Regardless of disease state, exercise is (still) a cornerstone of prostate cancer care. And the amount of literature proving it is growing. 150 minutes’ aerobic exercise per week combined with at least two sessions of resistance exercise and daily stretching exercises for major muscle groups is recommended.
However, the prevalence of physically active prostate cancer patients is not growing at a similar pace. Scientists are investigating how barriers to exercise can be eliminated. They are also investigating how exercise programmes can be promoted, since the evidence of the positive effect of exercise is delivered in numerous studies.
Studies investigating the association between exercise and prostate cancer-specific mortality even show lower risk of prostate cancer-specific mortality in activities such as walking and biking. This means that prostate cancer patients with a performance status higher than 0-1 are able to carry out beneficial exercises.
Topic for future research
Studies in localised prostate cancer suggest that exercise may reduce disease progression, however, strong evidence for this is still lacking and more intervention studies are needed. A relevant topic for future research is to investigate the optimum exercise modality, duration and dose, as this is not yet clearly verified. And, as mentioned above, even low-intensity physical activity after prostate cancer diagnosis has shown to be beneficial.
In prostate cancer patients at any treatment stage (including post-treatment), low-volume resistance exercise undertaken at a moderate-to-high intensity has found to be beneficial with regard to fatigue and quality of life. Furthermore, it has the ability to mitigate depression and anxiety symptoms.
“Exercise training and testing is generally safe for cancer survivors.”
Androgen deprivation therapy
Exercise studies are mostly performed on and described in patients undergoing androgen deprivation therapy (ADT), and exercise has been stated as the most effective intervention in reducing side effects to ADT. In the EAU guideline for prostate cancer, there is strong evidence for recommending 12 weeks of supervised combined aerobic and resistance exercise in patients undergoing ADT. A concern in this patient group is safety, due to the prevalence of bone metastases. This issue has recently been addressed in studies by giving specific recommendations regarding which exercises to avoid and which to perform based on the location of metastases. In 2019, the American College of Sports Medicine International Multidisciplinary Roundtable on Exercise and Cancer was published with specific recommendations regarding bone metastases.
In this patient group too, a standard exercise prescription is difficult to formulate. However, it is recommended to:
- Avoid contraindicated movements that place an excessively high load on fragile skeletal sites. This means avoiding hyperflexion or hyperextension of the trunk, flexion or extension of the trunk with added resistance, dynamic twisting motion and high-impact loads;
- Preventing falls must also be a goal of therapy, since falls play an important role in fracture aetiology;
- Be aware of signs and symptoms of bone metastases.
The 2018 American College of Sports Medicine’s guideline on exercise in cancer survivors concludes that exercise training and testing is generally safe for cancer survivors and that every survivor should avoid inactivity.
References and suggested reading
• Ramalingam S et al. What should we tell patients about physical activity after a prostate cancer diagnosis? Oncology (Willston Park). 2015. Sep; 29(9): 680-5, 687, 694.
• Campbell K.L. et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019. 51 (11): 2375-2390.
• Lopez et al. What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes. Prostate Cancer Prostatic Dis. 2021 Jun;24(2):465-481.
• Mottet N. et al. EAU Guidelines on Prostate Cancer 2020. www.uroweb.org/guidelines/
Dr. Brigitta R. Villumsen, Dept. of Urology, Gødstrup Hospital, Herning (DK), firstname.lastname@example.org