Did you know that exercise lowers the risk of prostate cancer. Avinesh Pursad tells us more.

Prostate cancer is a carcinoma of the prostate gland, found in the male reproductive system. Prostate cancer is the most common cancer diagnosed within the South African male population and, in fact, is the second most common cancer diagnosed in the worldwide male population^1,6,9.

Risk factors of prostate cancer

Worryingly, recent research shows  that the incidence of prostate cancer continues to rise in many countries¹. It is therefore imperative to know the potential risk factors.

• Weight: A body mass index (BMI) of <30 is classified as obese, and increases the likelihood of developing prostate cancer¹.
• Diet: No clear links with specific dietary factors have been established although many items, including red meat, dairy, protein, dietary fat, and coffee have been suggested¹.
• Lack of physical activity: Partaking in less than 150 minutes of moderate physical activity per week has been shown to increase the risk¹.
• Genetics: The risk is higher in men who have a first-degree relative with prostate cancer or those under 65 years of age¹.
• Smoking: Research has shown that smoking is associated with a moderate increase in the risk of prostate cancer. Current and/or heavy smokers appear to be at a two-fold or higher risk of prostate cancer¹.

Exercise and prostate cancer

Cancer has been associated with a variety of long-term health and psychosocial conditions, thus affected individuals have been described as a very vulnerable population.

Studies have emphasised the importance of health promotion for cancer patients and suggest nutrition, diet, weight management and exercise as possible methods to promote health and reduce the risk factors described^3,12. Of these, exercise is arguably the most important as it targets multiple-risk factors of prostate cancer at once⁹.

Individuals who have survived, or are currently receiving prostate cancer treatment are at a heightened risk of developing secondary malignant diseases and other conditions, including cardiovascular disease, diabetes and osteoporosis, when compared to age- and race-matched populations^3,7,10,11,13.

Due to the various prostate cancer treatments and their influence on the human body – causing pain, weakness and fatigue – physical activity appears to be just as important for those suffering from prostate cancer as it is to those at risk of developing prostate cancer⁸.

In fact, a recent meta-analysis, comprising studies until 2012,   suggests that being physically active is associated with a significant reduction in the risk of prostate cancer⁹. Furthermore, studies examining physical activity in relation to high-grade prostate cancer and prostate cancer mortality also reported a significant risk reduction⁹.

Benefits of exercise

Individuals with prostate cancer are shown to have significantly diminished cardiorespiratory fitness⁸. It is therefore imperative for those with prostate cancer to partake in some form of aerobic exercise, like walking, daily.

Strength exercises are extremely important for functional benefits, such as reducing risk of falling, improving bone health (reduced fractures) and ability to sustain exercise regimes^8,10. Strength exercises should incorporate mainly weight-bearing exercises at an intensity that exceeds the average daily load to achieve the desired benefits¹¹.

Pelvic floor muscle strengthening is of particular importance as it may help with urinary and bowel problems that are often associated with prostate cancer. These include incontinence, and leaking bodily fluids when you sit down, cough, sneeze or bend forward. Pilates and yoga classes are two ideal ways of pelvic floor muscle strengthening.

Other benefits of exercise include: a reduction in cancer related fatigue; prevention of sarcopenic obesity; increasing the patient’s chances of completing their full course of treatment and returning to work sooner^3,8,11.

Exercise recommendation 

For exercise to be beneficial, it is recommended that strength training should occur two-three days per week, consisting of 30-60 minutes for each session. Strength exercise for prostate cancer patients should include upper and lower body exercises and the use of free weights, weight machines and resistance bands^4,5,11,12.

Strength exercises to incorporate in your programme include elastic band rows, squats, lunges, wall push-ups and tricep dips⁸. It is recommended to perform 15-20 repetitions of each exercise for at least one set to enhance muscle endurance^8,9.

Aerobic training should occur three-five days per week of a similar duration to that of the strength training. It should comprise of activities enjoyed the most by the patient to enhance adherence and should make use of lower, trunk and upper movements ^2,4,9,11. Additional benefits have also been experienced when aerobic and resistance (strength) training is combined into a training programme^7,11.

MEET OUR EXPERT  – Avinesh Pursad

Avinesh Pursad has been practicing as a biokineticist for the past 16 years. He is the manager of the Orthopaedic and Neurological Department at the Sports Science Institute of South Africa (SSISA). Over the years, he has managed many patients who have been diagnosed with cancer.

References

1. Cuzick, J., Thorat, M.A., Andriole, G., Brawley, O.W., Brown, P.H., Culig, Z., Eeles, R.A., Ford, L.G., Hamdy, F.C., Holmberg, L. and Ilic, D., 2014. Prevention and early detection of prostate cancer. The Lancet Oncology, 15(11), pp.e484-e492.
2. de Nijs, E., Ros, W., & Grijpdonck, M. (2008). Nursing Intervention for Fatigue During the Treatment for Cancer. Cancer Nursing, 31(3), 191-206. doi:10.1097/01.ncc.0000305721.98518.7
3. Demark-Wahnefried, W., Rogers, L.O., Alfano, C. M., Thomson, C.A., Coumeya, K.S., Meyerhardt, J.A., Stout, N.L., Kvale, E., Ganzer, H. & Ligibel, J.A. (2015). Practical clinical interventions for diet, physical activity, and weight control in cancer survivors. CA: a cancer journal for clinicians, 65(3), 167-189.
4. Durstine, J., Moore, G.E., Painter, P.L., Roberts, S.O. (2009). ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. United States of America: Kerry O’Rourke.
5. Herbst, M. (2014). Fact Sheet on Known Causes of Cancer. Cancer Association Of South Africa (CANSA), 1-35.
6. Herbst, M. (2015). Fact Sheet on the Top Ten Cancers per Population Group. Cancer Association Of South Africa (CANSA), 1-6.
7. Mishra, S., Scherer, R., Geigle, P., Berlanstein, D., Topaloglu, O., Gotay, C., & Snyder, C. (2015). Exercise Interventions on Health-Related Quality of Life for Cancer Survivors (Review). The Cochrane Collaboration, (8), 1-373.
8. Noble, M., Russell, C., Kraemer, L., & Sharratt, M. (2011). UW WELL-FIT: the impact of supervised exercise programs on physical capacity and quality of life in individuals receiving treatment for cancer. Support Care Cancer, 20(4), 865-873. doi:10.1007/s00520-011-1175-z
9. Pescatello, L., Arena, R., Riebe, D., & Thompson, P. (2013). ACSM’s Guidelines for Exercise Testing and Prescription (9th ed., pp. 264-270). Wolters Kluwer & Lippincott, Williams & Wilkins. Rundqvist, H., Augsten, M., Strömberg, A., Rullman, E., Mijwel, S., Kharaziha, P., Panaretakis, T., Gustafsson, T. and Östman, A., 2013. Effect of acute exercise on prostate cancer cell growth. PloS one, 8(7), p.e67579.
10. Scott, J., Koelwyn, G., Hornsby, W., Khouri, M., Peppercorn, J., Douglas, P., & Jones, L. (2013). Exercise Therapy as Treatment for Cardiovascular and Oncologic Disease After a Diagnosis of Early-Stage Cancer. Seminars In Oncology, 40(2), 218-228. doi:10.1053/j.seminoncol.2013.01.001
11. Smith, B. (2013). Annual review of nursing research. New York: Springer Pub. Co.
12. Thompson, D.L. (2009). Cancer and Exercise. ACSM’s Health and Fitness Journal, 12(2), 5.
13. Wright, M., Bryans, A., Gray, K., Skinner, L., & Verhoeve, A. (2013). Physical Activity in Adolescents following Treatment for Cancer: Influencing Factors. Leukemia Research And Treatment, 2013, 1-7. doi:10.1155/2013/592395