Exercising in the real world

[Wendy_Winnall]

Exercise has many benefits for men with prostate cancer who are taking hormone therapy. Some clinics offer exercise programs to these men. Supervised exercise programs are a safe and structured environment to promote exercise. But what happens when the program is over, and men are "kicked out into the real world"?

Exercise has many benefits for men on ADT

Men with prostate cancer often take androgen deprivation therapy (ADT; also called hormone therapy). This treatment is used by men with advanced prostate cancer, as well as some who have radiotherapy to treat their localised prostate cancer. ADT reduces the testosterone present in the body, which slows the growth of prostate tumours. Unfortunately, ADT has many side effects. These include loss of sex drive, erection problems, fatigue, thinning of the bones and mood swings. There are also effects on the body such as weight gain, increased fat and reduced lean muscle mass.

Exercise can benefit men taking ADT in a number of ways. A combination of muscle-building (resistance-training) exercises with aerobic exercises (running, walking, cycling etc.) is recommended. It reduces fat build-up, increases lean muscle mass, reduces fatigue and promotes bone strength in men taking ADT. A tailored exercise program designed by a physiotherapist or exercise physiologist is crucial to ensure benefit and minimise any possible harms from the exercises. The importance of exercise has been demonstrated by Australian researchers, who are world-leaders in research on the best types of exercise for prostate cancer patients.

An exercise program for men with prostate cancer in Denmark

The success of an exercise program at the largest urological clinic in Denmark is currently being studied. Men taking ADT for prostate cancer at this clinic are offered a 12-week supervised exercise program. This program is hospital-based and free (paid for by their health care system). Each patient received an individualised resistance training program. At the hospital program, men trained in groups of 10 to 15. The groups met and trained under the supervision of physiotherapists. Resistance training was performed using exercise machines. This was supplemented by aerobic exercises, such as jogging, walking or rowing. The men are encouraged to continue exercising in a community-based gym after the 12-week program is over.

How do men experience the transition from the hospital exercise program to the community?

A new study has been published that specifically asks how these men experienced the transition from the hospital exercise program to exercising in the "real world". This study was conducted using qualitative research. Qualitative studies use open-ended surveys and interviews. They use questions with long verbal or written answers are given, rather than choosing between possible answers. The idea is to broadly explore the topic, gaining as much information as possible. Qualitative research is often used as a first step to understanding an issue, before interventions are tested to improve the situation.

The Danish study involved 29 men who had previously completed the 12-week exercise program. 25 of the men were continuing to exercise after the program, but 4 had ceased. For the men who continued to exercise, the improvements to their physical fitness were maintained 3 months after the hospital-based program finished. But how did they all experience the transition to the "real world"?

To answer this question, the researchers used focus groups of up to 7 men. Interviews were loosely structured with questions followed by discussion between the group members. Some of the questions asked in the focus groups included:

• What do you think worked well in the transition from supervised to non-supervised exercise?
• What challenged you in the transition from supervised to non-supervised exercise?
• What happens during an exercise session when you exercise in the fitness centre?
• How do you feel that your physique is influenced by exercise?
• What does it mean to you to exercise with each other? Are any of you exercising alone?

The study uncovered a number of important issues that will help in the future management of the transition to the community:

1. A structured transition was important

The last two sessions of the supervised hospital-based program were conducted in a community-based gym. The physiotherapists running the hospital program introduced the men to the exercise machines in the gym, providing them with confidence to exercise independently. Many of the men brought their exercise charts from the hospital program and continued the same process of keeping records of their progress in the community gym.

2. Social relationships were very important

Establishing and maintaining social relationships was highlighted as the most important factor in the transition. The men who continued to exercise in the community gyms usually did so in groups or pairs, with men who they met at the hospital program. They emphasised the importance of having a talk with peers after the training session. Men who were exercising alone, or with their wives, stressed how they missed exercising and talking with their peers. When exercising alone, among younger and more muscular people, men found the environment in the gym alienating.

3. Men were motivated by improvements to their well-being

Most of the men felt that exercise had a really good effect on their health and the way they felt. Exercise also gave them improved physical strength and this made some daily activities easier for them. They also felt better about their bodies, leading to increased daily energy and enjoyment of life. These positive experiences became a motivating factor to continue exercising.

The Danish researchers concluded that a hospital-based exercise program provided a safe learning environment, and that transition to community-based exercise could be confronting. This transition could be eased by a structured transition, such as supervised sessions in a community gym. Having sustained peer support and continual monitoring were also helpful, and the improvements to health and well-being were an important motivator for these men.

This type of study is referred to as translational research. The aim is to turn research results, such as the benefits of exercise, into programs that make a difference in the real world. Just as men are "kicked out into the real world" when the 12-week program finishes, research is useless unless it helps people in the real world. Translational research is very important for improving the lives of men with prostate cancer.

Exercise is good for everyone affected by prostate cancer. If you thinking of getting more exercise, these links may help your with more information:

Speak to your GP about a referral to an exercise physiologist in your local area

Currently there are two affiliated support groups that focus on exercise, further details from this link.

Information brochure from the Australian Physiotherapy Association from this link

The Australian Physiotherapy Association website

or ask your doctor about clinical trials testing exercise as a medicine for prostate cancer