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Exercise During Radiation Therapy For Prostate Cancer

Physical Activity And The Person With Cancer

Radiation therapy for prostate cancer: What to expect

Research shows that for most people exercise is safe and helpful before, during, and after cancer treatment. It can help improve your quality of life as well as the energy you have to do the things you like. Physical activity may also help you cope with side effects of treatment and possibly decrease your risk of new cancers in the future.

Too much time spent resting or sitting can cause loss of body function, muscle weakness, and reduced range of motion. Many cancer care teams are urging their patients to be as physically active as possible before, during and after cancer treatment.

When You Are Living Disease

During this time, physical activity is important to your overall health and quality of life. Research shows that getting to and staying at a healthy weight, eating right, and being physically active may help reduce the risk of other serious chronic diseases, as well as the risk of a second cancer.

A healthy lifestyle might also decrease the risk of some cancers coming back. A growing number of studies have looked at the impact of physical activity on cancer recurrence and long-term survival. Exercise has been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem, happiness, and several quality of life factors in cancer survivors. Studies of people with breast, colorectal, and prostate cancers suggest that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive.

Exercise As Adjunct Therapy In Cancer Treatment

In the field of exercise oncology, i.e. the application of exercise as medicine in the oncology setting, there is consistent evidence that greater levels of physical activity, commonly defined as any bodily movement produced by skeletal muscles that results in energy expenditure , are associated with a lower risk of developing certain types of cancer as well as decreased all-cause and cancer-specific mortality for patients diagnosed with breast, colorectal, or PCa . For example, Kenfield et al. found that men with PCa who did 3h/week of vigorous physical activity had a 49% lower risk of all-cause mortality and a 61% lower risk of dying from PCa compared to men who did < 1h/week of vigorous physical activity. Furthermore, Richman et al. reported that men with localised PCa who walked at a brisk pace for 3h/week had a 57% lower risk of disease progression compared to men who walked at an easy pace for < 3h/week. This association between walking pace and reduced risk of cancer progression was independent of walking duration , suggesting that not only the volume of physical activity but also the intensity of physical activity is an important factor regarding clinical outcomes in PCa. It is important to note, however, that these findings are based on observational data and randomised controlled trials are currently investigating the impact of exercise on overall survival in patients with PCa as well as colon cancer .

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Synthesis Of Evidence On The Impact Of Exercise Intervention By Cancer Type

Twenty-nine studies were included in this study. The study selection is detailed in the PRISMA flow chart . The detailed characteristics of the included studies are shown in Table 1 and the summary of the outcome measures used is described in Supplementary Appendix 1.

ADT: androgen deprivation therapy AG: aerobic group ASM: appendicular skeletal muscle BMI: body mass index CG: control group CRT: chemoradiotherapy CT: chemotherapy Gy: grey FM: fat mass H: home-based HNC: head and neck cancer HRmax: maximal heart rate I: in-hospital IAT: intervention after treatment IDT: intervention during treatment IG: intervention group IL-1ra: interleukin-1 receptor antagonist IL-6: interleukin-6 LL: lower limb LM: lean mass MIPT: maximal isokinetic peak torque MVIC: maximal voluntary isometric contraction N/A: not available NACRT: neoadjuvant chemoradiotherapy nS: non-supervised NSCLC: non-small-cell lung carcinoma PA: physical activity PCa: prostate cancer PSA: prostate-specific antigen QoL: quality of life RCT: randomized controlled trial Reps: repetitions RG: resistance group RM: repetition maximum ROM: range of motion RPE: rating of perceived exertion RT: radiotherapy S: supervised SD: standard deviation UL: upper limb VO2: volume of oxygen consumption VO2 peak: peak oxygen uptake VO2R: oxygen uptake reserve.

Significant increase significant decrease no significant change/difference.

How Can I Strengthen My Muscles

Importance of physical activity for prostate cancer patients prompts ...

The muscle that surrounds the prostate may be weakened from cancer surgery or other treatments. This can cause urinary incontinence, which is a loss of bladder control. There are different types of incontinence, ranging from mild to severe. For example, stress incontinence can cause a person to leak urine during activities such as coughing, laughing, sneezing, or exercising. Urge incontinence is loss of urine with a sudden, urgent need to urinate, while continuous incontinence is not being able to control the bladder at all.

Kegel exercises can strengthen your pelvic floor muscles. These muscles support the bladder and bowel and are used to stop the flow of urine. Kegels are great for men with prostate cancer because they can help control incontinence without medication or surgery, as well as may improve erectile issues.

Its smart to start Kegel exercises before surgery and other treatments. To perform a Kegel, tighten and release your pelvic floor muscles. To activate them, pretend youre stopping and starting a flow of urine. Perform 10 Kegels, holding the stopping contraction tight for 5 seconds each time. Take a 5-second break between each repetition. Try to do 4 sets per day. It may take several weeks or months to work up to these recommendations.

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What Exercise Precautions Do I Need To Take

Always consult your doctor before you begin an exercise program. Prostate cancer and its treatments can cause specific side effects that may require you to modify your exercise program. If youre experiencing any of the side effects below, stop exercising and talk to a member of the health care team.

Read more exercise content on the Cancer.Net Blog.

How Can We Improve The Delivery Of Physical Activity And Exercise As Therapeutic Tools

As the body of evidence for the benefits of physical activity and exercise grows, we need to improve the mechanisms for delivering physical activity and exercise as therapeutic tools. Because many patients may not be able to afford or access supervised programs, delivery of physical activity and exercise will need to be made scalable from the supervised environments of most clinical trials to home-based programs. Therefore, providers need to be aware of strategies to encourage physical activity and exercise in the clinic.

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Physical Activity And Prostate Cancer: Impact On Disease Progression And Survival

The Prostate Cancer Lifestyle Trial suggests that lifestyle changes play a role in preventing disease progression in men with prostate cancer. A total of 93 patients under active surveillance for localized prostate cancer were randomized to an intervention arm or a control arm . After 2 years, 27% of patients in the control arm underwent further conventional treatment , compared with only 5% of those in the intervention arm . Despite preclinical data suggesting physical activity plays a role in preventing prostate cancer growth by a variety of mechanisms, there is an overall lack of long-term prospective clinical trials examining the effects of physical activity on disease progression and survival.

Exercise Adherence And Compliance

Exercise medicine for men with prostate cancer

Aerobic exercise

Fifteen of the 19 patients assigned to HBEX reported increased daily steps walked. The mean number of daily steps walked in this group was 7,222 at baseline, 11,200 at postintervention, and 12,878 at 3-month follow-up. In addition, the mean increase in daily steps walked from baseline to postintervention was 5,959 steps and from baseline to 3-month follow-up, 7,095 steps. Patients in the SC group had mean daily steps of 5,544 at baseline, 4,796 at postintervention, and 5,180 at 3-month follow-up. Their mean change in daily steps walked from baseline to postintervention was â572 steps and from baseline to 3-month follow-up, â64 steps. ANCOVAs with mean daily steps as the response and baseline daily steps as the covariate showed significantly more daily steps walked post intervention and at the 3-month follow-up in the HBEX group, compared with the SC group .

Resistance exercise

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What About My Heart Rate

Many people have been taught to measure their pulse during an aerobic workout to see whether theyve reached a target heart rate. To figure your maximum heart rate, subtract your age from 220. Multiply the result by 50% for the low end of your target range or by 75% for the high end.

There are drawbacks to this technique, however. Few people take their pulse accurately enough to make the effort worthwhile. And since your pulse drops rapidly when youre not exercising, measuring it after youve stopped wont say much about your true level of exertion. Simply paying attention to your bodys signals, such as how hard you are breathing, will tell you whether you can work harder or should slow down.

Radiation Therapy For Prostate Cancer

High energy rays are used in radiation therapy to eliminate cancer cells. Based on the prostate cancer stage and various factors, radiation therapy for prostate cancer can be used:

  • Radiation therapy can be used during the first treatment of cancer located in the prostate gland and low in grade.
  • Along with hormone therapy, you can use it as the first treatment for cancer that has spread from the prostate gland to the nearby tissues.
  • In case of cancer still exists or comes back after surgery in the prostate area.
  • When cancer is advanced, RT can assist with managing cancer and preventing the symptoms caused by prostate cancer.

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Should You Exercise If You Have Prostate Cancer

Carol Michaels is the founder of Recovery Fitness®, a nationally recognized exercise program designed to help people diagnosed with cancer recover from surgery and other treatments. She is an award-winning exercise specialist, author, presenter, and consultant. She received her degree from the Wharton School of the University of Pennsylvania. Carol has produced DVDs and created the Cancer Specialist Recovery course in partnership with the National Federation of Professional Trainers. Her book, Exercises for Cancer Survivors, is designed to help anyone undergoing cancer surgery or other treatments.

Did you know that exercise can provide health benefits for men with prostate cancer? Exercise improves heart health and bone density, as well as decreases the risk of diabetes and obesity. In addition, exercise can decrease blood sugar levels, which lowers insulin levels and inflammation. Thats important because there appears to be an association between insulin levels, inflammation, and prostate cancer risk.

The other big benefit of exercise is that it can reduce the side effects of common prostate cancer treatments, such as androgen deprivation therapy . The side effects of ADT can include muscle loss, an increase in fat mass, and the bone disease of osteoporosis. Risk for diabetes and heart disease also increases with ADT. In addition, exercise can reduce the stress, anxiety, and depression often experienced by men with prostate cancer.

Fortifying The Treatment Of Prostate Cancer With Physical Activity

Importance of physical activity for prostate cancer patients prompts ...

Colin E. Champ

1Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15215, USA

2Department of Integrative Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA

3Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA

4Department of Radiation Oncology, Leopoldina Hospital, 97422 Schweinfurt, Germany

5Relentless Fitness, Philadelphia, PA 19106, USA

Abstract

Over the past decade, significant data have shown that obese men experience a survival detriment after treatment for prostate cancer. While methods to combat obesity are of utmost importance for the prostate cancer patient, newer data reveal the overall metabolic improvements that accompany increased activity levels and intense exercise beyond weight loss. Along these lines, a plethora of data have shown improvement in prostate cancer-specific outcomes after treatment accompanied with these activity levels. This review discusses the metabolic mechanisms in which increased activity levels and exercise can help improve both outcomes for men treated for prostate cancer while lowering the side effects of treatment.

1. Introduction: Prostate Cancer, Obesity, and Metabolic Health

Minimizing excess adipose tissue and the reduction of blood glucose and insulin levels may be a potent method of reducing prostate cancer risk and improving outcomes.

3. Physiological Benefits of Physical Activity

Calories expended

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Search Strategy For Identification Of Studies

See Appendix A for detailed search strategy.

The following databases were searched for relevant RCTs, from the initiation of each individual database:

Cochrane Library

ISRTCN Registry

A manual search of reference lists of the included trials and review articles relating to exercise and prostate cancer radiotherapy was also carried out.

Calculation Of Sample Size

The target sample size of 168 patients is based on having 80% power to be able to detect a HR of undergoing curative therapy in the exercise intervention group, compared with the usual care group, of 0.35 or smaller . This is equivalent to a difference between 25% of the usual care group undergoing curative therapy within 3 years postrandomisation versus < 10% in the group undertaking the exercise intervention. A difference of this magnitude has been recommended by our practice clinicians to be clinically important. This sample size accounts for a possible 5% dropout due to clinical records not being available at study completion. This sample size will give us sufficient power to examine our secondary outcomes of interest. For example, for muscle mass we will have > 80%power to detect differences between groups of 0.8kg or greater at 6months postintervention, assuming an SD for change of ~1.5kg and 30% loss to follow-up .

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Strengths And Limitations Of This Study

  • This is a novel multicentre randomised controlled trial of 12-month supervised resistance and aerobic exercise versus usual care in men with prostate cancer on active surveillance, with subsequent follow-up of over 2 years to monitor therapeutic progression and psychological well-being.

  • The study proposed here will determine the efficacy of a comprehensive exercise programme during active surveillance in delaying or preventing patient morbidity associated with prostate cancer primary therapy. Savings to the health and medical system could be extensive with any delay in prostatectomy, radiation therapy or androgen deprivation therapy, reducing costs of current overtreatment substantially.

  • The study will be undertaken in the Australian clinical setting of prostate cancer care, and differences in active surveillance and disease progression definitions may exist within the context of other countries.

Exercise Modulation Of Tumour Perfusion And Hypoxia

Prostate Radiation Therapy

As detailed above, physical activity has been associated with a reduced risk of PCa progression and mortality . However, little is known about the underlying biological mechanisms that delay progression and improve survival in PCa patients. Potential mechanisms have been summarised by Galvão et al. and include, among others, changes in tumour vascularisation that may permit better drug delivery and oxygenation of the tumour through improved perfusion . Indeed, tumour vessel morphology has been associated with survival outcomes in men diagnosed with PCa. Mucci et al. evaluated whether tumour microvessel morphology would predict PCa mortality among 572 men in the prostatectomy cohort of the Health Professionals Follow-up Study. While greater microvessel density was associated with extraprostatic extension it was not a predictor of mortality in this analysis. However, the authors found that men with tumours containing the smallest and most irregularly shaped vessels had a ~6 times and ~17 times higher likelihood of developing lethal PCa, respectively.

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What Should We Tell Patients About Physical Activity After A Prostate Cancer Diagnosis

There is ample evidence suggesting that physical activity and exercise can be therapeutic tools for patients with prostate cancer. Patients diagnosed with localized disease should be advised to stay physically active furthermore, patients who are undergoing radiation therapy and/or treatment with ADT appear to benefit from regular aerobic and resistance exercise to alleviate side effects.

A number of observational studies and clinical trials have shown that physical activity after a diagnosis of prostate cancer is associated with a decrease in disease progression and an increase in survival, and that specific exercises reduce morbidity from prostate cancer treatments. However, providers need more guidance on what types of physical activity to recommend to patients across different disease states and treatments in prostate cancer, and when and how to initiate the discussion. In addition to evaluating important studies showing benefits of physical activity in patients with prostate cancer, this review suggests some evidence-based methods for incorporating physical activity interventions into clinical practice.

A Stronger Pelvic Floor

Exercise can help strengthen the pelvic floor area, which can become weakened after radiation therapy and surgery, says Dr. Allaf.

Doing pelvic floor muscle training can also help treat urinary incontinence after surgery for prostate cancer, according to a November 2019 review in âClinical Interventions in Agingâ.

How to Do Kegel Exercises

Kegel exercises are an effective way to strengthen the pelvic floor muscles, which sit just below the prostate. Here’s how to do them, according to Seattle Cancer Care Alliance:

  • Lie down comfortably or sit in a chair.
  • Squeeze your pelvic floor muscles using the same contraction you would use to stop your urine stream. Try to isolate the muscles by not tensing your abs or anus.
  • Hold the contraction for 10 seconds, then rest for 10 seconds. Repeat five times.
  • Perform this exercise three times a day.
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    Exercising Your Way To Recovery From Prostate Cancer Treatment

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    Do you need more help?

    Regular exercise is an essential ingredient for good health it helps our immune systems, cardiovascular systems and joints. It can help to prevent chronic disease and has well-known benefits for our mental health. An increasing body of evidence also shows us that regular exercise has an important role to play during, and after, prostate cancer treatment, and is also a vital part of Androgen Deprivation Therapy a popular, and highly effective treatment of prostate cancer.

    Exercise and prostate cancer

    Prostate cancer is the most common form of cancer in men, with upwards of 19,000 Australian males diagnosed with some form of the disease each year. Radiation, chemotherapy or prostatectomies are among the most effective methods we have for treating prostate cancer.

    Evidence shows us that while it wont cure cancer, regular exercise can prevent some cancers from developing in the first place. Theres also strong evidence that alongside keeping stress and anxiety at manageable levels, and watching your weight, regular exercise is an essential part of reducing symptoms, lessening the side-effects of radiation treatments and increasing prostate cancer survival rates.

    What is ADT? Why is it important to exercise when undergoing ADT?
    What kind of exercise will help?
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