Why regular exercise is key to living well with prostate cancer

I’ve worked as a physiotherapist at the Royal Marsden for 15 years in various roles and my main clinical interest is in what we call ‘exercise oncology’. That means exercise for people with cancer. 

Over the last decade or so, I’ve been struck by the amount of evidence there is about the positive impact of regular exercise on people who are living with cancer. Not only is it safe, it may actually help with the side effects of treatment and lower your risk of getting other types of cancer.

Historically, the message from medical teams might have been to discourage cancer patients from doing too much exercise – the advice has often been to take it easy. But there needs to be a culture shift, in keeping with the growing evidence.

We’re working to embed physical activity as a standard of care within our hospitals. We want to make it everyone’s business to know about the importance of physical activity, and for our colleagues to share this with our patients.

My view is that we all need to be physically active, whether we have a health condition or not.

Find the balance that’s right for you

When people are diagnosed with cancer, their physical activity levels tend to drop. There are a variety of reasons for this but they’re often not supported to get active again. 

Some people will be required to exercise with a physiotherapist at the hospital. But for most, there’s no reason they can’t exercise normally. That’s why we encourage people to exercise in non-medical spaces, so it just becomes part of normal life.

Talking about exercise early on also creates a positive association with being active, which can be really empowering when someone has been diagnosed with cancer. Starting to lift weights or going for a run might not be the sorts of things you’d usually think of doing, but it could really help your cancer journey in so many ways.

It depends on the individual, but sometimes the advice to focus on gentle exercise isn’t quite right. You’ll get the most benefit from completing cardiovascular exercise that gets your heart rate up, or by doing strength training. (Any increase in movement is beneficial to your overall health, though).

In fact, if you’re not active at all, the evidence suggests that going from nothing to something has the greatest health benefits – even if it’s just walking a few more steps a day, being more active around the house or going for a walk. 

I like to approach exercise in the same way you might approach a medicine: you set a dose and you make a prescription. But everyone is different, so what works to motivate one person might not work for you. 

Prostate cancer usually affects older men, often at a time in their life when physical activity has dropped off. You might have other health conditions or, for example, a dodgy knee. It’s important to consider these things and what you enjoy doing, as well as your cancer diagnosis.

Exercise can play a part at any stage in your treatment journey

Our exercise service is available to men at any stage of their prostate cancer treatment. If you’re having surgery to remove your prostate, you might only be in hospital for a brief period – so before the op, the nurses will show you videos and give you information about exercise, to make sure you’re prepared for what you will or won’t be able to do during your recovery. We’ll also share tips on exercising more comfortably, like using a padded seat to ride a bike.

For men on hormone therapy, we provide a seminar that offers advice on the importance of exercise to counteract the side effects of muscle loss, bone thinning, weight gain and metabolic changes.

With prostate cancer, it’s often the case that men were well at the point of diagnosis and had no symptoms. They typically start feeling less well as they go through treatment, so we encourage our teams to check in with them about their physical activity levels at regular points on their prostate cancer journey.

For someone who’s in hospital with advanced prostate cancer, they might be referred to our inpatient physiotherapy team to get a plan tailored to their needs and goals. They might still want to go running or go to the gym, so it’s important that we support them to do that safely.

If you’re receiving an active treatment, like chemotherapy or radiotherapy, you might need to avoid exercising in public places where there’s close contact with others because of the risk of infection. 

But being active is one of the best things you can do for your immune system, so just take precautions if you’re going to the gym. Wipe down the equipment, wash your hands afterwards and go at quieter times.

Listen to your body and change your activity levels as needed, but try to do something every day.

Great ways to stay active if you’re experiencing fatigue or bone damage

Exercise might feel counter-intuitive if you’re feeling fatigued. But gradually increasing your physical activity, especially muscle strengthening exercises, really works.

I explain the importance of physical activity to my patients early in their cancer journey, so I'm not bringing up the idea of exercise when they feel like they can barely get out of bed. If you start exercising before fatigue hits, it may reduce your risk of developing really bad fatigue later.

If you’re receiving hormone therapy, you’re more likely to experience fatigue due to muscle loss. Doing regular strength training exercises can help prevent both muscle loss and fatigue – and there are lots of these you can try.

There are some limitations when it comes to appropriate exercises if you have bone damage from advanced prostate cancer, bone thinning from hormone therapy, or spinal cord compression. For larger bone lesions, there’s a higher risk of fracture, so we complete a personal risk assessment and create a specific exercise plan.

But it’s still important to keep the muscles around the bones strong. And now we have better bone-strengthening medication, we can do this safely.

It’s also important to do balance exercises and put strategies in place to reduce the risk of falls.

Take every opportunity to get out and about

I'm really aware that hospitals are sedentary spaces, even if you’re coming in as an outpatient. There’s a lot of sitting, between consultations, blood tests, scans and treatments – and you can spend a good half of the day waiting. 

So my colleagues and I worked with Living Streets – a charity that aims to inspire people to walk more in their everyday lives – to create two special walking maps for our hospitals in London.

Each map shows three routes of different lengths, to help patients explore the local area and find green spaces. With these maps, we can tell patients if they have time to go for a walk. We’ve done this specifically for men with prostate cancer who come in for our seminars on hormone therapy.

As well as getting people active, it’s been great for making hospital visits more enjoyable. I've seen people coming back from walks saying they’ve discovered new places. Or they’ve found a tube or bus stop and realised they could take public transport to the hospital rather than drive, which is such a good way of getting more steps in.

Wellbeing support that works for you

Prostate cancer can affect you physically, mentally and emotionally. Our Wellbeing Hub has support and information to help you take care of yourself. It’s for anyone affected by prostate cancer – whether you’re newly diagnosed, undergoing treatment, living with side effects or supporting a loved one with prostate cancer.

VISIT THE WELLBEING HUB