Physical activity during prostate cancer – treatment and beyond

September is the month to raise awareness in support of men living with prostate cancer in Canada. That support includes programs, services, and information that can help manage life with cancer and beyond into survivorship. This article highlights the importance of staying or getting active after a prostate cancer diagnosis.

Prostate cancer is the most common cancer among Canadian men. About 1 in 8 men will get this disease.¹ 

The research cannot tell us yet whether physical activity reduces the risk of getting prostate cancer.² But we do know that physical activity can reduce the effects of cancer and its treatments.

Physical activity extends life and improves outcomes

There is research showing that physical activity reduces death after a prostate cancer diagnosis by 38%.³ 

There is also strong evidence that regular physical activity during and after cancer treatment improves health outcomes and quality of life.⁴ For instance, it reduces problems that can arise during treatment and last a long time, like:

·     fatigue

·     anxiety

·     depressive symptoms

Scientists are still studying if physical activity can also help with nausea, pain, sexual function, and nerve damage from cancer treatment. While individuals receiving a life-altering cancer diagnosis have many other concerns, taking the time for physical activity can help and may have the ability to reduce the effects of cancer and its treatments.

Is it safe to exercise?

Yes. Most men can start a low-intensity aerobic and resistance training program (with gradual progression) without any additional medical clearance. If you have other health conditions, such as heart disease, peripheral neuropathy, extreme fatigue, or poor bone health (particularly if there is bone metastases) then talk to your oncologist for medical clearance.⁴ The doctor may refer you to an exercise professional who has had training in various types of cancers and their treatments. The exercise professional can modify an exercise routine to ensure it is safe for you.

A safe exercise routine can be tailored to fit each person at each stage -- during treatment, after surgery, and into survivorship. Ask if your hospital or local wellness centre has a cancer rehabilitation centre.

What kind of exercise should I do?

To maximize your health outcomes, research suggests your program should include:

·     moderate-intensity aerobic training at least 3 times a week, for at least 30 minutes and

·     resistance training 2-3 times a week, with at least 2 sets of 8 to 15 repetitions.⁴ 

It is important to include both types of exercise. Aerobic training strengthens the heart, lungs, and blood vessels. People can have a decline in their aerobic fitness during cancer treatment. Some treatments can actually increase the risk of heart disease. But being physically active can help maintain and even increase aerobic fitness.⁴ Resistance training strengthens the muscles. Losing muscle mass and muscle strength is common with cancer treatment. It is a special concern for men who get hormone therapy for prostate cancer. It can be a challenge to maintain muscle mass during this time. Resistance training can help.⁵ 

Dealing with fatigue

Anyone who goes through cancer treatment gets tired. You may be less able to be physically active as a result.

But some people find that physical activity helps with the fatigue. Many sense a pattern of when they have more energy during the week and use that time to move around more or exercise. Some even feel like physical activity helps them tolerate the treatments better.

But if you are just feeling too tired, that’s okay. Try to think about ‘sitting less and moving more’, even if it’s just standing up or light activities around the house. In other words, try to break up the amount of sitting or lying down time.

Coping with other barriers to being active with prostate cancer

Men dealing with prostate cancer treatment have other barriers to staying or becoming active⁶. For instance:

·     Bladder control (urinary incontinence), or worrying about it, may get in the way of being active.

·     Men who live in rural areas may not have access to health professionals or programs that can give them the support they need to be active.

·     Men with lower physical function or lower mental quality of life have lower levels of physical activity and its harder for them to adopt a more active lifestyle.

Below are resources that can help you overcome barriers. Whether it’s a convenient at-home video program, finding a local qualified exercise specialist or finding a group physical activity opportunity, every step you take, takes you closer to a better quality of life.

Resources:

Being Active When You Have Cancer

https://www.exerciseismedicine.org/wp-content/uploads/2021/04/EIM_Rx-for-Health_Cancer.pdf

Moving Through Cancer program for Prostate Cancer

https://www.movingthroughcancer.com/prostate-cancer

Home Exercise Program Videos from Prostate Cancer Supportive Care

https://www.youtube.com/playlist?list=PLhwf96qJqHYKFIYIogqNW1dyIRGLfrsiG

Cancer Exercise Program Directory for Canada

https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer/exercise-program-registry/?_cancer_registry_country=canada

Search for Rehabilitation and Exercise services with the Canadian Cancer Society’s Community Services Locator

https://cancer.ca/en/living-with-cancer/how-we-can-help/community-services-locator

Learn about tips to make physical activity a fun and safe part of your life with this Active Aging Canada brochure on ‘Getting Active After Cancer Treatment’:

https://www.activeagingcanada.ca/assets/pdf/cancer/consumer_brochure.pdf

Learn about the different types of physical activity and how to get started:

https://www.activeagingcanada.ca/assets/pdf/participants/get-active/active-agers-in-canada/Physical-Activity-for-Older-Adults-2021.pdf

References:

1.  Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2022. Canadian Cancer Society; 2022: https://cancer.ca/en/research/cancer-statistics.

2.  Leitão et al. The Impact of Lifestyle on Prostate Cancer: A Road to the Discovery of New Biomarkers. J Clin Med. May; 11(10): 2925. 2022.

3.  McTiernan et al. Physical Activity in Cancer Prevention and Survival: A Systematic Review, Medicine & Science in Sports & Exercise: Volume 51, Issue 6, p1252-1261, 2019.

4.  Campbell, Kristin L. et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine & Science in Sports & Exercise: Volume 51 - Issue 11 - p 2375-2390. 2019

5.  Gardner et al. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 1;32(4):335-46. 2014.

6.  Stone et al. Determinants of changes in physical activity from pre-diagnosis to post-diagnosis in a cohort of prostate cancer survivors. Support Care Cancer. Aug;27(8):2819-2828. 2019.

Liza Stathokostas, PhD

Research Director

Active Aging Canada