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Exercise has many benefits for men with prostate cancer, both during and after treatment. Staying active helps you manage treatment side effects like incontinence, builds your strength, and lifts your spirits.

Regular exercise and healthy eating may even lower the risk that your cancer will come back after treatment, especially if you have early-stage prostate cancer, says Evan Pisick, MD, an oncologist at the Cancer Treatment Centers of America hospital in Zion, IL.

The type of exercise you do is up to you, he says.

“The research on activity’s benefits for men with prostate cancer doesn’t go into the specific exercises to do. Your doctor may tell you to eat healthy and exercise, but some men don’t know where to start,” Pisick says.

He suggests that you vary your exercise routine to include both aerobic and strength training. Choose activities you enjoy, so you’ll want to keep doing them.

“Do the workouts that work for you,” he says. “Some of my patients lift weights at the gym. Others do cross-training. Some walk or run.”

What to Do Before You Start an Exercise Routine

Before you start an exercise program, talk with your oncologist. Ask what activities are best for you right now, to lower your risk for injury or embarrassment. Your doctor may also refer you to a physical therapist.

“It depends where you are in the treatment process,” Pisick says. “Guys who are having radiation treatments can work out. If you’re a man who has just had prostate surgery, then you may not be able to do pelvic floor training or ride a bicycle at first, because you might pee your pants.

“But 2 or 3 weeks after surgery, once your catheter is out, go see a physical therapist who will guide you on how to exercise safely. They can show you how to do pelvic floor training exercises to practice at home, all day, every day.”

Pelvic floor training, also called Kegel exercises, strengthen muscles that control your bladder and bowel function. They can ease incontinence for men who’ve had surgery to remove the prostate, called radical prostatectomy.

“Work with your therapist to learn how to do your pelvic floor training exercises properly. They can insert a small monitor device up your butt. When you contract your pelvic floor muscles, the monitor detects it, and your therapist can show you on a graph that you’re working the right muscles,” Pisick says.

Once you learn to contract the correct muscles, slowly build up to doing a set of 20 pelvic floor exercises at least three times a day. In a few weeks, you’ll notice better control of your urine flow and fewer leaks. Don’t stop doing your daily sets.

Exercise Fights Medication Side Effects

Androgen suppression therapy (AST), or drugs that lower male hormones to suppress the growth of prostate tumors, may cause side effects like:

• Loss of muscle strength
• Loss of bone density
• Weight gain
• Fatigue
• Increased levels of fats, or lipids, in your blood
• Emotional ups and downs

Exercise can tackle many of these negative effects.

“When you take away someone’s testosterone, their muscles can turn to mush. Men may also have hot flashes and depression,” Pisick says. “Doing cardio and strength training can help you maintain your muscle mass and prevent weight gain. Some guys even lose weight.” 

If you’re overweight or obese, prostate cancer is more likely to come back after treatment. Cardio exercise, the type that gets your heart pumping like biking or fast-paced walking, helps manage your weight. This not only improves your chances for long-term survival with prostate cancer, but lowers your risk of heart disease.

Further, exercise can improve your mood and outlook. It helps ease anxiety and depression from having prostate cancer or dealing with treatment side effects.

“You’re going to feel better overall if you exercise. There is an endorphin release with exercise. It can even help you sleep better,” Pisick says.

Pisick’s father, a 78-year-old recovering from prostate cancer, takes brisk walks every day. “He is in the best shape of his life and says that since he became more active, he feels happier,” Pisick says.

How Much Exercise Do You Need?

Start slowly and build up your strength and stamina, Pisick suggests.

A physical therapist or personal trainer can assess your condition, create an exercise routine that’s safe and appropriate for you, and help you stay motivated to stick with it.

“I have some patients who start to work out, overdo it and have sore muscles, and then they don’t go back to the gym for a few weeks,” he says. “It’s important to exercise safely. A therapist or trainer can help you learn how to do the exercises correctly. Some hospitals even have gyms with physical therapists on staff to train you.”

Aim for 30 minutes of physical activity 5 days per week, or more if you feel up to it. Include a mix of:

• Cardio activities, like walking, swimming, cycling, or jogging, to improve heart health and manage weight
• Weight-bearing exercises, like walking, stair climbing, lifting weights, or dancing, to prevent bone loss
• Strength-training, like lifting weights and pelvic floor training, to build muscle strength and reduce bladder leaks

“Yoga is also a good exercise for improving your strength and flexibility. Pilates is also a good option, and I also like to recommend meditation,” Pisick says. Slow movements like yoga, tai chi, or Pilates may be a good choice on days when you’re fatigued, he says.

On days when you feel crummy or tired, try to do even a small amount of cardio, he suggests.

“The best treatment for fatigue is do get up and so something,” he says. “You may get tired. But any amount of activity will make you feel better. Pull that stationary bike in front of the TV, remove the clothes you have hanging on it, get on and ride for a little while. You’ll do better long term if you do.”

By Cara Murez 

HealthDay Reporter

MONDAY, Oct. 24, 2022 (HealthDay News) – About 88 nursing homes in the United States are on a watch list for worrisome care that puts residents in danger, but now they will face tougher penalties for any future violation.

Those tougher penalties could include the loss of federal funding if they receive more than one dangerous violation, the U.S. Department of Health and Human Services (HHS) said Friday.

The new penalties will apply to fewer than 0.5% of U.S. nursing homes that are already designated as a “special focus facility” because of a previous violation.

“Let us be clear: We are cracking down on enforcement of our nation’s poorest-performing nursing homes,” said HHS Secretary Xavier Becerra said in a statement announcing the tougher penalties.

The existing watchlist already requires the U.S. Centers for Medicaid and Medicare Services to do more monitoring at these facilities.

Nursing homes with more than one violation will also be monitored for at least three years. Staffing levels will be among considerations for adding a facility to the watch list.

The U.S. Centers for Medicare and Medicaid Services may implement staffing ratio requirements; it is studying that issue now.

President Joe Biden earlier this year promised to overhaul the nation’s nursing home system.

Residents were hit particularly hard by the pandemic, which killed more than 200,000 residents and staffers. About a million people live in these homes, some of which are plagued by subpar care and staffing shortages, the Associated Press reported.

The Biden administration also plans to award $80 million in grants to health care organizations, trade groups and labor unions to train and hire nursing staff. Grant applications are due by Jan. 6, the AP reported.

When Howard Chang, 50, first learned about biologic treatments for psoriasis almost 20 years ago, he was eager to give them a try. Now they’re a mainstay in his overall treatment plan.

Chang was first diagnosed with psoriasis around age 8. He tried lots of different treatments, including tar, phototherapy, topical creams and ointments, steroids, and oral medications.

“I definitely was always looking for the next new treatment, given that it was so hard for me to find anything that was effective,” Chang says.

He hoped biologics would provide much needed relief.

What Are Biologics?

Biologic drugs — often called biologics or biologic medications — work by changing parts of your immune system. You usually give yourself a shot. But some are given through an IV at your doctor’s office. The FDA approved the first two biologics for psoriasis in 2003. Now there are several options.

They’re generally prescribed for people with moderate to severe psoriasis, based on the amount of skin affected. But doctors also consider how psoriasis impacts a person’s life when deciding, says Malini Fowler, MD, a board-certified dermatologist in San Antonio, TX.

“There is no cookie-cutter candidate,” Fowler says. “Even if someone has mild disease, they are still probably a candidate for biologics, depending on how it affects their life.”

These drugs might also do more than just clear up your skin. They could help protect your heart, joints, and other body parts from inflammation.

“When we talk about using biologics, it’s a systemic medication treating (people) from the inside out, decreasing psoriasis on the skin, and hopefully helping with inflammation on the inside, too,” Fowler says.

What Are the Pros and Cons of Biologics?

Chang read up on how the drugs work, possible side effects and the risks when first considering biologics.

“Putting something in your body via an injection is something you have to think about, especially how it’s affecting your immune system,” Chang says.

Next, he spoke to his dermatologist.

“It’s key to have a dermatologist who understands the medications and also collaborates and connects with me as a (person),” Chang says. “We work on a plan together.”

While biologics can ease psoriasis symptoms, there are potential dangers, like with any drug. Some of them can up your odds for inflammatory bowel disease and cancer.

“You need to check if you have underlying cholesterol or hypertension problems,” Fowler says.  “Every biologic medicine is slightly different; most of them have a different mechanism of action with different safety profiles.”

It’s important to tell your doctor about any other conditions you may have, so they can make sure the biologic won’t interfere with them or any medications you take.

Which Biologic Is Most Effective for Psoriasis?

Chang has tried six biologic drugs since 2003. One helped for about 8 years, but he had to switch up the rest because he couldn’t tolerate the side effects of some drugs, they stopped working after a certain period of time, or they just didn’t work at all.

While Chang says he knows many people who have achieved healthier skin with biologics, treatment hasn’t been as successful for him.

“I’ve never really been clear,” he says. “It’s not a cure. There are still triggers that can cause a flare.”

Finding a biologic that works for you can be emotionally draining.

“It’s a roller coaster ride. You keep hoping it’s going to work, and you wait for it to kick in. And then if it doesn’t work for you, it can be a big letdown,” Chang says. “Especially since [psoriasis] has such a big impact on my life. Sometimes, I feel like I can’t fully function because I have all of this physical discomfort when I’m running, working, teaching, meeting with people. I just want to be comfortable.”

Fowler likes to give a biologic 3 months to run its course.

“Not every medicine is going to work for every (person), but it’s also important to stick with the medications and give them a chance to see if they help,” she says. “I tell (them), ‘If this doesn’t work, we’ll go on to the next one. We will find the right medicine for you, but it may be a bit of trial and error’.”

Can I Take Biologics With Other Treatments?

Chang continues to use other psoriasis treatments, including topical creams and phototherapy.

“I feel better about things overall [with biologics], that I don’t have to do everything perfectly,” he says. “It feels a little better to know I have a medication that is working in the background.”

And he knows that managing stress, exercising, and eating healthy are critical to keeping flare-ups at bay. They do the same for metabolic syndrome, a group of conditions linked to stroke, type 2 diabetes, and heart disease. People with psoriasis have a higher risk of metabolic syndrome.

In addition to regular appointments with a dermatologist while on biologics, Fowler suggests keeping your primary care doctor in the loop, getting blood work done every year, and seeing a rheumatologist every 6 months.

“I also routinely ask patients about joint pain, because about 30% [of people with psoriasis] will develop psoriatic arthritis,” she says.

What’s Most Challenging About Taking Biologics?

One of the hurdles is learning how to inject the medications yourself.

“I think I’ve self-injected myself over a thousand times,” Chang says.

Luckily, the number of injections is significantly lower with newer biologic medications. Chang says he used to have to inject himself two times a week, but some injections can now be weeks or months apart, depending on the medication.

Chang came up with a routine to follow when giving himself an injection, from washing his hands and setting out all the materials, to ensuring he has something to watch in the background.

“It calms me to have a routine,” Chang says. “[Injecting yourself is] something you never completely get used to, but you get more skilled at.”

Another hurdle can be getting approval from your insurance company to cover different biologics.

Chang is hopeful that the biologic treatments for psoriasis and other options will continue to improve.

“It’s just a time to be really optimistic as someone living with psoriasis,” he says. “With all the research, medications, and advocacy, we have options and more coming.”