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    Old 03-05-2009, 06:41 PM   #1
    IADT3since2000
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    Thumbs up Exercise is important for prostate cancer patients

    Yesterday gregeva raised this question about exercise in his on-going thread, and I realized it would probably be more helpful to address it in its own thread where we could all see it and pitch in. Also, I think I've learned a lot and am achieving success, but I am far from an exercise and fitness guru.

    Greg, here's an excerpt of your post in green, and my response. Thanks for raising this important subject!

    Re: Intermittent Hormone Therapy Side Effects

    -------------------------------------------------
    Hi Jim,

    ... I'm awfully impressed with your exercise regimen (as described in this and another recent post of yours), and could sure use some help or encouragement with mine. This past year on Zoladex has seen me lose an awful lot of muscle mass ... and energy. I'm trying to walk an hour a day, but that's about it. Any suggestions for getting started on a strength program? (There are no gyms around here, but I do have a basic bench and barbell set-up.) ...


    First of all, it appears that exercise for prostate cancer patients can be a considerable help in improving odds of success of our therapies, minimizing side effects, and generally enhancing our quality of life. I'm thoroughly convinced that's especially true for those of us on hormonal therapy, including both continuous and intermittent therapy.

    This isn't just one of those pablum type recommendations like "take two aspirin, drink plenty of fluids, and go to bed." There's actually a ton of research behind it, and many leading doctors expert in prostate cancer also strongly recommend exercise. For instance, Dr. Charles "Snuffy" Myers, MD, a very well known medical oncologist specializing in prostate cancer and one of my heroes, considers exercise one of the three cornerstones for support of prostate cancer, along with nutrition/diet/supplements and stress reduction. Dr. Mark Scholz, MD, another of my heroes, is convinced that exercise - particularly strength exercise - greatly reduces or eliminates a number of the side effects of hormonal blockade.

    Greg, here are my own tips, won after years of trial and error. Maybe the first tip should be to stay within the boundaries of what you can do without injury; as you probably are aware, those boundaries will expand as you grow stronger. Even with walking, I've heard that it's smart to increase your weekly distance by just 10% or less. Consulting a doctor before changing the level of exercise is frequently recommended and seems wise to me. Rule 2 should probably be to take at least one day off between demanding strength exercise sessions. I learned some of this from the School of Hard Knocks; after joining the gym, for a few weeks I would do all the machines that were different on the floor - talk about being stiff and sore! (Lots of trouble sleeping too!)

    For resistance/weights/strength type exercise, I'm convinced that something like what some have called the "slow burn" method is best. Essentially this involves doing a fairly limited number of repetitions, but doing each slowly and using a weight that is difficult to handle with good form on the last repetition. My gym advises doing twelve repetions with this approach, and each is done to a slow six count: zero, one, two (going out) and three, four, five, six coming back. This takes about five or six seconds, and you go smoothly through the motion and into the next rep without pausing, or pausing slightly at the most demanding point of the move.

    Doing just twelve reps on each machine saves time, and the approach produces the tearing down and building up of muscles that leads to increasing strength. Some experts advocate three sets of ten, or variations, but the idea is to have some difficulty completing work on the machine at the end. If it has become comfortable, it's time to increase the weight. I'm also not too impressed with rapid repetitions that use momentum to help move the weight; from what I've read, that's not a great way to build muscle.

    I wish I knew more about getting the best mix of machines per session. I've heard that it's good to do machines that work opposing muscles in the same session, and I've heard it's good to do at least as many back machines as chest machines. (I'm not overly clear on that last one.) Also, for now almost all the machines I use fully control the motion, which I'm convinced is prudent for me, and I use no free weights. (I did use some barbells for a while, but the deltoid muscles I had injured in the past let me know that was not a good thing.) No doubt there are more good tips needed here for mixing machines in a workout, and I hope some of our fellow posters will contribute to the list.

    I keep a table of each type of exercise (rows) by the date (column) for the weight machines. I think most of us find that keeping score is motivating. Because I'm 65 and want to be cautious, I'm not pressing to build strength quickly; slow and sure is fine for me, and I back off if I sense possible trouble. I know I could go faster with the rotary ankle machine, but I'm already at 325 pounds - about double my weight, and I'm moving almost all of the weight the machine has to offer. Similarly for the leg extension, where I'm lifting 290 pounds. I'm easing that along as knee trouble is the last thing I want. I eased back a few months ago when I felt a twinge in one knee. It seems completely better now, and I'm lifting more than I did at that time. I have not completely recovered from injuring deltoid muscles several years ago (another story ), so I'm building shoulder muscle very slowly.

    For each machine I record the weight with a horizontal arrow if I think I should keep the weight the same for the next session. I use three dots under the arrow to indicate: not coming close to 12 smooth reps (1 dot); beginning to come close (2 dots); and almost doing it smoothly for 12 reps (3 dots). An arrow with no dots means I'm doing it smoothly, but with some difficulty. I use dots over the arrow too: beginning to get easy (1 dot); fairly easy (2 dots); proficient and could move up (3 dots). I use an upward arrow to signal increased weight for the next session, and a downward arrow if I need to fall back. I try to ease my way upward through the dots and arrows, and having so many "steps" helps me see progress without waiting til I've added another five pounds or so to the load. You may have already found a system that works for you.

    I usually feel pretty good after a session, but, if I do more than eight or nine weight machines, I take a couple Bufferin before going to bed. I sometimes have trouble sleeping on those nights, especially after the Bufferin wears off in four hours, so that means another two Bufferin in the middle of the night. There's probably a better medication out there, at least longer lasting, but I haven't gone to the trouble to find it. I'm also fortunate to be able to use a massage chair which my wife won in a contest; it's especially great for the back and shoulders. I usually don't need the Bufferin during the day following the workout or that night, but I often feel more stiff and sore that day.

    Experts advise not exercising when you feel very tired, or your muscles are sore or heavy feeling, or you feel pain rather than soreness. That means I almost always skip at least two days before the next workout. I shoot for a workout after about three days of rest. That works for me. I'm also doing some physical activity around the house and yard most of the time, and lately I'm throwing in a few exercises I can do at home.

    I usually do eight to twelve weight machines, after a warm up. My typical workout is five minutes walking/racewalking on the treadmill with increasing spead. After that I row "1,500 meters", seven to eight minutes, on the rowing machine, set to its highest resistance (10). Then I do the weight machines. After that I do several stretches for racewalking (calf, quadricep, and hamstring stretches for the legs, then several shoulder, arm and body torqueing exercises). I usually finish with about a half hour on the treadmill, walking to warm up again, then racewalking, including a little elevation.

    I'm now typically doing at least ten minutes at 4.6 mph, equivalent to a mile in 13.02 with some elevation. I know I can go faster, but I'm building toward that slowly, watching my heart rate. Because I have an "athlete's heart rate" and blood pressure, I've been told that I can have a higher rate than the numbers recommended on the machine for age 65. But I figure I'm on the safe side if I keep the rate at about 150 beats per minute or lower. Gradually I'm able to go faster with the same or a lower rate. That safe range for the pulse is something to discuss with a doctor, and even though I'm confident, during my annual physical I go over what I'm doing with my internal medicine doctor. (About a dozen years ago I could consistently racewalk a mile at top speed in about nine and a half minutes; that's really moving out, though it is not a competitive speed for serious racewalking. I think those days are probably behind me.)

    By the way, racewalking is more demanding than jogging or running. There's an old saying that racewalkers can jog or run, but joggers and runners can't racewalk (meaning for a significant distance at a good speed). There are reasons for this, including the fact that you use a lot more muscles (such as vigorous arm swings); jogging (or an eliptical machine to ease the load on the knees) are easier options for aerobic exercise. Racewalking is superb exercise if you are willing to spend the time and effort to learn how to do it - posture, technique, stretches, conditioning, etc. Among other things, it takes a while (months) for your shin muscles (tibialis anterior - one of the dozen or so mucles I can name) to get adequately conditioned. Until they are, it's hard to racewalk fast for more than a couple hundred yards without that muscle burning like crazy and aching afterward. After conditioning, the shin muscles gives you no trouble at all. Racewalking is easy on the knees and, while weight bearing and therefore good for bones, has a very low rate of injury if you warm up and stretch properly, in contrast to running, and you can work up a heck of a sweat and burn a bundle of calories.

    In addition to aerobic and strength work, I get in a little balance and flexibility work. It seems odd to me, but the hamstring stretch makes it much easier to torque your body around, such as when you look backward when backing up a car. That stretch involves standing on one leg while positioning the other leg straight out, resting on a support (like a stair) at about waist level, then you slowly bend and stretch your hands toward your toes. When I started this, I could get to my knees only with difficulty. Now I have no trouble doing the full range exercise, touching the toes of my shoes.

    The payoff is being able to keep up or even build strength while on hormonal blockade and to minimize weight gain. I've increased strength, which I thought for several years was impossible with very low testosterone. I changed my view when Dr. Mark Scholz stated that that was a myth (one of many): it is possible to maintain or gain muscle while on blockade, it just isn't easy! I've held my weight down fairly well, including abdominal weight gain, but a friend on intermittent blockade says you can actually zero the gain or even lose weight; it just takes a lot of work. I'm striving for that in my third cycle of blockade, but I haven't succeeded yet. It's nice to be able to have the strength for household chores, such as those involving a heavy ladder. It's great to be able to go up and down stairs many times a day with no concern. It's nice to have energy to work hard all day.

    Here's a way to look into the research being done. Go to [url]www.pubmed.gov[/url], a site we can use on the board because it is Government sponsored, and search for " exercise AND prostate cancer "; I just did that and got 335 hits. I changed the search to " resistance exercise AND prostate cancer " and got 18 hits. You can also add a therapy description as in " exercise AND prostate cancer AND hormonal therapy " (23 hits). By clicking on the blue hypertext authors lists, you can get abstracts of these studies, if there are any, and sometimes free copies of the complete study.

    Dr. Myers was so impressed with the exercise/prostate cancer connection that he devoted three issues of his Prostate Forum newsletter to the subject: "Getting Stronger, Staying Thin, I (and II), Volume 7 #12 and Volume 8 #1 (early 2004), plus an earlier issue. In addition to discussing exercises, he described how certain supplements, such as whey and creatine, can help some of us, the latter depending on our genetic makeup. He also provided descriptions of exercises that can be done at home in Volume 7 #6.

    By the way, I'm convinced that adequate water (liquid - a lot of green tea for me) is key to enabling us to do demanding physical work or exercise. I believe in consuming at least a half ounce per pound of body weight per day, and around two thirds of an ounce when doing heavy physical work; the scientific evidence is not convincing, but my personal experience has persuaded me. As with many fitness issues, increasing water (liquid) consumption should be done gradually.Likewise for glucosamine - my knees clearly do better when I consume it daily; I avoid the combo with chondroitin as there is evidence that is not good for prostate cancer patients. I've also heard it's important to consume ample protein when in a program of vigorous exercise. That's a bit tricky when you are avoiding red meat as I am, but it can be done.

    Dr. Mark Scholz, one of the leading experts in hormonal blockade therapy for prostate cancer, especially intermittent hormonal blockade therapy, is highly impressed with the value of exercise for us and strongly recommends it, especially strength exercise. He feels it makes a huge difference not only in muscle mass, bone density and weight control but also in the quality of sleep, in avoiding fatigue, and in feeling up-beat and avoiding depression, as well as in other aspects of well being.

    I hope we get comments and more points of view.

    Jim

    Last edited by IADT3since2000; 03-05-2009 at 07:54 PM. Reason: Minor appearance editing right after posting. Added point about gradually increasing consumption of liquids.

     
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    Old 03-05-2009, 07:03 PM   #2
    gregge
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    Re: Exercise is important for prostate cancer patients

    Wow. That's all I can think of to say right now, so ... wow. I couldn't have imagined a better response, Jim. Thanks for all the time and effort you spent in putting it all together. Though I have to admit that I'm feeling a bit overwhelmed and wimpy after reading all you do - especially seeing that you're 14 years my senior. My bravest act comes next when I forward your response to my wife. :-)

    Thanks again, Jim. I really appreciate it

    Bless you!

    Gregg

     
    Old 03-06-2009, 09:56 AM   #3
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    Re: Exercise is important for prostate cancer patients

    Hi Jim,

    Two things...

    First, I was a bit surprised when I had my "2nd opinion" appointment last month, and after the first 5 mins of overview, the doctor spoke for 5 minutes or more about the importance of exercise. His bottom line was that I should be elevating my heart rate to 125-130 bpm for 50 mins every day...EVERY DAY. My surprise was the emphasis he placed on this. His reasons were twofold. First, in the short term getting my body ready for major surgery (planned for early April). Second, longer term, the way he phrased it was "lets not cure the cancer, and die of a heart attack". I had been going to gym about 3 days per week before that (although, when I got my initial biopsy/diagnosis, I'll admit that I stopped everything and started eating lots of ice cream...come on, when you think you are going to die, what the heck, right?). Have been going pretty much daily since then, although not always making time for 50 mins. 4 miles/40 minutes on elliptical trainer this morning before work. Anyhow, my main point here was how surprised I was on the strong emphasis my doctor placed on me getting exercise.

    Second, I wanted to inquire about your comment on chondroitin (your next-to-last paragraph). I had knee reconstruction--twice on the same knee over 25 years ago--and am very arthritic there. (I can run forever on an elliptical tranier, but can't run 50 yards on my own without straining my knee/joint.) I've been taking the combination glucosamine chondroitin for nearly 10 years, and it definately has reduced pain. Can you add anything to your comment "I avoid the combo with chondroitin as there is evidence that is not good for prostate cancer patients"?

    thanks
    kcon

     
    Old 03-07-2009, 02:13 PM   #4
    IADT3since2000
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    Re: Exercise is important for prostate cancer patients

    Hi kcon,

    Thanks for sharing the advice on exercise your doctor gave about exercise. It's encouraging to learn of more MDs getting on board.

    You also wrote:


    Quote:
    Originally Posted by kcon View Post
    ...
    Second, I wanted to inquire about your comment on chondroitin (your next-to-last paragraph). I had knee reconstruction--twice on the same knee over 25 years ago--and am very arthritic there. (I can run forever on an elliptical tranier, but can't run 50 yards on my own without straining my knee/joint.) I've been taking the combination glucosamine chondroitin for nearly 10 years, and it definately has reduced pain. Can you add anything to your comment "I avoid the combo with chondroitin as there is evidence that is not good for prostate cancer patients"?

    thanks
    kcon

    I was preparing a response that would fit nicely in this thread, but I decided to dig into the research so I could give you added detail beyond the brief recommendation to avoid chondroitin that I've heard Dr. Myers and others repeat over the years.

    Well, I was surprised. To put it bluntly, the evidence of danger practically took my breath away! I think it's better to set up the response as a new thread so it will be hard to miss. Thanks for asking about this. I've learned key facts behind the recommendation, and hopefully a lot of us will benefit. It's too bad , because many of us could use help with our knees, and chondroitin does seem to help. At least we do have glucosamine, and research indicates that is safe!

    Jim

     
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