2)
I Have Prostate Cancer. What Kind of Exercise is Good for Me? The short answer is: whatever you like and are able to do – because even moderate amounts help lower your risk of dying from prostate cancer and from heart disease.
Five pioneers in the study of health habits and prostate cancer took part in a PCF-sponsored panel discussion on the effects of exercise and diet in prostate cancer and survivorship. They brought good news: You don’t have to spend hours in the gym, run a marathon or lift heavy weights! There is a health benefit to even moderate exercise. You don’t have to run fast or even jog. Walking is great!
What if you don’t have a place to walk or access to a gym? That’s okay! Exercise physiologist Christina Dieli-Conwright, Ph.D., M.P.H., of Harvard and the Dana Farber Cancer Institute, and one of the experts on the panel, is conducting trials involving patients who are in this situation. She has good news: Even if you don’t have a neighborhood conducive to walking, and even if you don’t have access to fancy exercise equipment, you can still work out, right in your own home! First, talk to your doctor about what you can and can’t do. Then, “if you don’t already exercise, start slow; there is always a risk of injury,” concurs UCSF epidemiologist June M. Chan, Sc.D., who was also part of the panel. “But as you make incremental gains from wherever you start, there is a benefit.” Start walking – outside, if you can; inside, you can make a circuit from room to room or up and down a hallway. “There’s a wide variety of ways you can get the cardiorespiratory benefit that also may help slow down prostate cancer.”
Removing barriers to exercise: In recent studies of patients who lack regular transportation or access to a gym, Dieli-Conwright and colleagues have supervised patients one-on-one in their homes – thanks to Zoom! “We’ve delivered the exercise to them. They don’t have to worry about being transported to a clinical facility. We find lower-cost equipment that takes up a small footprint in the home that they can use; they get to keep it.” Examples include resistance bands, Powerblocks, or adjustable dumbbells. Their message to patients: You don’t need a lot of hardware to exercise at home. Instead, in these studies, participants are doing short intervals of high-intensity interval training – for example, 30 seconds of standing up and sitting down repeatedly. The key is “high-intensity;” on a scale of 1-10, with 10 being highest, you should be working at a level 9, regardless of the exercise. “It sounds a little bit daunting, but actually, we found that patients really enjoy it, because it is so time-efficient. You can work harder in a shorter amount of time, and then be done!”
What’s Good for the Heart is Good for the Prostate
There’s no drug so good for your overall health as exercise, Dieli-Conwright continues: “The benefits are endless – improved quality of life and physical function, muscle strength, fitness, improved cardiometabolic health.” In other words, exercise not only helps your cardiovascular system; it also improves your metabolism. It helps you lose weight and reduces the risk of diabetes.
Now, you may be thinking, my biggest concern is the cancer; why should I worry about my heart or my weight? Because cancer is not the only thing that can hurt you. “Cardiovascular disease is a huge problem in men with prostate cancer,” says Dieli-Conwright, “particularly those on androgen deprivation therapy (ADT).” In fact, many studies of exercise and prostate cancer look at improvements in cardiovascular biomarkers in the blood, and at markers of insulin resistance, as endpoints of success. The greatest benefit in both of these areas comes from combining aerobic exercise with resistance training. But Dieli-Conwright and other scientists are looking for cancer-specific endpoints, too. “There are very large clinical trials in men with prostate cancer looking at whether exercise can extend survival,” she says. “A lot of exciting work is happening.”
Urologist William Aronson, M.D., who also took part in the panel discussion, says he makes a point of talking about exercise with his patients at UCLA and at the West Los Angeles VA Medical Center – particularly those who are on ADT. One tip is to find an exercise that you enjoy and stick with it. Better yet, find a partner to do it with. Again, it doesn’t have to be anything fancy: “If they can do 30 minutes of brisk walking every day, that’s important for a number of reasons, and if they can do more, great!” He also recommends that his patients do resistance training every other day. “A lot of our patients don’t have the ability to get to the gym, but I tell them to get some bands and work on their lower body or upper body with them.”
What if you have metastatic cancer? “Exercise is still safe,” says Dieli-Conwright. “Certain precautions have to be taken when it comes to the site of metastases, particularly bone metastases, but we have had a lot of success with no adverse events in men with advanced metastatic disease. It has to be prescribed very safely, though,” and done with your doctor’s okay, “especially with resistance exercise.” But if you are cautious and progress very slowly, “the benefits can be profound.” What benefits? Gains in strength, improvements in quality of life, in depression, anxiety, sleep, and cognitive ability. In men with metastatic prostate cancer, “we don’t necessarily prescribe exercise that much differently; we just take extra precautions with safety and make sure that we have a full understanding and awareness of their medical history, so we can prescribe exercise appropriately.”
How much you can do starting out “depends on the stage and where you are in your treatment,” says Aronson. “In our practice at the VA, many of our patients are on ADT and newer hormonal therapies. They’re doing well, and they feel well.”
UCSF epidemiologist Chan reported on an exercise study led by her colleague, Stacey Kenfield, Sc.D., “specifically looking at men with advanced and metastatic prostate cancer. The study successfully demonstrated the feasibility of a remotely-monitored exercise program (done with the men in their homes), a high-intensity training program.” These results are now being leveraged for a larger, global trial, designed to look at cancer-related measures such as overall survival and progression-free survival.
One last point about exercise, prostate cancer, and your health: If you are moving, you aren’t being sedentary, and that’s a good thing. “Exercise literally is work,” says Dieli-Conwright. “It can be hard to do, and often may not be enjoyable. That’s why it’s so important to find something that you like, that motivates you to do it, and being consistent with it. Even if it’s in small doses, it’s really going to go a long way.” The key, she continues, is moving more and sitting less. “There’s exciting research coming out about interrupting sedentary behavior. Maybe we don’t need to prescribe exercise based on a certain volume: 300, 150, or even 75 minutes of exercise per week can be really daunting for somebody to hear if they’re sedentary.” It may turn out that just the act of movement itself can be helpful. “Maybe simply getting up every hour, walking down a hallway and coming back. We’re not there yet, but I think there’s something important about reducing that sedentary behavior, that sitting time, that might actually go a long way to improving your health.”
Read Part 1: Monkey Wrench in the Works: How Exercise Helps Sabotage Prostate Cancer