Susan received a referral for a client with prostate cancer. She’s been a Cancer Exercise Specialist for a little over a year, but this is her first client with prostate cancer. She asked if she could hire me to help her with and teach her how to put together Eric’s exercise program. She completed his initial assessment and health history and shared the following information with me:
- Eric is 64 years old and in excellent health prior to his cancer diagnosis
- Eric is 6’2 and currently 200 lbs. (he’s gained 20 from treatment) He has 15% bodyfat (up from 9%).
- He has been a marathon runner since his 20’s and has run in over 40 marathons. Prior to his cancer diagnosis he typically rana 10 miles a day 5 times per week. He has not exercised in 3 months and is anxious to get back to his running.
- He was diagnosed with prostate cancer in February 2019
- He underwent a retropubic radical prostatectomy, lymph node dissection, and bi-lateral orchiectomy in April 2019
- He is taking an anti-androgen – Flutamide – he has regular bouts of diarrhea, is starting to develop breasts, and complains that he sometimes gets dizzy when he walks.
- He has osteopenia
- His BP is 110/70 and his RHR is 60.
- Upper-crossed syndrome
- Flexed forward at hips – does not stand erect
- Both feet supinate
- Lateral knee rotation on both legs (noticed on squat test)
Excellent balance and muscular endurance. Did not perform sit-up test due to surgical incision and flexed-forward hip position.
Susan was concerned about working with Eric because of the osteopenia as well as his large surgical incision and risk for lower extremity lymphedema.
I started by compiling my own notes and breaking everything down for Susan one step at a time.
- Because Eric underwent a radical retropubic prostatectomy, he has a large incision from his naval to his pubic area. He is unable to stand erect due to a combination of fear and scar tissue that has built up.
- Because he had a bi-lateral orchiectomy and is taking Flutamide, Eric is experiencing menopausal-like symptoms. He is struggling with fatigue, weight gain (increased body fat), breast tenderness and growth, and osteopenia.
- Because he has had inguinal lymph nodes removed he is at risk for lower extremity lymphedema.
- Eric has occasional dizziness and regular bouts of diarrhea from the Flutamide. On days when he has diarrhea, he should be advised to stay home and refrain from exercising for 24-26 hours. He needs to drink plenty of water and replenish his electrolytes. If he has some dizziness, but no diarrhea, he can come in to do gentle stretching and breathing exercises.
- Because of the osteopenia, as well as wanting to increase his lean muscle mass and metabolism, Eric needs to incorporate a strength-training component to his workouts.
- Because of the upper-crossed syndrome, Eric needs to stretch both his pecs and lats while strengthening the scapular stabilizers to help correct round shoulder syndrome and the winged scapula. He should avoid pushing exercises like push-ups and chest press and focus on shoulder retraction/depression, rowing, and maybe reverse flys. He should do shoulder protraction exercises like ceiling punches or wall push-ups for his winged scapula. Until he can stand erect, he should not do any “crunch-type” exercises as they will only exacerbate his flexed-forward stance. In the interim, he should be stretching through his torso whiles strengthening the opposing lower back muscles. He can also be working on his core through balance exercises on the exercise ball, BOSU, foam roller, etc.
- Susan is recommending that Eric be fitted for running shoes that will cater to his over-supination. She will also include exercises that will include stretches for the plantar fascia, calves, and achilles tendons.
- After Susan completed the Modified Thomas Test on Eric she was able to determine that both his left and right IT Bands are tight. Therefore, he would need to focus on hip adduction and avoid hip abduction-type exercises.
- Because Eric wants to get back into running long distances, but he is at risk for lower extremity lymphedema, he must regularly perform lymph drainage exercises and slowly and gradually progress both cardio and strength training for his lower body
Once I gathered my thoughts, I was able to come up with the following workout routine for Susan to facilitate with Eric for his initial 6-8 weeks.
Lower extremity lymph drainage exercises these should be done before exercise sessions (can be done more often if desired) He can do these alternative crunches that will be better for his neck and not require full flexion like a sit-up or even a crunch. Following the lymph drainage exercises Eric can do a variety of core exercises that Susan will instruct him to do safely and effectively. Eric will also include door stretches (chest), head retractions (forward head), end-to-end stretch for abdominals, calf, achilles, and plantar fascia stretches.
2 x PER WEEK
Upper-body strength training – starting very basic. Eric can do chest flys, focusing on broad range of motion and opening up the chest; beginning with very light weight and just focusing on ROM. He should avoid any time of “pushing” exercise until his posture is ‘corrected.’ Susan will incorporate some rowing and lat pull downs to his chest to strengthen the opposing back muscles. There is no risk of lymphedema with his upper body so Susan can start him with light weights, cables, or resistance bands and gradually increase them as his energy level and muscle soreness dictate.
Lower-body strength training – squats are critical for activities of daily living. Susan will work with Eric on form and correcting lateral knee rotation and tight ITB. She can try alternating traditional squats with wall squats with Eric’s legs pressing against one another. This will help to strengthen adductors and stretch ITB. She needs to remember that he can not use bands or have any compression on legs because it may increase the risk of lymphedema. Start with only one or two repetitions of each and gradually add more as tolerated. Susan will re-assess Eric in 8 weeks and either continue with this routine, or progress to longer duration of cardio, more repetitions, and the addition of more strength training exercises.
ALTERNATING DAYS (or as tolerated) – walking/jogging/running beginning with 1/2 a mile of just walking. Each session should end with lower body lymph drainage exercises. If there is no swelling, Eric may increase either intensity (walking to jogging to running) or duration – in very small increments. He should not wear tight fitting clothing on his lower body or exercise in very hot/humid temperatures. He should also stay well-hydrated. If at any point there is swelling in his pelvic area, either leg, feet or toes, he needs to notify his doctor right away. Upon returning to exercise with his doctor’s permission, it is recommended that he wear a compression stocking to exercise as well as going back to the level of intensity and duration that he was at prior to any swelling. Susan may also want to incorporate water jogging for Eric. The buoyancy of the water may help prevent and/or manage lymphedema.
Susan is also suggesting that Eric work with a registered dietitian, or nutritionist who specializes in working with cancer patients, that can put together a healthy plan for Eric to lose the extra weight he put on. This is out of Susan’s scope of practice as a personal trainer and Cancer Exercise Specialist.
If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help in with custom exercise programming.