Exercise Oncology...what say you?

I needed a couple of years of rehab and physio to get back to walking (sort-of) after the metastasis compressed my spine, so that dominated my early time. But here's how I understand it the situation on hormone therapy:

1. Moderate and aerobic exercise are important for heart health and weight management.

2. Moderate resistance training (e.g. with weights or exercise bands) is even *more* important, because your metabolism has slowed and and your bones and muscles are weakening; you'll get more out of your aerobic exercise through the resistance training, because it will increase your metabolism (so that you burn more calories) and strengthen your bones and muscles (for faster post-exercise recovery).

3. Recovery days are as critical as exercise days, because your body needs more time to reset after exercises than it did before. Think of resting as a third kind of exercise.

The important lesson is that without the support of the testosterone, doing more doesn't always bring greater benefits. You have to find your personal balance where you're pushing your envelope a little bit, but not driving off the hidden edge of the energy cliff that's part of your life now. For example, if you're currently walking 10,000 steps/day and pressing 60 lb on the weight bench, pushing straight to 15,000 steps/day and 100 lb won't make you stronger; it might even leave you feeling too weak to get out of bed for a few days. Go gradually, listen to your body, take no-exercise recovery days, and back off whenever you need to (it's not a failure to lower the steps or the weights).

Sounds like you enjoy biking and I’m sorry to burst your bubble, but the science indicates little to no measurable benefit (as it relates to slowing PCa progression) for extended light exercising (like walking).

That said laying down a solid base of Zone 2 (70% of maximum HR) training (moderate exercise) is foundational to making significant long term gains.

If you enjoy biking maybe targeting 30-60 minutes of Zone 2 level cycling, at least 3-4x per week is a great starting point.

I didn’t learn about the incredible long term benefits of Zone 2 training until I had taken up running for over two years.

Zone 2 training is definitely for the long game, major benefits and permanent changes are measured after years, not weeks or months.

However, some PCa treatments protocols, like ADT, involve similar timeframes.

So why not commit to another long term treatment whose only negative side effect is possibly the perception of the lack of short term gain.

For me Zone 2 training means running 85% of the time in the 130-135 bpm heart rate range for ~40 minutes per session, every other day.

I started this four months ago and now add 2-3 sessions/week of HIIT.

It’s definitely a long term treatment protocol; but at my age I’m not expecting to find any short term treatment that is going to “make everything like it was before”.

This video is probably one of the best, most realistic and authentic representations of what one can truly expect from Zone 2 training that I have ever seen.

I think the latest research shows 130 minutes of exercise a week can reduce PC recurrence up to 30%+. One need not run marathons to reap the benefits of exercise on PC recurrence.

While this sounds wonderful, I finally was able to run about a month ago For the first time in maybe 10 years. Finally got used to my 2nd new knee after over a year. The best I can do running is probably more like a jog, but I am 77 and it’s good for cardio.. My son (a personal trainer) was over so we went walking on the track across the street. I showed him how I was now able to run and he was surprised. He said he couldn’t tell if I actually got 1 foot off the ground while I was running, which would mean technically I was running. He then warned me of the dangers of running.

There are some real issues with people running if they have prostate cancer. I have damage to my L4 in my spine, L4 controls your legs. It has also been hit by radiation to remove a metastasis. Running could put too much stress on that L4. I have to watch that I don’t jar my body when I run. A lot of other people that have prostate cancer have had it in their spine and whether that resulted in weakened bones, is just something to think about.

I do go to the Track twice a day and Jog about half of the time, Still building up my stamina after a long time getting my knee to work. I can’t begin to compete with what you are doing because my body won’t take it. There are a lot of older people like myself, that are in this forum, we do the best we can.

Jeff,

I'm absolutely so impressed!!! I'm sure you are being super careful.

My two cents worth of jogging/running advice is (first of all) purchase Hoka Bondi 8 or Hoka Bondi 9 running shoes (the absolute best for maximum cushioning).

I add a Dr. Scholls heel cushion (placed under the Bondi 8 heel) AND ALWAYS wear two layers of running socks.

I have never sustained a running injury AND I have never had even so much as a toe blister, after three years of jogging/running, with this approach.

If you go this route, make sure you get a large enough shoe size to accommodate the Dr. Scholl cushion AND a double layer of running socks.

Finally, ALWAYS jog/run on a rubberized track...hopefully a local high school or college track is nearby and available, even if only during certain times of the day.

If you feel joint soreness/any pain or something seems wrong, stop immediately, walk it off an call it a day....there's always tomorrow....

I always walk at least 0.50 mile, after my jog/run and I also have another "hack" that I know has helped me immensely....I always take a 30 minute therapy hot tub AFTER a run...I like the Hot Springs brand - "JetSetter LX"....if you go this route get a quality hot tub known for water jet therapy.

When outside temperatures are under 60F, I use the hot tub for a 30 minute "warm-up", doing my prerun stretches in the hot tub....then I'm fully "warmed up" and it makes my jog/run that much more enjoyable. This "hack" also minimizes "after run" joint soreness.

My 61 year old brother, who used to run long distance all the time when younger, cannot run now due to hamstring and knee injuries, so he uses an elliptical to get his Zone 2 training.

Another 66 year old brother, a lifelong long distance runner, and my two sons all have Garmin VivoActive 4 watches and we formed a "Runners Group" on Signal. We can see and share all our exercise activities and motivate each other, as we compete against ourselves in whatever personal goals we have set. Also a great way to share information regarding whatever we've been learning about exercise.

The Vivoactive 4 watch allows bluetooth "buds" AND you can download your favorite exercise music DIRECTLY to the watch...so there is no need to carry a phone, while exercising...then you can run to your favorite music!

IMHO exercising, for non-athletes (like myself) is primarily a matter of the will...all of us on a "long term" exercise treatment program need encouragement and motivation that is supplied by those who know and care about us. Maybe you have younger family members, or a friend or two, who could be part of such an exercise support group.

In any case, all the best as you apply yourself to your own personal exercise goals...as I like to say....exercise like your life depended on it 🙂

Yes, there are many studies showing correlation, and a few preliminary ones hinting at a causal link (like https://www.nature.com/articles/nrc2325 ), but it's tricky because you can't pick 1,000 cancer patients and randomly assign them into exercise/no-exercise groups, especially not without their knowing which group they're in.

So to some (unknown) degree, the studies are simply showing that people who have good-enough health to exercise frequently also have good-enough health to fight cancer more-effectively, which isn't surprising. But since heart disease, bone-density and muscle loss, and diabetes are all common side-effects of long-term hormone therapy, it makes a lot of sense for those of us with advanced prostate cancer to exercise within our abilities *regardless* of whether it turns out that it actually reduces the risk of further metastases.

Actually my exercise oncology protocol is based on the “gold standard” of medical studies; the randomized clinical trial (RCT)….there’s nothing “magic” about it….of course there is never ANY guarantee with ANY PCa treatment protocol.

For example, everyone should know that 20-40% of men who undergo radical prostatectomy will experience biochemical recurrence within 10 years and there are also no guarantees with any exercise oncology protocol.

That said, randomized clinical trials often follow stricter regulatory protocols than other randomized control trials, including ethical oversight (e.g., Institutional Review Boards) and compliance with standards like Good Clinical Practice (GCP).

Single or double blinding is only possible in drug based RCT’s.

The randomized clinical trial is the “gold standard” when comparing protocols such as different surgical techniques, where “blinding” is not possible.

The exercise protocol I’ve adopted is based on the ERASE randomized clinical trial (published in August 2021); whose conclusion follows:

“The ERASE trial demonstrated that HIIT increased cardiorespiratory fitness levels and decreased PSA levels, PSA velocity, and prostate cancer cell growth in men with localized prostate cancer who were under active surveillance.“
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273

@handera
I have been a exerciser all my life.

Before I was diagnosed with prostate cancer I was exercising 6 days a week for an average of 2 hours a day. I was an avid tennis player until got ICD/Pacemaker then started doing Sprint Triathlons instead training for them.

I will pass on that I was diagnosed with heart failure but had little to now symptoms. I was told by being an avid exercise all my life my body compensated very well from reduced blood flow. However I still got prostate cancer.

I'm mostly trying to stay active (flex/aerobic exercise weekdays with resistance training twice weekly). Resistance training is highly recommended to avoid excessive muscle mass loss from ADT. Dr. Scholz, http://www.pcri.org

You bring up a great point that needs some explanation.

Many observational studies have found NO association with vigorous exercise and a reduced risk of being diagnosed with prostate cancer.

A comprehensive 2018 meta-analysis of 48 cohort and 24 case-control studies (151,748 prostate cancer cases) found no association between total physical activity and prostate cancer incidence.

However, a subgroup analysis, in that meta-analysis, showed that vigorous physical activity was associated with a 25% reduced risk of advanced prostate cancer.

A 2004 Harvard Health Professionals Follow-Up Study followed 47,620 men over 14 years. Men aged 65 or older who engaged in ≥3 hours per week of vigorous physical activity (e.g., activities such as running, cycling, or swimming) had a 67% lower risk of advanced prostate cancer, as compared to those with no vigorous activity.

However, no significant association was found between vigorous exercise and total prostate cancer incidence.

This suggests vigorous exercise may specifically reduce the risk of aggressive forms of prostate cancer but not its initial diagnosis.

The ERASE trial was particularly important, because it addressed men already diagnosed with localized PCa.

As odd as it sounds, the science indicates that men diagnosed with PCa are the beneficiaries of a ramped up vigorous exercise treatment program….. however, vigorous exercise does not prevent one from acquiring PCa.

…a very important difference to understand.