Customized Exercise Programming – Testicular Cancer

Jim received a referral for a client with testicular cancer. He’s been a Cancer Exercise Specialist for a little over a year, but this is his first client with testicular cancer. He asked if he could hire me to help him with and teach him how to put together Eric’s exercise program. He 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’s lost 20 lbs. from treatment) He has 15% bodyfat (up from 9%).
• He has been a marathon runner since his 20’s and has run in over 20 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 2023
• He underwent a radical inguinal orchiectomy and retroperitoneal lymph node dissection on 2/16/2023
• He completed external beam radiation to the pelvic area on 3/30/2023
• He is currently undergoing chemotherapy

Postural Assessment:

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

Jim told me that Eric has excellent balance and muscular endurance with minor postural deviations. Jim took baseline measurements for lower extremity lymphedema and explained to Eric how to look for “pitting” edema.

Jim was concerned about working with Eric because he has not exercised since he was diagnosed and he is dealing with extreme fatigue, vomiting/diarrhea, chemo brain, and neuropathy in his feet from the chemotherapy. He is also concerned about his risk for lymphedema and wants to keep him safe.

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

1. Because Eric underwent a radical inguinal orchiectomy, he is very likely to lose some of his lean muscle mass and have a difficult time building new lean muscle due to the reduction of testosterone.
2. Because he had a retroperitoneal lymph node dissection 2 months ago, he has another four weeks before full recovery can be expected. Since he is two months out, however, he can begin to lift weights. He is at risk for lower extremity lymphedema also, with the risk increasing due to the pelvic radiation.
3. Eric has regular bouts of vomiting/diarrhea, typically the day after chemotherapy. On days when he has vomiting/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 is struggling with chemo brain, you should keep the exercises very simple and exercise in an area with minimal distractions. 
4. Long-term side effects of chemotherapy and radiation include diabetes, heart and lung damage, osteoporosis, and an increased risk of future cancers. He should work up to 150 minutes of low to moderate intensity, or 75 minutes of high-intensity cardiovascular exercise to strengthen his heart and lungs and incorporate strength training to prevent osteoporosis and improve his body composition.
5. Because of the extreme fatigue he is dealing with from the radiation and chemotherapy, his goal should be to exercise only 20-30 minutes 3-4 times per week. He should be encouraged to do this incrementally on days that he can’t do 20-30 minutes. He should never leave a session feeling more exhausted than when he started.
6. 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. 
7. Because of the neuropathy in his feet, Eric should avoid high-impact activities and those with the risk of falling.
8. Jim is recommending that Eric be fitted for running shoes that will cater to his over-supination. He will also include exercises that will include stretches for the plantar fascia, calves, and achilles tendons.
9. After Jim completed the Modified Thomas Test on Eric he 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.
10. 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 Jim to facilitate with Eric for his initial 6-8 weeks.