Exercise and ADT: 6 ways to reduce the side effects in prostate cancer

Exercise and ADT: 6 ways to reduce the side effects in prostate cancer

Have you heard about how exercise and ADT should go together like sausages and bread? Research has shown exercise can help to reduce side effects of this treatment (without influencing the effectiveness of the drug). Prostate cancer, unfortunately, needs male hormones (androgens such as testosterone) to thrive, so one of the main types of drug therapy for this disease is androgen deprivation therapy (ADT). These medications aim to reduce or block the effect these hormones have. Whilst it can be an effective treatment, reducing the amount of testosterone in a man’s body does have a significant impact in the form of confronting side effects such as weight gain, loss of muscle mass and menopause-like symptoms. Here is a look at 6 different ways exercise can help you deal with treatment side effects:

 

1. Exercise and ADT: Improving body composition whilst on ADT

As a typical side of effect of ADT, men may notice an increase in abdominal fat and reduction of your muscle mass. However, did you know that exercise can lessen the change in your body composition? Research shows that if men complete 2-3 sessions of progressive resistance training per week, they will minimise the loss in muscle mass and strength. If men were taking ADT for a short time (3 months), a combination of moderate to high intensity aerobic and resistance training will help prevent changes in fat mass. However, if men are using ADT over a long period of time, they will have to also make changes with their diet to see changes in your fat mass.

 

2. ADT can impact your strength and endurance: Exercise can help!

ADT and the lack of testosterone can impact their day-to-day capacity/endurance and as such can affect their ability to do the fun things in life (playing with grandchildren, working in the shed, catching up with friends etc). The great news is exercise can help! Whilst it is not new that exercise can help keep everyone feeling fit and capable, the interesting thing is that the sooner men start/continue once ADT is commenced, the less ADT related capacity you stand to lose.

 

3. ADT can lead to excessive fatigue, but did you know exercise is one of the best treatments?

Due to the decline in androgen production (ie: testosterone) and other cancer-related issues, men may notice an increase in their fatigue levels. This may mean they do not feel as able or motivated to live life as they used to. Whilst it may be counterintuitive, research shows that progressive exercise (building up to 150mins per week) is arguably the BEST medical management strategy to reduce fatigue. That being said, it is important to learn how to regulate how much they do depending on how they feel. One day they may find the walk to the letterbox is moderately hard, whereas another day they may be able to complete a full 30 min moderate intensity brisk walk. Interestingly, the higher the fatigue levels, the greater the benefits from exercising.

4. Keeping the bones strong is really important when on ADT

Another side effect of ADT is a possible reduction in bone mineral density (and may even lead to osteoporosis and bone fractures). Preliminary research shows that at least 2 sessions of resistance training per week can mitigate losses in bone density. However, this exercise needs to be reasonably heavy and “impact” the bone – we want to challenge the bone enough to increase its density. We recommend that exercise is slowly progressed to this impact exercise so as not to increase the risk of injury.

 

5. Exercise can reduce your risk of other diseases whilst on ADT

Men are already dealing with a lot thanks to a prostate cancer diagnosis. SO it is important to note that due to the changes in hormone levels and a combination of other factors, there is an increased risk of developing other metabolic conditions such as type 2 diabetes, cardiovascular disease and high blood pressure in men on ADT. There is preliminary research showing positive changes in blood sugar, cholesterol and triglyceride levels. In other cancer populations, they have shown that exercise can provide a protective effect against the cardiometabolic diseases. So to reduce the burden, get on your bike!

Beliefs and Health Outcomes

 

6. Other side effects from ADT can be impacted by exercise

There are a few other benefits, which are fantastic for men on ADT! Did you know that new evidence suggests that exercise may help to preserve sexual activity and libido and lessen declines in sexual function? It may improve mood and reduce psychological distress, anxiety and depression. Finally, observational data suggests that is may even reduce the risk of dying from prostate cancer and even improve overall lifespan. If we could put all these benefits into a pill, would you take it?

 

The when, where and how of exercise for men undergoing ADT?

For many men, they are not exactly sure where to start, so here are a few ways:

  • You can visit an accredited exercise physiologist who specialises in treating those with cancer who can set you up with an individualized program. This will help give you the tools and knowledge to exercise and get the benefits from it.
  • There are a few online programs that can guide you if you do not want to or do not have the resources to visit an exercise specialist. Check out online!
  • If you are comfortable exercising on your own, you can get straight into it. Much of the literature prescribes 2-3 resistance training exercise sessions per week plus building up to 150 minutes of moderate intensity aerobic exercise per week (but remember that you do not want to go to hard to quickly – building up is the best way!)

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22 benefits of an iNform session

22 benefits of an iNform session

What makes YOU exercise? (Other than your trainer)

We all know that exercise is good for us. Some of us exercise for particular reasons and to get certain benefits over others. Whilst some of us exercise with goals in mind like running a half marathon or just being able to pick up our grandkids. Or it might just be that this our time for ourselves each week. Whatever the reason you exercise, and whatever form of exercise you do, for whatever amount of time you do it for; I pat you on the back for the fact that you do it!

The World Health Organisation has released some fresh data last week showing almost one third (30.4%) of Australians aren’t getting enough exercise. Out of 168 countries, we ranked 97th for the % of population being sufficiently active. Which is scary considering physical inactivity is so highly associated with chronic health problems.

Just one type of exercise we do: Resistance Training (aka strength training or weight training)

This is what most clients at iNform typically spend the majority of their session doing. It can look like anything from body weighted strength, focusing on alignment and control, to lifting very heavy weights only a handful of times. The person that hasn’t broken a sweat all session, and the person that is drenched in sweat at the end of the session – have both engaged in strength training. It looks completely different for everyone. That’s the beautiful thing about strength training, it can be adapted and individualised just for you and your body’s specific needs.

For those who are reading this that are regulars at iNform, you will know better than anyone the effects that training with us has. Hopefully from brightening your mood and giving you a giggle, to helping increase your body awareness, getting you stronger and facilitating better movement throughout life’s activities. But for those who maybe don’t know all of the amazing benefits that strength training alone can have on your body; I have made a nerdy little list below. Please feel free to share this with your friends and family members who maybe aren’t quite convinced on exercise, there’s something in here for everyone!

Your 30 minute session at iNform…

Mentally

  • Improve focus
  • Improve cognitive function
  • Decrease anxiety
  • Decrease depressive symptoms
  • Improve feelings of well-being
  • Increases self-esteem
  • Decreases risk of dementia

Metabolically

  • Decrease markers of inflammation (particularly in people who are overweight)
  • Decrease cholesterol
  • Decrease blood pressure
  • Improve insulin-swings for those with type 2 diabetes
  • Improves insulin-sensitivity
  • Boosts metabolic rate
  • Reverse ageing factors in mitochondria and muscles

Musculoskeletally

  • Increases bone mineral density (and prevents bone loss)
  • Increases muscle mass
  • Improves movement control
  • Reduces chronic lower back pain
  • Reduces arthritic pain
  • Reduces pain from fibromyalgia

Functionally

And I guarantee I have left some benefits out.

How can you get all these benefits, plus more? (we didn’t even look at the benefits of aerobic exercise!)

If you would like to start getting more out of your resistance training sessions, or if you’re wanting to start resistance training but you have some niggles that bother you, I recommend getting in touch with one of our amazing movement specialists who can help find the right exercises for you!

If you would like more information on particular benefits and which study I sourced it from, feel free to email me at: [email protected]

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Exercise and chemotherapy: 7 key reasons why they should go hand in hand!

Exercise and chemotherapy: 7 key reasons why they should go hand in hand!

Chemotherapy is prescribed to do a great number of things: to cure, aid other treatments, control the cancer, and help with symptom relief. It is a powerful tool, but as everyone knows, it brings with it a vast array of challenges, both during your cycles and after. But where does tailored exercise fit into this? Is it possible to stay active whilst undergoing chemo, and why on earth would you want to?

The plain and simple fact is that there is a growing body of evidence that shows tailored exercise during chemotherapy can reduce unwanted side effects, limit de-conditioning, AND now it is also being found to aid treatment. So, why are we not prescribing exercise like a drug? Why are we still not using it to its potential? Well, let’s talk about the benefits first…

1. Exercise creates a reduction in chemotherapy related neuropathy symptoms

Neuropathy is a relatively common side effect of chemotherapy. Essentially, it effects the hands and feet, creating symptoms like numbness, tingling and pain, cramping, difficulty handling small objects, and issues with gait and balance. Unpleasant! Multi-modal exercise, such as resistance exercises coupled with low to moderate intensity aerobic exercise like walking, creates significant reductions in both the severity and prevalence of neuropathic symptoms. Now that sounds to me like a pretty useful treatment!

2. Exercise reduces cancer related fatigue

Chemotherapy is associated with a crippling fatigue, known as cancer related fatigue. This can have a sudden onset and can impose a significant physical burden. It is also psychologically draining as it often means you are unable to do the things you love, and can impose a financial burden due to missed days as work. There are now hundreds of studies that show that exercise reduced fatigue levels. If you would like to know more, read my previous blog “Cancer related fatigue: Does exercise help or hinder?

3. Exercise reduces de-conditioning

Research has shown that the loss of rapid muscle mass is accelerated 24-fold during chemotherapy in comparison to healthy people. It is no wonder people undergoing chemo feel fatigued when they lose so much muscle, so quickly. Luckily we have a treatment for that! Specific resistance training has shown to minimise this loss of strength. Completing targeted strength training means that carrying your children, doing the shopping, getting out of the car doesn’t become so fatiguing. That has to improve your quality of life.

4. Exercise reduce risk of cardiovascular disease

Due to the direct toxic effects of anti-cancer therapies as well de-conditioning, people undergoing chemotherapy have a risk of developing cardiovascular diseases such as heart failure, stroke, and coronary heart disease. A study in 2016 found that post-diagnosis exposure to exercise was associated with substantial reductions in newly diagnosed cardiovascular diseases or cardiovascular related death. That is massive!

5. Improved completion rates of treatment

Now, oncologists provide treatment doses based on what they think will create the best chance on achieving the treatment goal. However, completion can depend on how well you can withstand the treatment and it’s side effects. So, given that exercise therapy can reduce general pain levels, cancer related fatigue, and neuropathy it makes sense that it allows more people to fully complete treatment. This can give you the best chance of survival!

6. Exercise reduces risk of death

If you exercise when diagnosed with cancer, you will reduce your chance of dying. I know that is a massive statement, but a review of 71 studies in 2015 found that exercise was linked to reduced mortality in breast, colorectal, and prostate cancers (those were the only cancers these studies focused on). In one of those studies they found mortality reduced by 24%, 32%, 39% and 40% when individuals participated in low, moderate, vigorous and very vigorous activities respectively. What they essentially found was that there was a dose response relationship with exercise and mortality. Therefore, some exercise is definitely better than none and more is better than less. It depends on personal side effects of your chemotherapy treatment.

7. There are always caveats to exercising whilst undergoing chemotherapy

It is important to be aware of the caveats to exercising while undergoing chemotherapy. Exercise must be tailored to the current functional status and capacity of each individual patient and then must be progressed and regressed based treatment cycles. Overstretching areas around catheters should be avoided. Stoma’s should be cleaned before and after sessions and if you are feeling feverish. It is also important to monitor acute changes in your pain levels, gastrointestinal disorders (nausea, vomiting diarrhoea etc), changes in heart rate, and blood pressure and breathing rates.

As we mentioned, exercise prescription must tailored to the current functional status and capacity of each individual patient. Typically you can exercise directly after each chemotherapy dose but usually once side effects really hit, intensities will need to be modified. For the same reported feelings of exertion, your exercise may change from being able to jog around the block, to being able to walk to the mailbox. Then, as you progress through your cycle, your intensity can increase. Just remember, exercise may sometimes feel like the last thing you want to do, but just like any good medicine, it will help when prescribed appropriately!

If you have any questions regarding how and when you can use exercise, please feel free to contact Holly on 8431 2111.

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Strength Train Your Blues Away

Strength Train Your Blues Away

Can we use Strength Training for depression?

Any keen gym goer would have heard of the film “Pumping Iron” – and the subsequent revolution of Bodybuilding. Besides from being built like Hercules and having a positive-B sample, Strength Training has a lot of wonderful benefits for men and women. But what about Strength Training for depression?

Well, a recent meta-analysis published in the journal: JAMA Psychiatry may have just eluded some neat findings for Strength Training as an adjunct for reducing depression. The meta-analysis included: 33 clinical trials, with 1,877 participants. Gordon and colleagues found: “resistance exercise training was associated with a significant reduction in depressive symptoms.”

Promising news. However, there are limitations to consider… “total volume of resistance exercise training, health status and strength improvements were not associated with an antidepressant effect”.

So what could be some potential hypothesis that are contributing to the antidepressant effects experienced by the participants?

 

Filling in the gaps for using Strength Training for depression

First and foremost – we are born to move! When are ancestors became bipedal – moving to find food, water and shelter was essential.

And what happens when there is an unexpected reward? Dopamine is released, which causes a surge (reward dependent) of this wonderful catecholamine increasing the likelihood that the behaviour will be repeated – such as moving to find more resources, or more dumbbells!

Secondly, Strength Training has noteworthy benefits in the release of particular growth hormones and hypertrophic increases in muscle tissue. It would be plausible that an increase in testosterone, along with bigger muscles, would most definitely increase motor behaviour (going to the gym), along with libido (I will leave you with your own imagination). Which would equate to more energy being utilized, while also affecting higher cognitive regions in the frontal lobe improving: attention, motivation and reduced impulsiveness. The same areas of the brain that are inhibited by depression!

Lastly, although are ancestors missed out on dubstep, listening to music whilst exercising greatly activates many brain regions, along with an endogenous release of natural opioids that increase euphoria. I can see Hippocrates prescribing dubstep for his melancholic patients…

So hopefully I’ve filled in some missing gaps in the aforementioned meta-analysis that would be difficult to quantify.

 

Key take home points when using Strength Training for depression:

  • Work with an accredited Exercise Physiologist/Scientist – to move with confidence. While also being guided about specific exercise prescription for your current goals, or medical condition.
  • Make a sweet as music-playlist to increase baseline mood when Strength Training.  Creating your own playlist will likely increase adherence to Strength Training along with enjoyment and motivation.
  • Lastly, always consult your GP – if you are currently inactive, and wanting to increase your physical activity levels. The team at iNform can assist you from there onwards.

James

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Cancer related fatigue: Does exercise help or hinder?

Cancer related fatigue: Does exercise help or hinder?

Have you ever been too tired to walk up your stairs, eat, or even go to the toilet? Welcome to the life of individuals with cancer related fatigue.

Fatigue is one of the most common and debilitating side effects of cancer treatments that presents itself before, during, and after treatment. A 2007 study found that 80-90% of people undergoing radiotherapy and chemotherapy reported experiencing incapacitating fatigue. Of those, approximately 91% felt they could not lead a normal life, participate in social activities or perform simple intellectual tasks. 75% had to change employment status and 65% needed their caregivers to take at least one day off per month. Worse still, many of these people can suffer similar symptoms long after the treatment has ceased.

What is cancer related fatigue?

Cancer related fatigue is unlike anything the apparently healthy individual has usually ever felt. The sense of utter exhaustion that you feel is disproportionate to the amount of effort produced. For a once fit individual, that can mean that a walk to the letter box produces the fatigue levels that are only imagined after completing an Ironman event (1 x 3km swim, 1 x 180km bike ride topped off with a marathon). The most disconcerting thing about cancer related fatigue is that rest or sleep does not always help alleviate symptoms.   On top of that, because the causes are not well understood, treatment is not always straight forward.

If that is that case, shouldn’t I rest rather than exercise?

Well this is where it gets interesting! Research has now shown that exercise should be used as part of a patient’s oncology treatment schedule. Not surprisingly, results show an increase in strength and capacity, especially in cases of breast, prostate, haematological, and colorectal cancer. However, one of the unexpected outcomes of these studies has been the effect of exercise on fatigue levels. It was first measured due to concern that exercise would exacerbate cancer related fatigue levels, BUT the results proved very interesting… It in fact showed the opposite!

A systematic review from South Australia showed that out of the 47 studies identified relating to exercise and cancer related fatigue, 32 found exercise to significantly reduce cancer related fatigue! In fact, there were no significant studies that didn’t favour an exercise intervention for improving cancer related fatigue.

So… exercise reduces your levels of cancer related fatigue!!

How exactly can exercise help?

As there is still no single definitive cause of cancer related fatigue, determining the physiological reasons as to why exercise is so effective is pretty difficult. When you begin treatment, just the thought of exercise would probably make you feel exhausted. However, if we look at the flip side, we know that without a doubt inactivity leads to increased fatigue. Exercise reduces the distance you can walk without puffing and also the amount you can lift. So therefore, movement allows you to complete all those activities quicker and for a longer period of time.

There are also theories around surmising that resistance training can prevent the dysregulation of our immune system and helps maintain our energy currency (ADP). All of which can be disrupted when we begin muscle wastage. Big words I know! The main take away message is that moderate exercise can increase your capacity to function, improve your quality of life, decrease risk of depression and anxiety, and decrease cancer related fatigue!

What exercise should I do to reduce fatigue levels?

Before we answer this question, I would like to make a caveat… The definition of exercise (and its intensities) is very broad. What a healthy individual calls exercise can be different to what someone undergoing treatment or who is now a survivor does. Also, no two cancers are the same and so no two exercise prescriptions are the same. It should be based on factors such as your cancer diagnosis, side effects, and treatment type, timing and trajectory. Plus your age, current activity levels prior to diagnosis and previous injuries and illnesses.

With all that in mind, research has shown that a combination of both types of training is recommended for you during and post treatment. So far the evidence says that best case scenario is twice a week progressive (60-80% 1RM) resistance training (lifting/moving heavy objects).  Adding to two-four times of moderate aerobic (huff and puff) exercise (40-60% max). If you have just undergone a chemo cycle that may be 2 x 5 minutes of a home-based program. This may include sit to stands, wall push ups and a single leg dead lift. If you are feeling strong that maybe 2 x 45 minutes of supervised gym using weights.

Do I need to train throughout my whole treatment?

Interestingly, timing and duration of the activity may be important since one of the biggest effects on fatigue was observed when the exercise intervention lasted until the end of the treatment. So, ensuring you move throughout the entire treatment period/s can decrease your cancer related fatigue by up to 50%. That could mean the difference between getting to the toilet, being capable to watch your children play sport, or even feeding yourself.

If you are unsure about how to begin or keep exercising as you undergo treatment, please feel free to give us a call or an email and we are happy to chat!

REFERENCES:

Brown 2010, Efficacy of Exercise Interventions in Modulating Cancer-Related Fatigue among Adult Cancer Survivors: A Meta-Analysis. The Journal of Cancer Epidemiology and Biomarkers

Curta et al 2000, Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition. The Oncologist vol. 5 no. 5 353-360

Maloney, L 2016, A summary of meta-analytic evidence on the impact of exercise on cancer related fatigue: An umbrella review.

NCCN 2016, Cancer-Related Fatigue, https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf

The big ‘O’ word: Osteoporosis and Exercise

The big ‘O’ word: Osteoporosis and Exercise

Osteoporosis is a global disease in which the remodelling process (replacement of new bone for the old) results in an excessive loss in bone mass. This issue here is that it leads to an increase in our fracture rate (and severity), musculoskeletal impairment and mortality.

 

Why should we care about Osteoporosis?

By 2022, it is estimated there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia. That is a 31% increase from our 2012 figures! Improving our lifestyle factors such as eating a well balanced diet, not smoking, minimising alcohol consumption and engaging in regular exercise are the easiest and most cost effective treatments in reducing our risk. Although osteoporosis is determined primarily by genetic factors, our environmental and lifestyle choices can modify around 30% of  ourbone mass, 

Women have higher risk of osteoporosis than men. Why the gender gap?

 

Did you know that women start with a lower bone density than their male counterparts. This becomes especially evident in postmenopausal women due to the decreased levels of estrogen production. This is because estrogen helps regulate a woman’s reproductive cycle as well as plays a role in maintaining bone density.

 

So what is actually happening in our body?

Human bones are constantly changing, our old bone cells are being replaced with new cells. The removal of old bone is controlled by cells called osteoclasts, while the formation of our new bone is controlled by cells called osteoblasts. Like a simple mathematical equation, bone growth is achieved when there is higher activity of osteoblasts. This is present in children up to early adulthood, where it peaks by 20 years of age. From our 30’s  this process starts to reverse, which is why it’s so important to maintain bone strength through proper diet and physical activity.

The role of exercise in osteoporosis is well known, especially in promoting calcium intake, maintaining bone mass and strengthening the functionality your bone. Regular exercise is believed to be the most important factor to increase or maintain bone mineral density (BMD). Basically the mechanical forces placed in the skeletal system when you exercise stimulate bone size, shape and strength. 

 

So what about Osteopeania then?

Osteopenia refers to a decreased BMD, but not low enough to be classified as osteoporosis. Having osteopenia means that there is a greater risk that you may eventually develop osteoporosis.

 

Good news

Well the good news is that osteopenia is reversible. A balanced diet and regular resistance based physical activity will help slow the loss of bone density and delay or better prevent osteoporosis. So lift some weights, get some sun and eat healthy to give yourself the best chance of maintaining a healthy BMD and decreasing the risk of fracture.