August 5th, 2018

Exercise and diet

Exercise and diet programs reduce the negative side effects of prostate cancer treatment
Prostate Cancer | Where The Money Goes
Exercise and diet hold the key to maintaining quality of life for men who have been diagnosed with prostate cancer, according to health professionals from Canada and Australia.
“Prostate cancer was the wake up that I got in life,” says 52-year-old Australian man Marc Webster nervously laughing. He was just 49 when he was diagnosed and told he had to drop 34 kilos before the surgeon could perform a radical prostatectomy.
It took just 90 days for the council worker who levels rural roads to achieve his ideal weight, despite his working day starting at 5am and ending at 5pm.
The father of three was motivated to adopt healthy eating and become more active immediately after his diagnosis because he says he “was worried about living.” 
“For you to lose weight, you're being told you're going to die. I was an emotional wreck,” he emphasises.
Coming from a long line of men with prostate cancer, Mr Webster explains that he wasn’t going to take any chances. He recalls the impact of seeing his grandad, a World War II veteran die from prostate cancer.  
“He was a big proud man. A farmer that worked hard all his life. I've seen him deteriorate in a couple of years and when he passed away he was only about 38 kilos – from 110 down to 38 kilos.”
To accomplish the mammoth task of massive weight loss, Mr Webster was introduced to TrueNTH, a global initiative of the Movember Foundation that tackles critical areas of prostate cancer care.
Through TrueNTH’s Australian telehealth system Mr Webster received one-on-one advice and care from a prostate cancer nurse, otherwise known as a care coordinator, as well as support from a psychiatrist.
Living in the bush in the east coast of Australia, Mr Webster was also identified as an ideal candidate for TrueNTH’s exercise and diet program trial. Through it he was able to access information around diet and exercise to help him meet his surgery deadline. 
“I kept an exercise book of what I was eating and how many calories it was worth. I was writing down what exercises I was doing. I was riding my pushbike 20 to 30 k's a night after I finished work. And on the weekend, I was riding 40 k's first thing in the morning, and then I was doing 30 laps of the swimming pool.”
In addition to preparing him for surgery, the exercise and diet program also reduced the impact of common side effects from prostate cancer surgery on urinary function, bowel function, sexual function and mental health.
When his grandad passed away, Mr Webster says he started having his PSA (Prostate-Specific Antigen) checked each year on his birthday and has been sticking to the ritual since he was 26 years-old. He’s now asked his eldest son to do the same. His motto for every man is: “man up, glove up.”
Dietitian Nicholas Denniston says he jumped at the opportunity to work with TrueNTH’s trial program in Australia “because men’s health is something that we don't do particularly well.” He explains that the program identified “a real gap in lifestyle services.”
“We knew that there were very few private dieticians. And they certainly didn't offer affordable pricing for men, which is a known barrier.”
Running for 12 months, the 2015 trial involved 40 men from northern New South Wales and 40 from the Sunshine Coast. The program offered six months of intensive support predominantly using video conferencing and phone support.
Mr Denniston says whether the men had a specific need or not, their urologist would refer them to a care coordinator, who in turn would refer the patient directly to him as well the exercise physiology team which operated out of Edith Cowan University in Western Australia.
According to Mr Denniston “65 to 80% of men look at changing their diet after diagnosis of prostate cancer.” He says the program proved this by showing “some really good physical outcomes around weight loss (from surgical referrals) and some reasonable outcomes in reduction of alcohol intake.”
“They're extremely motivated to make a change. That's an opportunity to help out either in general health or around the quality of life aspects of treatment options.”
Care Coordinator Sam Gebert is more blunt in his explanation.
“We get them when they're vulnerable, when they're questioning their own mortality and that's really powerful.”
Changes in diet and exercise can help with the multiple side-effects that men experience after prostate cancer treatment such as; reduced libido, increased fatigue and a wider girth, which particularly affects men who have had hormone therapy.
“With hormone treatment if you eat more than you need, it will go directly on your stomach, which then puts you at risk. Eating well can have a really big impact on someone's quality of life,” explains Mr Denniston.
Mr Gebert describes the TrueNTH diet and exercise program as “ground-breaking” with multiple benefits.
“If you've got good heart health, you're going to have good erectile health. It's going to limit your chances of getting diabetes. You're going to have a lot better mental health.”  
The TrueNTH pilot program has now been scaled up, with up to 12 regions across Australia trialling it. Mr Denniston says the aim is to look at “as many geographical and socio-economic areas as possible to prove that the concept works across different areas.”
Over in Canada, Professor Nicole Culos-Reed from the Faculty of Kinesiology at the University of Calgary is among those spearheading a push for wellness and lifestyle programs to help men not “just survive cancer but thrive with cancer.” 
“We can't continue just to focus on getting rid of the cancer and then leave these individuals as survivors to figure out what's next. We have to provide the resources and the support.”
Dr. Culos-Reed says there's a lot of evidence that shows that exercise and dietary interventions can alleviate men’s experience of treatment related side effects, such as incontinence and sexual dysfunction.
“We can potentially reverse things. We can build back muscle mass. We can increase bone density. We can improve psychological indices of well-being that may have been diminished by prostate cancer treatment.”
As the National Lead for Canada’s TrueNTH Lifestyle Management Program, funded by the Movember Foundation Dr. Culos-Reed oversaw the roll-out of a 12-week trial program built around two physical activity sessions per week, as well as nutritional education and stress reduction through yoga classes.
The multi-modal program was designed for men at different stages of their prostate cancer journey, from active surveillance to advanced prostate cancer. The activities included a mix of aerobic and resistance training, stretching, flexibility, and balance.
Delivered by Prostate Cancer Canada, the trial program was made available to all prostate cancer survivors through community-based partners and recreation partners. It was also made available online, given the vast nature of the country.
Unlike a regular gym program, Dr. Culos-Reed says the strength of this tailored program comes from the fact that it was developed by cancer experts and overseen by fitness professionals who were trained specifically in cancer and exercise. 
“One of the big things it addresses is incontinence. It helps men focus on how they work their pelvic floor muscles. And it focuses on cancer related fatigue, which we clearly see as a number one reported side-effect.”
Since the completion of the Canadian trial, up to 300 professionals have been trained in the ongoing delivery of this program, and over 60 resource kits have been distributed across the country.   
Dr. Culos-Reed argues that providing exercise and diet “support is going to be nothing but a benefit to our health care system.”
She says the men involved in the trial reported back that “engaging in this exercise program gave them back their lives.”
It’s a sentiment echoed in Calgary, Canada by 76-year-old prostate cancer survivor Colin Cantlie. He says, “The exercises have been absolutely profound towards the success of my surgery and to where I am today.”
“I am a senior person and I still feel really rejuvenated by the fact that I am very active.”
Profoundly deaf since the age of 40, and already suffering from Meniere’s Disease Mr Cantlie had his fair share of health problems leading up to his prostate cancer diagnosis. He says, “Getting cancer was not a happy moment, but it did reinforce the need to keep your body in good health as best you can.”
“When I first started, we walked up seven flights of stairs. By the end, I didn't think I was going to see the next day. But surprisingly enough I did. They worked us very well. They want us to do the best that we can.”
For the disability activist, the added benefit of the program has been the comradery and friendships he’s developed.
“We try to help each other by indicating that it's ok to have a bad day, but to continue trying.”
Married for almost 50 years, one of the most obvious side-effects for the grandfather has been the change to his sex life. Despite such challenges he claims TrueNTH’s Lifestyle Management Program has given him a new lease on life.
The retired flight operations coordinator now happily combines his love of travel and amateur photography and recently visited Italy and the Balkans.
“I'm doing a lot more now. I'm enjoying life immensely,” he declares.
By sharing his story, Mr Cantlie hopes to help other men who’ve been diagnosed with prostate cancer to “not feel that they have been sentenced to darkness.”
“If I can help two people what a blessing, and if I can help more than that, I'm just euphoric.”