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All movement is good movement: tips for exercising with prostate cancer

Being active has many benefits for men with prostate cancer, regardless of where you are on your cancer journey. Exercise can help to slow progression of localised cancer,1 reduce your risk of cardiovascular disease,2 relieve fatigue,3 and improve your physical, cognitive,4 and mental health.5

Intrigued? In this article, we describe evidence-based exercise guidelines for men with prostate cancer and we explore how much exercise might be right for you. We also outline some simple recommendations for integrating more activity in your day-to-day life and provide tips for staying motivated and developing a routine that you can stick with long-term.

How much exercise should I aim for with prostate cancer?

Everyone is different, so the ideal amount, type, and intensity of exercise for you is a personal choice. This will be influenced by your current state of fitness and your treatment journey so far. If you’re starting a new exercise routine, it’s important to listen to your body. Start small and take it step by step, building up your activity level gradually.

Current physical activity guidelines for people living with cancer recommend 150 minutes of moderate-intensity exercise (e.g. brisk walking) or 75 minutes of vigorous-intensity exercise (e.g. running) per week, with 2 or 3 additional resistance training sessions.6 As a general rule, moderate-intensity exercise should elevate your heart rate and breathing rate, but you should still be able to hold a conversation. Vigorous intensity exercise should make your heart rate and breathing rate increase substantially —at which point, your conversations might be limited to short bursts of just a handful of words.

What exercise should I take up?

The type of activity you choose is up to you. The key to getting active is to find activities that you enjoy and that fit into your lifestyle. Find something you like, and you’re more likely to stay motivated and keep doing it in the long term.

Research suggests that regardless of what exercise you’re doing, supervised training is more effective than self-implemented routines.7,8 One of the benefits of exercising with support is the additional motivation it can bring. An instructor can also ensure you’re performing exercises with proper form and can help to tailor your training program to your specific needs and goals. So, if it’s an option for you, undertaking an exercise program with the support of an exercise physiologist, certified exercise instructor, or with a community program is strongly encouraged. Remember, you don’t need to have a professional by your side every time you exercise. If you have the opportunity, why not arrange a weekly support session, and exercise alone or with a companion for the rest of the week?

While a supervised exercise routine using a combination of aerobic and resistance training is most highly recommended, any amount of activity is beneficial – even if it’s not considered as “exercise”. Increasing your day-to-day activity level and reducing the time you spend sitting down has numerous health benefits. Breaking up periods of sedentary activity with regular movements can help to activate your metabolism and burn more energy, helping you to maintain a healthier weight,9 putting you less at risk of cardiovascular disease, and increasing life expectancy.10 Even for those who are achieving the recommended exercise guidelines above, breaking up periods of inactivity is still recommended to reduce the health risks of a sedentary lifestyle.11

If you feel you don’t have time to fit an “exercise program” into your week, there are plenty of time-efficient ways you can incorporate more activity into your daily life. Why not try:

  • Walking to the shops
  • Commuting to work by foot or bike
  • Getting off the bus one stop earlier
  • Opting for the stairs instead of the elevator
  • Getting moving by doing household chores, such as gardening or housework
  • Taking a 15-minute walk during your lunch break or coffee break.

Should I exercise if I’m undergoing treatment for prostate cancer?

If you are undergoing surgery to remove your prostate, gentle exercise is an excellent way to assist your recovery. Take it easy in the weeks after the operation to give your body the chance to recover. Gentle exercise, like taking walks every day, is a good way to rebuild strength while avoiding complications from being inactive, such as blood clots. To start with, try taking several 5–10-minute walks throughout the day, and gradually increase your daily activity level. It’s best to avoid impact sports, strenuous exercise, and heavy lifting for 6 weeks. Following your prostatectomy, it’s common to experience leaking urine (incontinence) due to the damage to the nerves and tissues around your prostate. Men who perform exercises to strengthen their pelvic floor before and after surgery tend to experience fewer urinary problems and recover continence faster than men who don’t perform these exercises.12 We advise talking to your physician for detailed and personalised recommendations to guide your recovery.

If you are undergoing androgen deprivation therapy (hormone therapy) for your prostate cancer, exercise can help to manage treatment-related toxicities, which include increased risk of cardiovascular disease, reduced bone density, and reduced muscle mass. Regular exercise is considered well tolerated and safe, and is recommended to lessen the adverse effects of treatment.13 Consistent with the guidelines stated above, a supervised exercise program combining resistance and aerobic training is strongly recommended.7,8

If you are undergoing radiotherapy or chemotherapy, physical activity can have multiple benefits – particularly the reduction of fatigue. By moving your body frequently, you can maintain your fitness and shape better, and this can help to keep fatigue at bay. It’s highly recommended to break up periods of inactivity with regular movement, and to exercise more vigorously if you feel up to it.11 Depending on how you feel, that might just mean getting up to wander around the house. But if you feel up to it, there’s nothing to stop you doing more energetic aerobic or resistance training!

If you have bone metastases, balancing exercise recommendations against the increased risk of bone fractures can be a delicate task – however, this shouldn’t prevent exercise entirely. The risk of complications is highly personal and is affected by the characteristics of your bone metastases, your treatment journey and other personal factors. For many people with bone metastases, low-impact exercise can still be beneficial despite the increased risk of fractures, and can reduce treatment side effects, maintain fitness, and improve quality of life.14 We strongly recommend consulting with your care provider and a qualified exercise professional to assess your risk of skeletal complications, and to understand what kind of exercise is safe for you.

Our tips for staying motivated to exercise:

Getting started with a new routine, and finding the motivation to stick at it, can be a challenge. If you’re struggling to get started, here are some ideas that can help you stay on track:

  • Make it social. Planning to work out with a friend or as part of a group means you’ll have people to hold you accountable to your plans. It’s also a great way to socialise and can motivate you to work harder.
  • Schedule your activity. Research shows that people who set reminders to develop habits are more likely to follow through with their plans.15 Set a digital alert or add it to your calendar to act as a physical reminder to get up and get moving.
  • Mix it up. Variety is the spice of life, and the same goes for exercise. Changing up your routine not only helps to prevent boredom but can also help to engage different muscle groups and different elements of fitness.
  • Set yourself a goal. People who have a goal to work towards are more motivated to stay on track. Make it attainable, but enough of a challenge to require a committed effort. Good luck!

Information you can trust

With so many opinions out there, it can be hard to know who to follow. At Oncolifestyle we do our best to provide you with evidence-based information that has been carefully researched with your health in mind.

Our sources

Where is this information coming from?

Our sources

Where is this information coming from?

  1. Kang, D.-W. et al. Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncol. 7, 1487 (2021).
  2. Nystoriak, M. A. & Bhatnagar, A. Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med. 5, 135 (2018).
  3. Baguley, B., Bolam, K., Wright, O. & Skinner, T. The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review. Nutrients 9, 1003 (2017).
  4. Omura, J. D. et al. Cross-sectional association between physical activity level and subjective cognitive decline among US adults aged ≥45 years, 2015. Prev. Med. 141, 106279 (2020).
  5. Schuch, F. B. & Vancampfort, D. Physical activity, exercise, and mental disorders: it is time to move on. Trends Psychiatry Psychother. 43, 177–184 (2021).
  6. Hart, N. H., Galvão, D. A. & Newton, R. U. Exercise medicine for advanced prostate cancer. Curr. Opin. Support. Palliat. Care 11, 247–257 (2017).
  7. Kokorovic, A. et al. UPDATE – Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies (Full-text). Can. Urol. Assoc. J. 16, E416-31 (2022).
  8. Mottet, N. et al. EAU Guidelines on Prostate Cancer. (EAU Guidelines Office, 2023).
  9. Healy, G. N. et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 31, 661–666 (2008).
  10. Länsitie, M. et al. Cardiovascular disease risk and all-cause mortality associated with accelerometer-measured physical activity and sedentary time ‒ a prospective population-based study in older adults. BMC Geriatr. 22, 729 (2022).
  11. Neuzillet, C. Nutrition et activité physique en cancérologie (recommandations Françaises). FMC-HGE https://www.fmcgastro.org/texte-postu/postu-2023/nutrition-et-activite-physique-en-cancerologie-recommandations-francaises/.
  12. Tienforti, D. et al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int. 110, 1004–1010 (2012).
  13. Cagliari, M. et al. Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review. Phys. Ther. 102, pzab288 (2022).
  14. Campbell, K. L. et al. Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncol. Pract. 18, e697–e709 (2022).
  15. Gollwitzer, P. Implementation Intentions: Strong Effects of Simple Plans. Am. Psychol. 54, 493–503 (1999).
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Health tips

The ABCs of heart health and prostate health

Thanks to good screening measures, most cases of prostate cancer are caught early, and the prognosis is among the best out of all cancers.1 So, if you have had a diagnosis, managing other aspects of your health is essential to help you live longer and enjoy a good quality of life.

Looking after your heart health is a great place to start. If you’ve had a prostate cancer diagnosis, you could be in the two-thirds of recently diagnosed men who are also at risk of cardiovascular disease.2 This is in part due to the high overlap of risk factors for both diseases.3 Adding to this risk, hormone therapy for prostate cancer induces metabolic changes, such as increased blood cholesterol, increasing the likelihood of cardiovascular events.4

The term cardiovascular disease describes several conditions affecting the heart or blood vessels, including heart disease and stroke. It is typically caused by an accumulation of “bad” cholesterol inside the blood vessels that supply the heart and brain. Cardiovascular disease has now surpassed prostate cancer itself as the leading cause of death for men with prostate cancer,5 so managing this risk is crucial to living well after a diagnosis.

The good news is that making healthy lifestyle changes can substantially cut your risk of cardiovascular disease.6 As a bonus, the recommended lifestyle changes for managing heart health are beneficial for prostate health too,3 and can help you to feel better mentally and physically.

Many doctors now apply the “ABCDE” approach  to help patients reduce their risk of heart disease.7,8 This approach combines screening measures and lifestyle changes in the following categories:

A

Awareness
Aspirin

B

Blood pressure management

C

Cholesterol management
Cigarette cessation

D

Diet and weight management
Diabetes prevention

E

Exercise

Here we describe the most impactful strategies across each of these categories that can help to look after your heart.

A

Awareness

Awareness is all about being informed of your increased risk of cardiovascular disease and being able to recognise the symptoms of heart disease. These include:

  • Chest pain while exercising
  • Shortness of breath while exercising
  • Feeling tired easily

If you notice any of these factors, it’s important to talk to your doctor so they can investigate further. Importantly, if you notice any of the following symptoms, it could be a sign of a heart attack, and you should seek immediate medical attention:

  • Sudden onset of chest pain
  • Shortness of breath
  • Pain in the jaw, neck, back, arm or shoulder
    Nausea or light-headedness

Aspirin

A daily low dose of aspirin can decrease the risk of heart disease by preventing blood clots from forming in your arteries. While this can be an effective prevention method for people with a high risk of heart disease, it does come with an increased risk of stomach ulcers and gastrointestinal bleeding. The risks vs. benefits should be discussed with your doctor to decide if it’s the right approach for you.

B


Blood pressure
High blood pressure is a key risk factor for heart disease. Also known as hypertension, high blood pressure puts strain on the heart and blood vessels over time. It can narrow and harden the arteries, restricting blood flow, and it can exert extra strain on the heart, putting it at risk of heart failure. It’s possible to have high blood pressure without knowing it, as there are no obvious symptoms. We recommend working with your doctor to understand whether your blood pressure is in a healthy range, or if you may need to manage it through healthy lifestyle changes or medication.

C

Cholesterol management

Cholesterol is a fat-like molecule that is essential for processes in your body, such as building cells and making vitamins and hormones. But too much cholesterol results in a build-up of fatty deposits in the bloodstream, narrowing the blood vessels and putting you at risk of problems such as stroke, heart failure or a heart attack.

The food you eat has a large influence over your cholesterol levels. But not all cholesterol is made equal. Low-density lipoproteins (LDLs, otherwise known as “bad cholesterol”) are linked to heightened risk of heart disease, while high-density lipoproteins (HDLs, or “good cholesterol”) can actually reduce the risk. Opting for a diet low in saturated fat can help to reduce your bad cholesterol levels, while healthy choices such as whole grains, fruits, vegetables, nuts and legumes can boost your good cholesterol. 

Cigarette cessation

Smoking is a hard-to-break habit, but giving up is the best thing you can do for your health – and especially for your heart. Within weeks of quitting, a rapid increase of good cholesterol in the blood occurs, helping your body to rid the excess bad cholesterol from your arteries.9 After quitting, your risk of heart disease, stroke, or heart attack will drop gradually over time. Within 4-5 years, your risk is halved, and over a period of 5-15 years your risk can drop to that of someone who has never smoked.10 So, it’s never too late to quit!

D

Diet and weight management:

Making healthy dietary choices can help you to manage your weight, your heart health, and your prostate health. Often described as the best diet to prevent cardiovascular disease,11 the Mediterranean style diet can cut risk of heart disease by 31%.6

“Eat food. Not too much. Mostly plants .”

A Mediterranean diet is composed mostly of plant-based sources, with plenty of fruits, vegetables and wholegrains, and only small quantities of animal-based foods. By minimising foods from animal sources, the diet is low in saturated fat, and focuses on healthy unsaturated fats, such as those found in olive oil and nuts. Minimising saturated fat is well recognised as the key to a heart-healthy diet,12 but the Mediterranean diet is also thought to lessen cardiovascular risk by reducing inflammation13 and maintaining steadier blood sugar levels.14 For a guide on creating healthy balanced meals that follow these dietary patterns, take a look at Harvard School of Public Health’s Healthy Eating Plate.

Adjusting the amount you eat can help to maintain a healthy weight, which could further reduce your risk of cardiovascular disease. For those of us looking to lose weight, the prospect of this can be daunting. If you can relate to this, you’re not alone. Over half of adults in Europe have a body mass index (BMI) that exceeds the healthy range,15 and this is a key contributor to cardiovascular disease.16,17 Maintaining a healthy weight can be even more difficult if you are going through hormone therapy, as it presents an added challenge of decreased metabolism and weight gain as a side effect.

While BMI is used as a gauge of cardiovascular risk in the general population, for men over 65, body fat distribution may be a more reliable indicator.18 Men who carry excess weight around their middle can lower their risk by reducing their waistline. Making healthy choices like our exercise and nutrition recommendations in this article are a great place to start, whether to reduce BMI or to lose weight around your middle. Not only can these lifestyle changes help you to get (or stay) in shape and cut your risk of cardiovascular disease, they can help you to enjoy a better quality of life and could even slow the progression of prostate cancer. If you want help to make changes to your diet, asking your doctor for a referral to a dietician is a good place to start.

Diabetes prevention:

Diabetes is a significant risk factor for heart disease, doubling the risk in comparison with someone without diabetes.19 It’s worth asking your doctor for a diabetes screening, to identify if you have high blood sugar and might be at risk of diabetes. This is even more important if you have undergone ADT, as the treatment can alter your metabolism. Fortunately, lifestyle changes and/or medication are effective ways to manage blood sugar levels.

E

Exercise

“if exercise was a pill, everyone would be taking it”

Being active is great for your heart. Whether you’re heading out running or doing the housework, getting your body moving can keep your heart healthy. Even late in life, taking up exercise is effective at reversing age-related or heart failure-related changes in your heart and blood vessels.20

Patient guidelines suggest a minimum of 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous exercise.21 The peak benefit is seen at 50-60 mins of vigorous activity (such as running) per day, but moderate levels of exercise (such as brisk walking) are still associated with a considerable reduction in CVD risk.20 However, even short 1-2 minute bouts of vigorous activity, such as climbing the stairs or walking briskly, repeated throughout the day are shown to substantially reduce risk.22

Understanding what kind of exercise, and how much exercise, is right for you is a personal choice and will be affected by your cancer stage, treatment, and existing fitness. We recommend talking to your doctor for further advice.

If you are ready to make lifestyle changes and would like additional support, we recommend talking to your doctor. They should be able to help by providing you with advice tailored to you, and can refer you to a specialist dietician or exercise physiologist.

Information you can trust

With so many opinions out there, it can be hard to know who to follow. At Oncolifestyle we do our best to provide you with evidence-based information that has been carefully researched with your health in mind.

Our sources

Where is this information coming from?

Our sources

Where is this information coming from?

  1. Cancer Today. https://gco.iarc.fr/today/online-analysis-multi-bars?v=2020&mode=cancer&mode_population=countries&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&orientation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522%253Afalse%257D.
  2. Leong, D. P. et al. Cardiovascular Risk in Men with Prostate Cancer: Insights from the RADICAL PC Study. J. Urol. 203, 1109–1116 (2020).
  3. Moyad, M. A. Preventing Lethal Prostate Cancer with Diet, Supplements, and Rx: Heart Healthy Continues to Be Prostate Healthy and “First Do No Harm” Part I. Curr. Urol. Rep. 19, 104 (2018).
  4. Nguyen, P. L. et al. Adverse Effects of Androgen Deprivation Therapy and Strategies to Mitigate Them. Eur. Urol. 67, 825–836 (2015).
  5. Ye, Y., Zheng, Y., Miao, Q., Ruan, H. & Zhang, X. Causes of Death Among Prostate Cancer Patients Aged 40 Years and Older in the United States. Front. Oncol. 12, (2022).
  6. Chiuve, S. E., McCullough, M. L., Sacks, F. M. & Rimm, E. B. Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications. Circulation 114, 160–167 (2006).
  7. Hsu, S. et al. A Clinician’s Guide to the ABCs of Cardiovascular Disease Prevention: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative: ABCs of CVD Prevention. Clin. Cardiol. 36, 383–393 (2013).
  8. Guan, J. et al. ABCDE Steps for Heart and Vascular Wellness Following a Prostate Cancer Diagnosis. Circulation 132, (2015).
  9. Forey, B. A., Fry, J. S., Lee, P. N., Thornton, A. J. & Coombs, K. J. The effect of quitting smoking on HDL-cholesterol – a review based on within-subject changes. Biomark. Res. 1, 26 (2013).
  10. General, U. S. P. H. S. O. of the S. & Health, N. C. for C. D. P. and H. P. (US) O. on S. and. The Health Benefits of Smoking Cessation. Smoking Cessation: A Report of the Surgeon General [Internet] (US Department of Health and Human Services, 2020).
  11. Lichtenstein, A. H. et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 144, (2021).
  12. Kris-Etherton, P. M., Petersen, K. & Van Horn, L. Convincing evidence supports reducing saturated fat to decrease cardiovascular disease risk. BMJ Nutr. Prev. Health 1, 23–26 (2018).
  13. Itsiopoulos, C., Mayr, H. L. & Thomas, C. J. The anti-inflammatory effects of a Mediterranean diet: a review. Curr. Opin. Clin. Nutr. Metab. Care 25, 415–422 (2022).
  14. Ahmad, S. et al. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Netw. Open 1, e185708 (2018).
  15. World Health Organization. Regional Office for Europe. WHO European Regional Obesity Report 2022. (World Health Organization. Regional Office for Europe, 2022).
  16. Bogers, R. P. Association of Overweight With Increased Risk of Coronary Heart Disease Partly Independent of Blood Pressure and Cholesterol LevelsA Meta-analysis of 21 Cohort Studies Including More Than 300 000 Persons. Arch. Intern. Med. 167, 1720 (2007).
  17. Berrington de Gonzalez, A. et al. Body-Mass Index and Mortality among 1.46 Million White Adults. N. Engl. J. Med. 363, 2211–2219 (2010).
  18. Rimm, E. B. et al. Body Size and Fat Distribution as Predictors of Coronary Heart Disease among Middle-aged and Older US Men. Am. J. Epidemiol. 141, 1117–1127 (1995).
  19. Barrett-Connor, E., Wingard, D., Wong, N. & Goldberg, R. Heart Disease and Diabetes. in Diabetes in America (eds. Cowie, C. C. et al.) (National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018).
  20. Nystoriak, M. A. & Bhatnagar, A. Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med. 5, 135 (2018).
  21. Segal, R. et al. Exercise for People with Cancer: A Clinical Practice Guideline. Curr. Oncol. 24, 40–46 (2017).
  22. Stamatakis, E. et al. Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nat. Med. 1–9 (2022) doi:10.1038/s41591-022-02100-x.