“Our vision for my research program is to use exercise as medicine for cancer.” – Kerri Winters-Stone
“There is potentially a 50% reduction in prostate cancer specific mortality and prostate cancer recurrence [from exercise]. It’s more powerful than chemo. It’s probably more powerful than a lot of the current treatments.” – Kerri Winters-Stone
Advanced cancer patients, especially patients on hormone therapy, want to learn more about how exercise can help treat their disease. Advanced prostate cancer and breast cancer patients on hormone deprivation therapy often suffer a decline in their muscle and bones. Their heart is a muscle, and declines in cardio health are a common side effect. Another side effect can be weight gain or weight loss. Prostate cancer patients often have metastases in their bones, which weakens them.
Exercise is an intervention patients can use to control or offset their cancer and the side effects of hormone therapy and other therapies. It is one of the best anti-cancer therapies, strengthening the heart, bones, and the immune system, and generally enabling resiliency in response to harsh treatments. For example, men with prostate cancer on androgen deprivation therapy need to preserve bone health through resistance training.
Dr. Kerri Winters-Stone is uniquely qualified to discuss muscle and bone toxicities and non-cancer threats to survival, such as falling, especially in relation to prostate cancer. She is an exercise scientist and professor and co-lead of Cancer Population Science in the Division of Oncological Sciences at Oregon Health and Science University. She is also co-director of the Knight Community Partnership Program and Co-program leader of the Cancer Prevention and Control Program for the OHSU Knight Cancer Institute, an NCI-designated comprehensive cancer center based in Portland, Oregon. As a scientist, Dr. Winters-Stone’s research focuses on the effects of cancer treatment on musculoskeletal health and cancer recurrence risk and the ability of exercise to improve health and longevity in cancer survivors. Her work has extended to consider the impact of cancer treatment on the health of intimate partners and relationships by innovating a partnered approach to resistance exercise that builds teamwork. More recently Dr. Winters-Stone received new NCI funding to determine the patterns and predictors of chemotherapy-induced neuropathy and mobility impairment during neurotoxic chemotherapy and several NCI supplements to integrate digital technology as a tool for continuous passive monitoring of symptoms, mobility and quality of life in aging cancer patients.
What are the complex health challenges that advanced cancer patients face?
People with cancer are often older and face problems from aging, as well as other conditions besides cancer. Cancer treatment side effects can either accelerate functional declines or add new problems that accelerate functional decline. It changes body composition, causes extreme fatigue, and can result in slowness, weakness, and instability. Hormone therapy adversely affects bone health and strength. The condition of “frailty” leads to falls, combined with bone weakness, that can cause fractures, and those end up creating significant morbidity and mortality. Other side effects from cancer treatments include cardiovascular disease, diabetes, and loss of independence.
What are the benefits of exercise?
Dr. Winters-Stones’ research projects have established that an exercise program using bone loading is able to completely stop bone loss in the spine for men on androgen deprivation therapy. The broader benefits of exercise, such as resistance training, include the ability to do more activities without any assistance, cardiovascular and metabolism improvements, and reductions in circulating insulin levels and body fat.
What exercise program should you do?
You should work towards aerobic exercise three to five days a week, 30 to 60 minutes at a time; resistance training two to three days a week; and flexibility, stretching, and mobility every day. This isn’t any different than the public health guidelines. But each one of those have different benefits and an ideal program would contain those different modalities, and these are the doses that are effective.
How should cancer patients with bone metastases exercise?
If you do exercises without weights and your form is correct, the risk is relatively low. As you start to increase weights, and if you do things incorrectly, the risk is going to increase. You should avoid highly dynamic, rapid loading kind of exercises, twisting exercises, hyperflexion hyperextension, or any extreme loading on the bone. You should be careful of exercises where the weights are away from the midline of your body.
Any advice on supplements?
- Calcium: For women who are hormone deficient, e.g., postmenopausal, the recommendation is about 1500 milligrams of calcium a day. For men, it’s 1500 milligrams a day and you should break up your doses throughout the day, with no more than about 500 milligram per dose, e.g., at breakfast, lunch and dinner. Calcium citrate tends to be the most absorbable followed by calcium carbonate. Oyster shell calcium is not as good as Citric Cal or some other supplements that are on the market.
- Vitamin D: It depends on where you live. For those in Oregon, who don’t get vitamin D in the wintertime, you might benefit from a supplement.
What do we need to do in the future?
Our goal is to make the patient’s quality of life as high as possible, for as long as possible. We know that exercise has the potential to control disease progression and to improve treatment side effects, but it is not yet part of standard care. Patients should have a warm handoff after treatment to an exercise program.
The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.
Relatedly, many people asked about our FIT Together community exercise program. This is a nonprofit I run outside of OHSU as a way to provide access to our exercise programs outside of the research context. Here is a link to the website, which is very basic (and is a work in progress), but shows the classes we offer and a little bit about our group. https://www.fittogethertraining.org/ . The costs look like they vary but they are all about $5 per session and the total cost varies by the length of the session. There is one class specific to prostate cancer, which is a yoga and mobility class, and the others include mixed cancer types. We also have created a once weekly online meeting space for our prostate cancer participants per their request. There’s no cost and it’s just a gathering space for men to talk. We don’t facilitate anything. We are also going to start an intro to resistance training class in a few weeks, that I mentioned. That is not yet posted to our website, but you could contact us and we’ll let you know when it is up.
One person asked about stretching and in addition to the live classes offered through FIT Together, I’m including a link to a DVD / YouTube program we used in a research study in women with cancer and in persons with advanced lung cancer. The program is for anyone and is taught at three different effort levels so someone can follow whatever level suits them at any time, even from exercise to exercise. I love this program!
Here are two stretch routines we made for a prostate cancer study, one is in the chair and the other on the floor:
GET FIT Prostate Seated stretch program
GET FIT Prostate Floor Stretch Program
Finally, someone asked about finding experienced trainers to help them and we are definitely under-resourced here, as a profession. But, the ACSM has a Cancer Exercise Trainer (CET) advanced certification for personal trainers and those would be the ideal type of trainer to seek out. Anyone outside of that, I would ask how much experience they have working with cancer survivors, other types of illness / limitations / considerations, and judge if they are the right person for you. Someone who can do their homework and adapt exercises as needed for your ability and tolerance is best. Some trainers have little education about chronic conditions and little empathy, so I generally discourage working with them and I would not hire them to work for me. But, there are a lot of good people out there nonetheless.
If you go to this website: https://www.acsm.org/certification/about/profinder, you can specify what type of trainer you want, including a CET, and your state/zip so this might be of help. There is also a directory of cancer exercise programs that can be found here: https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer/exercise-program-registry/.