Customized Exercise Programming - Testicular Cancer

Susan received a referral for a client with testicular cancer. She’s been a Cancer Exercise Specialist for a little over a year, but this is her first client with testicular cancer. She asked if she could hire me to help her with and teach her how to put together Eric’s exercise program. She obtained a medical clearance from his surgeon, completed his initial assessment and health history, and shared the following information with me:

Eric is 34 years old and in excellent health prior to his cancer diagnosis
Eric is 6’2 and currently 180 lbs. (he lost 20 lbs. from treatment) He has 15% body fat (up from 9%).
He has been a marathon runner since his early 20’s and has run in 16 marathons. Prior to his cancer diagnosis, he typically ran 10 miles a day 5 times per week. He has not exercised in 2 months and is anxious to get back to his running.
He was diagnosed with testicular cancer in February 2022
He underwent a radical inguinal orchiectomy and retroperitoneal lymph node dissection on 2/26/2022
He completed radiation to the pelvis on 3/30/2022 and is currently undergoing chemotherapy
He has extreme fatigue, chemo-brain, and regularly vomits the day after chemotherapy

Postural Assessment:

Upper-crossed syndrome
Both feet supinate
Lateral knee rotation on both legs (noticed on squat test)

Susan noted that he is struggling with his balance due to peripheral neuropathy in his feet.

Susan was concerned about working with Eric because he has not exercised since his diagnosis, and is extremely weak and fatigued. She is also concerned about preventing lymphedema and other co-morbidities.

Notes:

I started by compiling my own notes and breaking everything down for Susan one step at a time.

Because Eric underwent a radical inguinal orchiectomy, he is likely to lose lean muscle mass and have a difficult time building it due to lowered testosterone levels.
Due to the fact that he had a retroperitoneal lymph node dissection, he is at risk for lower extremity lymphedema. The risk is elevated by the fact that he had radiation to the pelvic area.
Exercise sessions should be kept simple and free of distractions due to his chemo-brain.
It is typical for Eric to vomit throughout the day on the day after he gets his chemo. On days when he has vomiting, 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 vomiting, he can come in to do gentle stretching and breathing exercises.
Because of the increased risk of osteoporosis from chemotherapy, as well as needing to increase his lean muscle mass and metabolism, Eric needs to incorporate a strength-training component into his workouts.
Due to 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.
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.
Since he is only 2 months post retroperitoneal lymph node dissection, he has another full month before he has completely healed.
Balance exercises should be performed in the safest way possible to minimize his risk of falling due to the neuropathy in his feet.
Eric wants to get back into running long distances, but because 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.

DAILY

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.

All New Gallery

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 his legs (this includes foam rolling) because it may increase the risk of lymphedema. He will 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 a longer duration of cardio, more repetitions, and the addition of more strength training exercises.

ALTERNATING DAYS (or as tolerated) – he should begin 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 the 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 on the affected leg when exercising. He should also go back to the level of intensity and duration that he was at prior to any swelling. Susan may also want to incorporate water walking or jogging for Eric. The buoyancy of the water may help prevent and/or manage lymphedema. He needs to avoid any high-impact activities, or those with the risk of falling, due to the neuropathy in his feet. He should also avoid using a treadmill because of the risk of falling.

Susan is also suggesting that Eric works with a registered dietitian who specializes in working with cancer patients, that can put together a healthy plan for Eric to safely gain back the weight that he lost. This is out of Susan’s scope of practice as a personal trainer and Cancer Exercise Specialist since he is currently undergoing cancer treatment.

If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help with custom exercise programming.

Customized Exercise Programming for Testicular Cancer