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Exercise and Prostate Cancer

The rising rate of prostate cancer necessitates developing better methods to prevent and treat prostate cancer. Prostate cancer is the third leading cause of cancer death among U.S. men, according to the American Cancer Society. The country’s 3.3 million prostate cancer survivors account for 21 percent of all cancer survivors.

There are many reasons why a cancer patient should stay as active as possible through cancer treatment and recovery. I will begin by pointing out a few studies that show how exercise can benefit cancer patients.  These studies demonstrate how exercise can reduce certain side effects from treatment, increase energy, decrease stress, and improve quality of life. In the last article of this series, I will suggest ways to develop an exercise program that is based on an individual’s needs and is safe and effective.

There is evidence to support the use of exercise in prostate treatment. Exercise plays a role in the all around improved physical and mental health and therefore should be considered in the treatment plan. We know that exercise can decrease recurrence for some cancers and the role it plays in weight control, which is correlated with some cancers. For prostate cancer specifically, data indicates that obesity increases the aggressiveness of prostate cancer, and thus mortality. Men receiving androgen deprivation therapy are at higher risk for depression. Exercise reduces depression.

Studies do have their limitations.  Some use self-reported data about lifestyle and exercise. Moreover, there may be a low number of minority participants who may often have higher cancer rates. The following are a few of the published studies, which confirm that exercise should be included in the treatment plan for prostate cancer patients.

Studies have suggested that patients with high levels of physical activity had a lower rate of disease progression and also reduced mortality from prostate cancer. Ying Wang, PhD, a senior epidemiologist in the Epidemiology Research Program at the American Cancer Society in Atlanta, and colleagues analyzed data on 10,067 men diagnosed with non-metastatic prostate cancer between 1992 and 2011.  Men with prostate cancer, which hasn’t spread may have longer survival the more they exercise.  A study demonstrated that men who were the most physically active had a 34% lower risk of dying from prostate cancer when compared with men who were the least physically active. Men who either maintained or increased their exercise level also benefited. Prostate cancer patients who kept up a moderate to high level of physical activity also had better survival prognoses compared with their more sedentary counterparts. Those men who were more active before diagnosis were more likely to have lower-risk cancer tumors and a history of prostate screenings. They were also leaner, more likely to be nonsmokers and vitamin users and they ate more fish. Wang concludes, “Our results support evidence that prostate cancer survivors should adhere to physical activity guidelines, and suggest that physicians should consider promoting a physically active lifestyle to their prostate cancer patients.”

Androgen Deprivation Therapy leads to numerous side effects, which can be decreased through exercise. Side effects of ADT include loss of muscle, increase in fat mass and osteoporosis. Risk for diabetes and heart disease also increases.  Brian Focht, reported at the November AICR convention, that functional ability increased dramatically as did quality of life for those that exercise, and side effects of ADT were reversed.

Exercise can decrease blood sugar levels, which lower insulin levels and also helps to lower inflammation. There does appear to be a positive association between insulin levels, inflammation and prostate cancer risk.

The evidence for physical activity in reducing anxiety and depression, while increasing general-well being is fairly substantial.  Improving well-being can have a dramatic beneficial effect on sexual function.  Consistent exercise will also help to lower insulin, blood sugar, and improve overall cardiovascular health, all of which have positive impact on erectile dysfunction and libido.

In 2016, Rider and Wilson studied the connection between ejaculation and prostate cancer, which was published in European Urology. Men that reported higher ejaculatory frequency were less likely to be diagnosed with prostate cancer. This study showed a beneficial role of frequent ejaculation particularly for low-risk disease.

Some doctors have traditionally told patients to rest during this time but Favil Singh’s research confirms the importance of getting fit prior to surgery. Singh’s research published in the journal Integrative Cancer Therapies has shown that a regular dose of physical activity prior to surgery helps the recovery process. This reduces time in the hospital.

Singh stated “This is the first time we’ve been able to demonstrate the benefits of ‘pre-habilitation’ for prostate cancer patients. It is safe, side effect-free and can be done while undergoing chemo or radiotherapy. Just two sessions a week of resistance and exercise training for six weeks can make a difference to recovery.”

Often, there is a waiting period in between diagnosis and surgery. If fitness level can be improved before surgery the patient, then the patient goes into the surgery stronger and may have a better recovery.

The American Cancer Society and American College of Sports Medicine recommends at least 150 minutes of moderate physical activity or 75 minutes of vigorous exercise each week. This advice is a good goal for those who have been inactive. Unfortunately, in my view this is insufficient for a significant number of cancer patients. Having worked with cancer patients for over 20 years, I believe that this recommendation needs to be changed. It is impossible to include aerobic exercise, strength training, and other exercise methods in the current recommended time frame. 


Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist. Visit her website, carolmichaelsfitness.com

References:

Steven C. Moore PhD, et al, Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016; 176(6): 816-825.

Lynch B.M., Dunstan D.W., Vallance J.K., Owen N. Don’t take cancer sitting down: A new survivorship research agenda. Cancer. 2013, Jun 1; 119(11): 1928-35 Medicine

Kristina H. Karvinen, Kerry S. Courneya, Scott North and Peter Venner, Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study, Cancer Epidemiology and Biomarkers Prevention May 2007, 10.1158/1055-9965

Gopalakrishna et al, Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review. Journal of Cancer Survivorship, 2016 (5): 874-82

Vallance, J., Spark, L., & Eakin, E.. Exercise behavior, motivation, and maintenance among cancer survivors. In Exercise, Energy Balance, and Cancer (2013) (pp. 215-231). Springer

Cannioto et al., The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis, Cancer Epidemiology, Volume 49 August 2017

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012; 14(11): CD006145.

Booth FW, et al., Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2): 1143-211.

Stephanie Cash et al, Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study. Cancer Epidemiology, Feb 2013,37(1): 46-53

Hwang, Yunji MS; Lee, Kyu Eun MD, PhD; Park, Young Joo MD, PhD; et al, Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study, Medicine, March 2016, Mar; 95(9): e2893

Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011; 4: 486-501.

Galvao, et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan 10; 28(2): 340-7.

Galvao, et al. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007; 10(4):340-6.

Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jan; 96(1): 7-14.

Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165: 1005-1010.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012, Mar; 14(2): 204-21.

Focht, Brian C.; Lucas, Alexander R.; Grainger, Elizabeth; Simpson, Christina; Fairman, Ciaran M.; Thomas-Ahner, Jennifer; Clinton, Steven K., Effects of a Combined Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer, Medicine & Science in Sports & Exercise. May 2016:48(5S): 515.

Rider J, Wilson K.et al. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow up, European Urology. December 2016, volume 70, issue 6

Singh F. et al. Feasibility of Presurgical Exercise in Men With Prostate Cancer Undergoing Prostatectomy, Integrative Cancer Therapies (2016). DOI: 10.1177/1534735416666373

Wang et al, Recreational Physical Activity in Relation to Prostate Cancer–specific Mortality Among Men with Nonmetastatic Prostate Cancer. European Urology July 2017 online bit.ly/2tXMK6Y

bladder-cancer-ribbon

Exercise and Bladder, Thyroid and Prostate Cancers: The Impact of Staying Active

Part I: Bladder Cancer

There are many reasons why a cancer patient should stay as active as possible through cancer treatment and recovery. I will begin by pointing out a few studies that show how exercise can benefit cancer patients. These studies demonstrate how exercise can reduce certain side effects from treatment, increase energy, decrease stress, and improve quality of life. In the last article of this series, I will suggest ways to develop an exercise program that based on the individual’s needs and is safe and effective.

Introduction

Research has shown that exercise can reduce the risk of getting some types of cancers. There are numerous published studies on the benefits of exercise for those with colon cancer, breast cancer, and endometrial cancer. An American Cancer Society’s newsletter stated: “Among breast cancer survivors, a recent analysis shows that getting exercise after diagnosis was associated with a 34% lowered risk of breast cancer death, a 41% lower risk of dying from all causes, and a 24% lowered risk of breast cancer recurrence. Among colon cancer, studies suggest exercise cuts death from colon cancer and all causes, and cuts the risk of the cancer coming back by up to 50%.”

The Journal of the American Medical Association reported that exercise lowers the risk of 13 types of cancers. Since there is limited research on exercise and bladder cancer, it is important to note that the results of the study showed that those who exercised the most had a 13 percent lower risk of bladder cancer. The JAMA study is empowering because it provides further ammunition as to the importance of exercise for additional types of cancers.

Studies suggest that exercise is safe and helpful for many people who are suffering from cancer and may lower the risk of some cancers. Other health benefits of exercise are weight control, cardiovascular health, increased bone density, and decreased fatigue, stress, anxiety and depression. Exercise can improve range of motion, improve endurance, and decrease the risk of lymphedema.

Exercise helps to control obesity, which is positively correlated with several cancers. Studies have shown that weight gain increases the risk of cancer and the risk of recurrence during and after treatment. Since exercise is a crucial component of weight control which effects cancer risk, exercise needs to be considered as part of the treatment plan.

How does exercise play a role in cancer prevention, control, and cancer outcomes?

  • During exercise, epinephrine is released which helps natural killer cell infiltration.
  • Exercise may restore normal gene function and may influence tumor-suppressing genes. There is a relationship between hypomethylation and hypermethylation and cancer cells.
  • Exercise can affect hormone levels
  • Exercise reduces insulin, increases IGF-1, and decreases leptin and may have an anti-inflammatory effect.

What does the research show for bladder cancer?

It has been observed that exercise can improve outcomes for those with bladder cancer. Research conducted by J. Vallance suggests that strength training and aerobic exercise can improve psychological and physical issues for those with bladder cancer and increases the chance of survival.

In May of 2007, “Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study” by Kristina H. Karvinen et al was published in Cancer Epidemiology and Biomarkers. The authors examined the association between exercise and quality of life in a sample of 525 bladder cancer survivors. They found exercise to be negatively associated with several aspects of fatigue. The study also suggested that active bladder cancer survivors have improved mood and energy and quality of life.

In 2016, “Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review” by Gopalakrishna, reviewed the literature on the associations between lifestyle factors and quality of life in bladder cancer survivors. Their conclusion was that there is some evidence for a positive association between quality of life and physical activity.

Kellogg Parsons, MD, an associate professor of Surgery at the University of California, San Diego, discusses modifiable lifestyle factors associated with bladder cancer on onclive.com. Parsons and his team found that participants who had any amount of physical activity had improved survivorship compared to those with no physical activity.

A recent study in by Cannioto et al in Cancer Epidemiology reports an association between living a life with little to no recreational physical activity and an increased risk for bladder cancer. The study suggests a connection between being inactive and increased risk of cancer.

In summary, we know that physical activity reduces the risk of numerous diseases. Now we have additional evidence, that it may also reduce the risk of bladder cancer.

Physical Activity in Bladder Cancer Patients

The sooner the patient starts to exercise the better. Starting before surgery and treatments and continuing during treatment can lead to a better recovery with less complications and medications.

Survivorship can serve as a strong motivator to make positive lifestyle changes. Everyone’s situation is unique. Accordingly, exercise needs to be tailored to individual people, taking into account their overall fitness, diagnosis, and other factors that could affect safety.

Regular physical activity can help rebuild a patient’s strength and energy level and help manage other health related issues. Health issues like diabetes, and cardiovascular diseases are a leading cause of death in cancer survivors and those without cancer. Managing health related issues through exercise could increase survival.

Some cancers and cancer treatments may result in incontinence. A side effect of biologic treatment may include irritation of the bladder, an urgent need to urinate, frequent urination, or incontinence.

Incontinence can occur in men or women with bladder cancer and last for a short time or longer. There are different types of incontinence, ranging from mild to severe. Some examples are: stress incontinence can cause a person to leak urine during activities such as coughing, laughing, sneezing, or exercising, urge incontinence is a sudden, urgent need to urinate and continuous incontinence is not being able to control the bladder at all.

Kegel exercises strengthen your pelvic floor muscles to control urine flow. The pelvic floor muscles are comprised of the bladder, sphincter and the pubococcyges muscle. These muscles are used to stop the flow of urine. You can find your pelvic floor muscles by squeezing your sphincter and contracting the urethra to stop the flow of urine when using the bathroom.

Exercise can help control incontinence without medication or surgery. It is wise to start Kegel exercises before surgery and treatments and to work with a pelvic floor specialist.

Kegel Exercise

Perform the Kegel 10 times holding for 5 seconds each. Try to do this four times per day. Take a 5-second break between each repetition. It may take several weeks or months to be able to contract your muscles for 5 seconds at a time, or to repeat it 10 times. If you perform the Kegel several times per day, your pelvic floor strength should improve.

Tips

  • Try not to use the surrounding muscle groups in the buttocks, legs and abdomen.
  • Try to lift the pelvic floor upward.
  • You can perform this exercise in any position: standing, sitting, or lying in bed.
  • Kegels can be done at any time, such as while watching TV, waiting in line or driving.

Part 2 will focus on thyroid cancer. Contact me at caroljmichaels@gmail or go to www.CarolMichaelsFitness.com or https://www.nfpt.com/product/cancer-recovery-specialist to find out about cancer exercise programs in New Jersey and cancer continuing education courses.


Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist.

References  

Steven C. Moore PhD, et al, Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults JAMA Intern Med2016; 176(6): 816-825.

Lynch B.M., Dunstan D.W., Vallance J.K., Owen N. Don’t take cancer sitting down: A new survivorship research agenda. Cancer. 2013, Jun 1; 119(11): 1928-35 Medicine

Kristina H. Karvinen, Kerry S. Courneya, Scott North and PeterVenner, Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study, Cancer Epidemiology and Biomarkers Prevention May 2007, 10.1158/1055-9965

Gopalakrishna et al, Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review. Journal of Cancer Survivorship, 2016 (5): 874-82

Vallance, J., Spark, L., & Eakin, E.. Exercise behavior, motivation, and maintenance among cancer survivors. In Exercise, Energy Balance, and Cancer (2013) (pp. 215-231). Springer

Cannioto et al. The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis, Cancer Epidemiology, Volume 49 August 2017

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012; 14(11): CD006145.

Booth FW, et al., Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2): 1143-211.

Stephanie Cash et al, Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study. Cancer Epidemiology, Feb 2013,37(1): 46-53

Hwang, Yunji MS; Lee, Kyu Eun MD, PhD; Park, Young Joo

MD, PhD; et al, Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study, Medicine, March 2016, Mar; 95(9): e2893

Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011; 4: 486-501.

Galvao, et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan 10; 28(2): 340-7.

Galvao, et al. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007; 10(4):340-6.

Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jan; 96(1): 7-14.

Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165: 1005-1010.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012, Mar; 14(2): 204-21.

Focht, Brian C.; Lucas, Alexander R.; Grainger, Elizabeth; Simpson, Christina; Fairman, Ciaran M.; Thomas-Ahner, Jennifer; Clinton, Steven K., Effects of a Combined Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer, Medicine & Science in Sports & Exercise. May 2016:48(5S): 51

 

Exercising woman

Lymphedema: Personal Trainer Perspective

Cancer surgery and treatment often results in survivors suffering debilitating physical impairments. These can often be ameliorated by a good exercise program that has the added benefit of helping survivors to engage in those activities in which they participated prior to their diagnosis. This article addresses some of the physical side effects cancer survivors may face, including lymphedema and a series of safe and effective techniques to restore functional fitness for those with or at risk for lymphedema.

Woman holding an x-ray image

Osteoporosis

According to the National Osteoporosis Foundation, 1 out of 2 women and 1 out of 4 men over 50 will have a wrist, hip, or spine fracture due to osteoporosis. If you have osteoporosis or osteopenia you should learn how to exercise properly and safely in order to decrease the risk the progression of this disease. Effective and safe exercise can improve your quality of life, overall health, and keep your osteoporosis under control.