Let’s think, for a minute, about falling – said no one ever. Nobody wants to think about falling! It’s awful! Plus, you may be thinking: “I’ve got prostate cancer! That’s my main concern!”
Falling is awful, but the thing is, if you are on androgen deprivation therapy (ADT), in addition to fighting against prostate cancer, you need to fight for your body. You are at higher risk of bone thinning, loss of muscle mass and falling, in addition to some other health problems associated with weight gain and metabolic syndrome.
Falls can be injurious to anyone, but if your bones are weakened and your muscles are not strong, you can get a fracture – and this can be a big health setback. But here’s good news, from PCF-funded investigator Christina Dieli-Conwright, Ph.D., M.P.H., an expert in exercise oncology: the loss of muscle mass, strength, and function, and the gain of fat and ADT “don’t have to go hand in hand.” Exercise can help prevent these problems.
What Kind of Exercise?
Patients on ADT need a well-rounded approach: cardiovascular exercise, strength training, stretching, and functional exercises to improve balance and movement, says Dieli-Conwright. Note: ADT takes away testosterone, and testosterone makes muscles big. But don’t let that be a stopper for exercise: “While it is difficult to increase muscle mass, you can gain strength without gaining muscle size.” You can also help protect the muscles that are involved in quick reactions.
This is really important. You may not have as big of a “gun show” as you used to, but you can still make your muscles stronger and conserve function. “When you lose muscle strength, that also affects your ability to balance yourself,” says Dieli-Conwright. “Unfortunately with aging, one of the major side effects for everyone is a loss of type 2 muscle fibers – the ‘fast-twitch’ muscle fibers that allow you to react quickly, move quickly, and sprint. This is worsened by ADT, and it makes you less able to react to prevent the fall.”
Cardio: Cardiovascular exercise helps prevent cardiovascular disease, weight gain, metabolic syndrome, diabetes, and the risk of a heart attack or stroke. It needs to be aerobic. Aerobic exercise is anything that makes you breathe harder and makes your heart beat faster. This floods your body with oxygen-rich blood, which also helps your brain. “Aerobic exercise makes your heart muscle stronger, improves your lung function, and increases your circulation throughout your body,” says Dieli-Conwright.
There are a lot of ways to get aerobic exercise, and the first thing you need to do before you start any exercise program is to check with your doctor to find out what you should and should not do. Then, “find something that you enjoy, something that motivates you,” says Dieli-Conwright. If you like it, you’re more likely to stick with it. “Consistency is so important. People tend to get that euphoric feeling when they start exercise, as they’re getting more in shape. But if anything tweaks their schedule or behavior and they fall off the routine, it’s hard to get back on; they can get into a slump.”
To avoid a slump, Dieli-Conwright has this advice: Do something, and keep at it. Even if you don’t feel like doing much; a little is better than no exercise, and maybe next time you can do a little more. Dieli-Conwright leads exercise programs for patients with other forms of cancer who are on chemotherapy and struggling to do much at all. “Even if they just do exercise involving standing up from a chair and sitting back down, it’s better than not doing anything,” and even incremental gains can improve energy and strength.
Check out your local gym or YMCA, where they not only have weights and exercise equipment, but classes and trainers. These classes may include: Zumba, step aerobics, dance aerobics, spin classes, even boxing or kickboxing, and high-intensity interval training (HIIT), which Dieli-Conwright often recommends. HIIT alternates short bursts – really short; 30 seconds to just a couple of minutes – of intense exercise with a few minutes of rest or gentle exercise. A session of HIIT may be as short as 15 minutes, but its effects are similar to, or even better than, those of sustained periods of exercise. “We are doing a handful of HIIT studies in our lab,” she says. “It is very effective; almost superior to other types of exercise, because of its effect on metabolism. When you stop, your engine is still going; the body is still working. Metabolically, that’s really desirable.”
Strength training and stretching: Strength training isn’t just about lifting weights; you can use your body as a weight (in a plank, for example, or in many Yoga poses or Pilates exercises). You can also use a resistance band – an inexpensive rubber band that you can either hold or hang over a door – to build up your strength. If you do lift weights, you don’t need to get a whole bench press with multiple, very heavy weights. You can do a lot with dumbbells ranging from 5 to 20 pounds – but again, check with your doctor first, particularly if there is cancer in your bones. Strength training doesn’t just help the muscles. It slows bone loss, and can even help build up bone mass. “Weight-bearing exercises, such as resistance band or dumbbell exercises, make the bones stronger and denser,” says Dieli-Conwright, “particularly, the bones that are most likely to fracture, like the wrists, spine, and hips.” They also can help with your balance and stability – more protection from falls.
Think of a seesaw, with weight training on one end. The seesaw doesn’t work very well; it needs something to balance it out, and this is where stretching comes in. “When you lift weights, your muscles get tight, and if they get too tight, they can be injured,” says Dieli-Conwright. “Stretching is integral in maintenance of the muscle. It is harder to move if your muscles are all tightened up. Stretching helps elongate the muscles and allows the body to move better. The goal is to open up the body – to relieve tight shoulders and hip flexors, and improve function in the knees.” You can find basic stretches on the internet, and you can do them at home. Here is an example.
Stretching doesn’t always get the respect it deserves. It doesn’t give you six-pack abs or allow you to walk or jog without getting so winded. “But it helps your body move and function better.”
Ask about physical therapy: “Physical therapy (PT) is underused in oncology,” says Dieli-Conwright. “When patients go through cancer treatments, they often become deconditioned. They may have cardiorespiratory and balance issues. Ask your doctor about a referral to PT. An exercise trainer at a gym is less likely to be tuned into some of the issues specific to cancer patients, and a physical therapist in oncology is a board-certified clinician – a great entry point for patients recovering from treatment.” Physical therapists are particularly good at stretching: “active stretching and mobility work, because they’ve learned to help people recover from an injury.”
What if you’re using a walker, cane, or wheelchair? Physical therapists can work with it! “We’ve had individuals in wheelchairs in our studies,” says Dieli-Conwright. “We just modify the exercise,” with upper-body stretches, dumbbells, hand bikes, and other equipment. Note to Veterans: “There are great PT services within the VA, where therapists are particularly trained to work with individuals who have some adaptive exercise needs.”
What about balance? The nice thing about improving your balance is that you can do it almost anywhere, or anytime, like when you’re waiting on hold on the phone. Try standing on one leg (near a piece of furniture or a wall if you need something to hold onto). Then stand on the other leg. If you wobble, try to do it for five seconds at a time, and then work up from there. Or stand on two legs, but close your eyes. Or stagger your stance, with one leg in front of the other, and then switch. Or walk across the room (or behind the couch, in case you need to grab it) heel to toe. Here are three simple exercises you can do for starters. All of these exercises may help lower the risk of falling.
No matter where you are in this journey, starting an exercise program (with your doctor’s okay!) is going to make you feel better. As Dieli-Conwright says: “What are you waiting for?”
