Keeping Bones Strong when on Prostate Cancer Hormone Therapy

Men with prostate caner often receive hormone therapies to reduce their testosterone levels, which in turn decreases the rate of prostate cancer growth.  However, this treatment does have its side effects, one of which is osteoporosis or the thinning of bones that can make them easier to break.  To minimize the chances of this happening you need to prioritise activities that encourage the body to lay down more calcium in your bones. 

Exercise is a good way of maintaining your bone health especially if it is weight bearing or includes resistance exercises.

Weight bearing exercises are any exercise where you carry your body weight such as walking or, if you are up to it, skipping, bounding or jogging.  Swimming, though good for your heart and lungs, is not an ideal exercise to increase bone strength as the water supports your body weight. Weight bearing activities stimulate your body to increase the amount calcium in your bones, making them stronger.  The target is to do theses exercises on a daily basis but start at a level you are confortable and gradually build up.  Every step counts.

Resistance exercises are exercises where you use weights to increase your muscular strength.  If you have strong muscles, the body is once again encouraged to lay down more calcium in the bones.  You will want to look at doing three strength training sessions per week with a day off in between.  Aim to do eight to ten exercises that cover all your major muscle groups.  The weight you use should be moderately heavy to heavy, in other words you shouldn’t be able to lift it more than 12-15 times without needing a break.

Alongside the exercise it is important to also look at your other lifestyle factors such as ensuring you don’t smoke, avoiding alcohol and caffeine and getting enough calcium.

You get calcium from your diet and it is found in dairy products, green vegetables, fish, whole breads and cereals.  To help your body absorb the calcium you need to make sure you are getting enough Vitamin D. Your body makes Vitamin D from the sun so if you go outside in the sun regularly you will probably be getting enough  (just make sure you are being sun smart).  If you don’t go outside much in the sun you should consider taking a Vitamin D supplement or eating foods such as oily fish, eggs, margarine spreads. 

Basic Exercise Recommendations

If you are wanting to make sure you are getting the right sort of exercise for your health it is important to ensure that you give the following areas of fitness equal consideration:

These are:

Cardiovascular     Exercise for the heart and lungs.  Improves your endurance.

Strength              Builds muscle mass and prevents age related muscle loss

Flexibility            The ability to move your joints within their normal range of motion

Balance              Confidence to  be steady and avoid falls

The following guidelines show the minimum levels you need to do to avoid developing chronic conditions:

Type	How long	Times a week	Exertion Level	Examples
Cardio	30mins a day or	5	moderate	Raise heart rate, break into a sweat but carry on a conversation
	20mins a day	3	Vigorously intense	As above but breathing heavily, and cannot say 3 words in a row
Strength	8-10 exercises	2	8-15 repetitions of each exercise	Wall push up, Squat, Row, Lateral raise, Lat pull, down, Calf rasie, Abdominal, Hamstring ball roll or core exercises
Balance	10 minutes	3	Have something sturdy to hold and a sturdy chair to sit on if required.	Single leg balance, Heel toe walking.
Flexibility	5-10min	2-3	To the point of tension not pain	Hamstring, Quad, Calf, Chest  and back stretches.

 The recomendations above are the minimum you should try to achieve each week as the more you do the greater the benefits.  A good target would be to look at doing twice the recomendations.  However if these targets seem to much at the momment try and at least do half of the recomendation as you will be getting a worthwhile benefit.

Weight loss requires more than these guidelines, a miniminum of 90minutes of cardio a day has been suggested as a target.

 

If you have a chronic condition, your needs will differ, and your exercise physiologist can help you make suitable adjustments.

A Paving Stone a Day

It doesn’t matter how fit you are today, the aim of any exercise programme should be to progress. In other words try and do a little bit more tomorrow than you did today.  If you do this you will reach levels you wouldn’t think possible today.

This was never better demonstrated than when Henry (name changed), an 84 year old man arrived at my gym in.  He was driven up to the gym by his son and was dropped off at the disabled parking spot.  It then took him nearly 20 minutes to walk 20 metres with his walker to the front door.  He had to stop for twice on route to rest and catch his breath.

When he arrived in the gym he told us that the only things he did all day was get out of bed, get dressed, eat and collect his post from the post box at the end of his drive.  He was fed up and wanted to do more.

On day one of his plan he managed two minutes on our arm crank at the lowest setting.  On day two he started the homework we gave him which was to walk one paving stone further every day.

He also saw us at the gym three times per week.  When at the gym we gradually increased his cardiovascular exercise from progressing him from  the arm crank to a seated bike. He also started a progressive strength and balance programme.  We started easy and gradually increased the load and difficulty.

Six months later Henry arrived at the gym one morning and said ‘Look what I can do,’ before proceeding to jog, albeit slowly, along the deck.

We were amazed and thrilled that he had progressed from using a walker to being able to jog.  Not only that he was now doing two, one mile, walks a day.

So six months of progressive exercise got Henry fitter.

Big deal!!

What really counted was that he had driven to the gym himself that day, he wasn’t using his walker, he was off to play bowls after the gym and was then heading to his social club.

The time he invested in exercise really gave him quality of life back.   

Exercises Post Axillary Dissection

This leaflet has been designed in conjunction with the CanMove – exercise for all cancer patients programme.

CanMove - exercise for all cancer patients are group exercise session run every week and are free to people with a cancer diagnosis or ongoing effects from cancer and its treatments.

What is axillary dissection?

Axillary dissection is a surgical procedure that opens the armpit to identify, examine or remove lymph nodes. Lymph nodes are small glands that are part of the lymphatic system, and filter fluids. These nodes are normally removed in order to determine the necessity of further treatment based on cancer cell spread.

Why do the exercises?

The aim of these exercises is to regain normal arm and shoulder movement after axillary node surgery or radiotherapy in the armpit area. It is important to move the arm so the tissues in your shoulder don’t get tight and cause pain.
The exercises should always be done slowly. You may feel some discomfort but they should not be painful. If you develop lasting pain for 30 minutes or more you might need to change the exercises by doing less of them or doing them more gently.
If pain continues consult your Exercise Physiologist or Nurse.

When do you start?
 
It is best to start these exercises as soon as possible after surgery, so if possible aim to start the day after your surgery. Always check with your Surgeon that they are happy for you to start.

Week 1       Start with the Level 1 exercises and if tolerated add in Level 2.
Week 2       Move on to doing Level 1 and then Level 2 exercises
Week 3       Move on to the Level 1 and then Level 3 exercises
Week 4+     If you have full range of motion start with gentle strength exercises
                   (Seek further advice about which exercises are suitable)

When do you need to seek further advice?
 
Before starting these exercises check with your Nurse or Surgeon that they are happy for you to start.

If you notice any excessive oozing, redness or severe pain please stop the exercises and consult your doctor or nurse as soon as possible.

If you are in doubt about the exercises and how to do them, or if you feel you are ready to progress, you can contact the CanMove programme for further advice or assistance.

How often should I do the exercises?
 
Start by running through them twice a day and if you can aim for 3 times a day. Pick times of the day when it will be easy for you to remember to do the exercises. When you first wake, after lunch and before bed can be good times to get in the habit of doing the exercises.
Always focus on having good technique during the exercises so if you notice you are tiring during the exercises and can’t do them properly it is better to have a break and try again later. Little and often is better than doing one long session.

Over time the exercises should start to become easier. If you notice you can regularly do an exercise fully you need to move on to one of the more advanced exercises in this book or consult with a healthcare professional to find the next step.

It is important to continually progress exercises so you get stronger. Continue to exercise even if symptoms or side effects have reduced.

If you have not regained full range of motion within 3 weeks or would like further assistance please contact your Nurse or Exercise Physiologist.

LEVEL 1

Shoulder Shrugs
Aim for 3 sets of 15 repetitions per day
Keeping your arms relaxed by your side
Shrug by lifting the shoulders up towards your ears.
Return to start.

Shoulder circles
Aim for 3 sets of 15 repetitions per day
Keeping your arms relaxed by your side
Shrug by lifting the shoulders up towards your ears then roll them backwards and down.
Return to start.

LEVEL 2
 
Back scratch
Aim for 3 sets of 15 repetitions per day
Slowly reach round behind your back to just under your shoulder blades.

 

Bent arm raises
Aim for 3 sets of 15 repetitions per day
Start with arms by your side, then lift fore arm so palms are touching the shoulder and elbows are pointing forwards.
Lift the elbows up to shoulder level and then return to the start.
 

Bent arm side raises
Aim for 3 sets of 15 repetitions per day
Start with arms by your side, then lift fore arm so palms are touching the shoulder and the elbows are out to your side.
Lift the elbows up to shoulder level and then return to the start.

LEVEL 3 – These can be done seated

Arm Lifts
Aim for 3 sets of 15 repetitions per day
Lie on your back and relax the shoulders.
Hold your hands together and then lift both arms up above your head.
Aim to get the arms as near to the ground as you can without arching your back.
Hold them in this position for 5 seconds then return them to the start position.

 


















Elbow pushes
Aim for 3 sets of 15 repetitions per day
Lie on your back, relax the shoulders and place your hands behind your head.
Gently push the elbows towards the floor. Hold for 5 seconds and return to the start position.
 

Snow angels
Aim for 3 sets of 15 repetitions per day
Lie on your back, relax the shoulders and place your arms by your side with the palms up.
Keeping the backs of the hands as close as possible to the floor. Slowly bring the arms up above your head.
Return the arms to the side by keeping them as close as possible to the ground.

Side wall climbs
Aim for 3 sets of 15 repetitions per day
Stand side on to a wall with your affected arm next to the wall.
Put the hand on the wall below shoulder level and gradually crawl the finger up the wall.
Aim to get higher with each attempt.
Hold for 5 seconds and return to the start position.

 



 
Wall Climbs
Aim for 3 sets of 15 repetitions per day
Stand a wall.
Put both hands on the wall, below shoulder level, and gradually crawl the finger up the wall
Aim to get higher with each attempt.
Hold for 5 seconds and return to the start position.

  















Once you have regained full range of motion in your shoulder area and your wound has healed it is beneficial to start some gentle strength exrcises. Strength exercises will help further improve and maintain function in the area.