Intriguing interview with Professor Rob Newton, a leading expert on Exercise Medicine, especially as it relates to cancer and bone health. He is a professor of Exercise Medicine at Edith Cowan University in Western Australia. To all of us who are on ADT, looking ahead to ADT, or recovering from ADT, Newton provides perspectives that may be eye-opening. He addresses prostate cancer specifically. Here's the link: youtu.be/H7_bUGjH_hM
Of particular interest to me, Newton raises the issue of what types of exercise are most beneficial to build bone strength. He is unimpressed with bisphosphonates, which many excellent doctors readily prescribe.
He also mentions research and practice with controlled isometric loading at site of bone metastases. Not sure whether this might be applicable to a spinal metastasis.
At the end, he discusses the lack of facilities and individuals with training in exercise medicine for cancer patients. Do any of you have experiences with exercise oncology? Has PCRI or PCF done any webinars on the subject? Has anyone reviewed the studies Newton mentions in passing?
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Revcat
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The interview is absolutely loaded with good info. One shocker -- I have not seen anywhere else, is when Dr. Newton says that men on ADT experience 3 times the rate of bone loss vs menopausal women. He said it is catastrophic if not addressed, and that bisphosphenates alone do not really help with healthy bone maintenance.
The best exercise for BMD maintenance involves some amount of skeletal shock loading. Walks. Stairs. Treadmills. Heavy foot steps. Vibration plates (not mentioned in the interview) seem to be of dubious overall benefit. Can cause other problems, etc.
Another angle I have not seen covered is exercise after ADT stops, for those of us lucky enough to get to that point. My take is exercise must continue for the rest of our lives. Otherwise BMD loss will still occur, sarcopenia likewise... And it is not clear how long if ever one's testosterone will recover to be of much help without exercise.
I can only comment from what I have experienced. Adding exercise 6 days a week (4 days heavy weights and 2 days cardio) My mental and physical health have greatly improved and my doctor swears exercise is a critical part of my treatment. In his words "patients don't emphasize working out enough" I based my workout with a trainer familiar with my cancer and she has got me increasing my muscle mass. Best shape of my life
Great share Revcat, and comments by Mr. Scruffy and Derf. I haven't seen the video yet but I have seen material from Professor Newton previously. I think the comment about they're not being much support for this is absolutely true. I'd go on to say that the knowledge isn't there either.
I saw a paper sometime ago about the question of biomechanical engineering and bone metastasis weakness. Apparently this is a thing - and one could do an engineering analysis on risk. The papers comment was that this domain of knowledge or front line practice is basically non-existent.
That would be very helpful for me with my compromised a vertebrae. I live a fairly normal life and avoid heavy spine loading. And I don't twist. But these are all just casual bits of advice. And yet quality of life related to fracture risk is a big yes/no. It's entirely on the patient.
And yes - exercise. Bone loading exercise with microshocks. And maybe calcium and magnesium and vitamin D - Who knows?
If you search you will see the majority of my posts and replies are about exercise. Some good replies here already from a few of the ‘usual suspects’ I always enjoy.
Biophosphinates are probably particularly unhelpful because they’re usually not paired with exercise. In fact, not much is.
A casual search of ‘exercise oncology’ will provide you with plenty of nice information, but unfortunately most of the admonishments to resistance train go unheeded. I read about and talk to men on ADT who say they are not ‘gym guys’ and fight their bone density loss with walking. This is of limited benefit.
All men on ADT should experience both the fatigue killing effects of lifting while it protects bones as well.
Yet the truth is that ALL older people should be training. Cardiovascular, resistance, balance, flexibility, stability-all of it. Disease or no. Testosterone or no. A consistent, well rounded program of these need not be overly time intensive and is worth it beyond description. Don’t outlive the last of your good health! Take a tour of your local nursing home if you need some cautionary tales.
Trust those of us who train, for we know-it’s the best way to get old by FAR.😀
You are a great evangelist for exercise London! I was doing some resistance or weights at home before my diagnosis.
Unfortunately my diagnosis includes several severely compromised vertebrae. As in 30 or 40% lucency. The original diagnosis had "severe" invasion of the epidural space. And in addition to pain I was developing a gait problem.
However and almost miraculously these masses have all receded and apparently not active anymore. But I am left with the vertebrae risks. The advice is "don't twist".
And what is needed is a "biomechanical engineering assessment". It's a thing! Which however is completely unavailable. Despite the fact that a huge number of metastatic prostate cancer patients could benefit significantly.
So without a real analysis of my specific skeletal risks, the various well-meaning physio people I have engaged with have not really been able to say anything specific.
I have been doing a lot of walking! And push-ups - at one point I was up to 25 at a time, multiple times a day. And other things with stretchy bands and dumbbells. But there are really wonderful weight-lifting things I don't do. Because of the risk.
Another good thing though: apparently I have started with very high bone density for my age. The rate of loss is 3% per year with the ADT (an antagonist).
My sister and I ride the Garmin Unbound on the 1st of June. It's a beautiful gravel bike ride through the Flint Hills of Kansas near Emporia.
Most know my history, diagnosed in 2014, surgery, SRT, triplet therapy, most recently completed SBRT and 12 months of Orgovyx.
Most days can find me at the gym doing time on the indoor bike, lifting weights and swimming. If not there and the weather cooperates, I ride my bike on the trails near my house, 25-40 miles. I play Pickleball and the yard work, well, mow the yard, edge it, trim shrubs, trees...
I am not sure it's rocket science, there are three things my medical team and I agree only I can do:
Maintain a healthy diet
Exercise routinely
Manage stress.
Those contribute to my ability to endure treatment, mitigate side effects while also contributing to cardiovascular health and aging "well!"
I experienced firsthand SE of ADT when I fractured my left hip joint in July 2023 and had it replaced. Bone density scan in august confirmed osteoporosis (Z-score: -2.7) in remaining right hip. This was real wake up call for me.
I did my research and refused to take any more drugs (and then deal with their own SE) and discovered osteogenic loading as the most efficient option that beats regular exercise and heavy lifting.
So, I signed up for OsteoStrong sessions at a local franchise (Los Gatos, CA) since last December and my monthly body-comp DEXA scans since then show gradual increase of BMD. It appears I'm on a way to reverse osteoporosis. Will do proper early dedicated bone density scan in August to confirm this.
I also follow X3 Bar variable resistance training to reverse sarcopenia (another nasty SE of ADT). That works great and I was able to regain some muscle (and loose fat).
this all is on top of all my long time cycling obsession, I ride 100-200 miles/week on average since 2009.
I am a cyclist, too, though not at your impressive level. Cycling, like swimming, doesn't do much to stress the bones and, therefore, has no appreciable affect on bone density. But it does wonders for mental and physical health. I used to do a 50-60 mile ride every Saturday and would love to get back to that.
That was a truly enlightening and practical video. I learned a huge amount. In my case I will definitely add impact training to my routine - jumping.
One of the most important takeaways was for people with spinal issues from the cancer. The use of isometric exercise was used and its effects. Do this rather then just plain old resistance training.
This video should be viewed by all newly diagnosed prostrate cancer patients. In my case my radiation oncologist told be to do three things prior to radiation. I started my program months prior to the radiation.
First, improve my diet and sent me to the dietitian for a plan. Second, start a comprehensive PT program to include resistant and cardio. Third, keep a log of the effects and changes in my programs.
I am not sure if this is standard practice but she told me it would improve the effects of the radiation on my cancer treatment and help me deal with the side effects of radiation and HDT. She was totally correct.
I have continued these steps in my post radiation treatment. I feel amazing and my mental outlook is superb. Her three points only took a couple of minutes to delivery but have had a profound effect on me.
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Putting things in perspective 
ADT + Abi + Docetaxel for metastatic prostate cancer?
rso oil and prostate cancer
Dexa scan report showing osteoporosis 
Friend with advanced Prostate cancer
