Exercise and your prostate

Regular physical activity can help keep you — and your prostate — healthy

By now, we’ve all heard about the value of exercise in maintaining good health. Literally hundreds of studies conducted over more than half a century demonstrate that regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer (colorectal cancer, for example). It also eases the toll of chronic ailments like high blood pressure, diabetes, and arthritis.

What may come as a surprise is that regular physical activity may actually help prevent some prostate disorders and improve prostate health. Emerging scientific evidence suggests that engaging in a few hours of exercise a week may help keep prostate enlargement in check and reduce the chances of developing erectile dysfunction. It can also ease the symptoms of prostatitis and lower urinary tract problems, as well as lessen the side effects associated with prostate cancer treatment. And a small number of studies suggest that it may even reduce your risk of developing advanced prostate cancer.*

Assessing the evidence

Skeptical? Here’s a summary of what the studies have found. If you want more detail, references for each of the studies highlighted below appear after each section.

Benign prostatic hyperplasia (BPH)

Relatively few studies have examined the relationship between physical activity and BPH, a condition in which the prostate becomes enlarged, causing frequent urination, a weak urinary stream, and other symptoms. One of the first papers, published in 1998, relied on data gleaned from questionnaires submitted by 30,634 men participating in the Health Professionals Follow-up Study, 3,743 of whom had BPH. Researchers found an inverse relationship between physical activity and BPH symptoms; simply put, men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits. Walking an additional three hours a week was associated with an extra 10% reduction in risk, researchers found.

The researchers also found that men who spent the most time watching television and videos (41 hours or more a week) were twice as likely to develop symptoms of BPH than those who watched the least (5 hours or less). And interestingly, spending more time on the couch watching television led to more cases of BPH, regardless of how much time was spent exercising.

Other studies have come to less definitive conclusions. For example, the Physicians’ Health Study, based on only 320 cases, showed that men who were relatively sedentary had a lower risk of BPH than those who were highly active. But men who were completely sedentary had the highest risk of BPH.

To further explore the relationship between physical activity and BPH, Italian researchers examined occupational and recreational activity levels of 1,369 men with BPH and 1,451 men without it. The men whose jobs involved strenuous physical activity, such as farmers and construction workers, were 30% to 40% less likely to develop BPH than men with desk jobs. Recreational physical activity helped, too. Men who engaged in five or more hours of exercise a week were 30% to 50% less likely to develop BPH than men who exercised less than two hours a week. Men who had the highest levels of both occupational and recreational physical activity were 60% less likely to develop the condition.

What’s the connection? No one knows for certain, but researchers say that higher levels of physical activity might reduce testosterone, which controls prostate growth and fuels the development of BPH. An alternative explanation is that physical fitness reduces activity of the sympathetic nervous system, the part of the nervous system that becomes active during times of stress, easing the severity of urinary symptoms.

Erectile dysfunction (ED)

Despite the prevalence of erectile dysfunction, most studies of the association between ED and lifestyle factors like physical activity have been relatively small or have been conducted in men mainly in their 50s and 60s. That changed with a 2006 report from Harvard’s Health Professionals Follow-up Study, which included 22,086 men between ages 40 and 75 who completed periodic questionnaires about their health over 14 years.

After analyzing the data, researchers found that men who ran for an hour and a half or did three hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise at all. More physical activity conferred an even greater benefit: men who ran two and a half hours a week were 30% less likely to develop the condition than their sedentary counterparts. Interestingly, regardless of the level of exercise, men who were overweight or obese had a greater risk of ED than men with an ideal body mass index, or BMI.

Chronic prostatitis

Also called chronic pelvic pain syndrome, chronic prostatitis is characterized by pain during urination, difficulty urinating, sexual dysfunction, anxiety, and depression. It can be prompted by an undetectable infectious agent or physical trauma that causes inflammation or nerve damage in the genitourinary area. Unfortunately, doctors can identify bacteria as the culprit in only about 5% to 10% of cases, meaning antibiotics are not an effective treatment in most men. While many other treatments have been tested, none have proved to have significant long-term benefits.

Wondering if exercise might alleviate symptoms when other treatments fail, Italian researchers randomly assigned 231 sedentary men with chronic prostatitis to one of two exercise programs for 18 weeks: aerobic exercise, which included brisk walking and strengthening exercises, or nonaerobic exercise, which included exercises such as leg lifts and sit-ups, as well as stretching. Each group exercised three times a week.

At the start of the study and at six and 18 weeks, participants responded to questionnaires about their symptoms and quality of life. At the end of the trial, participants in both groups felt better, but those in the aerobic exercise group experienced significantly greater improvements in prostatitis pain, anxiety and depression, and quality of life.

Lower urinary tract symptoms (LUTS)

Two recent studies demonstrated that exercise can help protect against LUTS. In the first, 2,797 men ages 60 or older participating in the Third National Health and Nutrition Examination Survey (NHANES III) were asked about their urinary symptoms — frequent urination during the night, hesitancy, weak stream, and a feeling of incomplete bladder emptying — and physical activity. Researchers found that men who reported no leisure-time physical activity were about twice as likely to develop LUTS as men who engaged in moderate or vigorous activities.

A year later, in 2006, a Swedish study came to a similar conclusion. Researchers asked 30,377 men between 45 and 79 years old about their occupational and leisure-time activities at age 30 and currently. They also asked about urinary tract symptoms. Their conclusions: the more physical activity the men got, the less likely they were to experience moderate to severe LUTS. Men who were physically active at work and during their leisure time were about half as likely as inactive men to develop LUTS. And although their recollection of physical activity decades earlier might not be accurate, men who reported high levels of inactivity at age 30 and at the time of the study were twice as likely to develop LUTS as men who were more active at both time periods.

Prostate cancer

Some studies have suggested that more physically active men may have a lower risk of prostate cancer — or prostate cancer progression — than sedentary men, but the results have been less clear-cut than with other prostate-related conditions. One of the earlier studies of exercise, the Harvard Alumni Study, found no significant association between physical activity and prostate cancer risk. Later, other Harvard researchers analyzed data from the Health Professionals Follow-up Study to determine the number of cases of prostate cancer among 47,620 men over a 14-year period and to look for associations between cancer and physical activity. They found no evidence that moderate physical activity lowers overall prostate cancer risk.

The researchers then looked at the impact of vigorous activity on different types of prostate cancer (local and advanced, for example) at various ages. They found that men ages 65 or older who engaged in at least three hours of vigorous physical activity a week reduced their risk of being diagnosed with high-grade, advanced, or fatal prostate cancer by nearly 70%. But vigorous exercise did not seem to protect against prostate cancer in men younger than 65.

The findings were consistent with an earlier study by the American Cancer Society, which followed 72,174 men for nine years. Researchers found no difference in the overall risk of prostate cancer between men who engaged in the most physical activity and those who reported no physical activity. But when it came to aggressive prostate cancer, physical activity appeared protective: men who got the most exercise were 31% less likely to develop aggressive disease than men who opted for the sofa. A 2006 Norwegian study yielded a similar result.

A 2005 San Francisco study took a slightly different tack in examining the exercise-cancer relationship. Rather than follow participants over time, researchers randomly assigned 93 men with low-grade prostate cancer who were pursuing active surveillance to one of two groups: a control group that received standard care and an experimental group that was asked to make comprehensive lifestyle changes, including the initiation of an exercise program. After one year, six patients in the control group (versus none of the patients in the experimental group) underwent conventional prostate cancer treatment due to PSA increases or disease progression. PSA scores increased by 6% in the control group, but dropped by 4% in the lifestyle-modification group. Although the study included a relatively small number of participants who made multiple lifestyle changes (significant alterations in diet, for example), it leaves open the possibility that exercise may slow the progression of low-grade prostate cancer.

Studies have more definitively concluded, however, that exercise can improve quality of life and, perhaps paradoxically, reduce fatigue in prostate cancer patients. For example, patients undergoing radiation therapy for localized prostate cancer who participated in a cardiovascular exercise program for eight weeks improved their cardiovascular fitness, flexibility, muscle strength, and overall quality of life. They also experienced less fatigue than patients who didn’t exercise.

Importantly, researchers have found that the exercise need not be vigorous to offer benefits. Scottish researchers determined that moderate-intensity walking produced a significant improvement in physical functioning with no significant increase in fatigue. Improved physical functioning, they wrote, may be necessary to combat the fatigue that comes with radiation therapy.

Exercise is beneficial, too, for men on androgen deprivation therapy (also called hormone therapy) for advanced prostate cancer. Hormone therapy commonly causes metabolic changes that lead to weight gain and up the risk for diabetes and heart attack. It has also been linked to bone loss. Regular exercise helps combat these side effects.

Reaping the benefits

Now that you are convinced (hopefully) about the value of exercise in preventing and easing prostate problems and urinary symptoms, what do you need to do to reap the benefits? How much exercise should you do? What activities can you do? Do you have to take up jogging? Must you spend hours huffing and puffing on a treadmill at a gym to keep your prostate healthy?

There is no specific exercise program for men concerned about prostate health. But a well-rounded exercise program that includes just half an hour of physical activity on all or most days of the week delivers solid health benefits. And you needn’t perform this activity all at once; you can break it up into three 10-minute segments. Aim for a moderate pace. A good guideline: you should be able to carry on a conversation — yes, short sentences are okay — while exercising. If you’re breathing too hard to talk comfortably, back off. When an activity becomes easy, boost the length of your workout or your speed. (For more on how hard to work, see “What about my heart rate?” following the exercises.)

If you want, you can jog or use the treadmill at the gym (see “Health club savvy”). But keep in mind that bicycling (see “Your bike seat and your health”), swimming, or even taking brisk walks around the block will do the trick. In fact, walking has been touted as a nearly perfect exercise because people of all ages and fitness levels can do it. Walking is also safe for nearly everyone. It doesn’t jar joints or raise the heart rate to a level that would be dangerous, even for someone who is not in good shape.

No matter what activity you choose (for ideas, see “Pick your favorite,” below), avoid sporadic bouts of high-intensity activity. For one thing, the health benefits of exercise depend on the total amount of exercise rather than its intensity. But more importantly, higher-intensity activity raises your chances for muscle or joint injury and for sudden death as a result of heart rhythm disturbances, especially if you’re a “weekend warrior” or you haven’t had a medical check-up to clear you for intense exertion.

Before you start a session of aerobic exercise, include five to 10 minutes of light stretching and low-intensity movement to warm up; this is crucial to avoid injury. Also work in a cool-down period of equal length.

In addition to aerobic activities like walking, a well-rounded exercise program includes strength training, flexibility training (stretching), and balance exercises; each benefits your body in a different way. Strength training builds your muscles and bones and improves your body’s ratio of lean muscle mass to fat. Flexibility training keeps your muscles stretched and your joints limber, and may help prevent injury. Balance exercises ward off falls that can prompt injuries. Some general guidelines for each follow, as well as a few exercises you can try.

Keeping exercise safe

As Harvard's Dr. Harvey Simon writes in his book The No Sweat Exercise Plan, “The greatest hazard of exercise is not doing it. Far more people are harmed by the lack of exercise than by its excess.” Although the benefits of regular physical activity far outweigh the risks, there are risks, which can range from minor inconveniences to life-threatening situations.

Perhaps the most common risks associated with exercise are muscle and joint problems. Strains, tears, or fractures can be caused by quick movements, such as lunging for a tennis ball. Stiffness, soreness of joints and muscles, and inflammation of tendons and ligaments may be brought on by training too hard or too often, using improper technique or poor equipment (such as worn-out exercise shoes), increasing your activity level too quickly, or not dropping back to a lower level of exercise after a period of inactivity.

By far the most frightening risk associated with exercise is sudden death. Sedentary people who abruptly embark upon vigorous exercise can increase their chances of dying from a heart attack or an arrhythmia, a change in the heart’s rhythm. But it’s important to keep this in perspective. The absolute risk of sudden death during any episode of exercise is minuscule: one in every 1.51 million exercise sessions. It’s equally important to remember that the risk of sudden death discussed here is associated with vigorous exercise. If you work out at a moderate level, your risk is negligible.

To make sure that your exercise routine is as safe and enjoyable as possible, take these simple precautions:

• Talk to your doctor before beginning an exercise program, especially if you have a health problem. He or she can help you determine your limitations and develop a routine that’s appropriate for your fitness level.

• Warm up and cool down properly.

• Drink plenty of fluids.

• Watch for signs of overheating — headache, dizziness, nausea, fainting, cramps, or palpitations — especially in hot, humid weather. If possible, schedule exercise sessions in the early morning or late evening, when temperatures tend to be lower.

• Don’t exercise if you are ill. Resume exercising after you recover, but give yourself time to work back up to your usual level.

• Let injuries heal. That doesn’t mean you need to give up exercise, though. For example, if you’ve sprained your ankle while jogging, try swimming or other activities that use your arms and keep you off your feet.

• Dress in loose, comfortable clothing that’s appropriate for the weather.

• Pay attention to your surroundings. If you walk or jog, for example, always face the traffic. If you bike, ride with the traffic; remember to wear a helmet and obey the rules of the road. Stick to well-lit streets. Consider bringing a cell phone.

Most importantly, listen to your body. Don’t overexert yourself. Cut back if you can’t finish an exercise session, can’t carry on a conversation while exercising, or feel faint or suffer aches and pains in your joints after exercising. Stop your activity and see a doctor right away if you experience burning, tightness, or a feeling of fullness in the chest or upper body; faintness or loss of consciousness; wheezing or shortness of breath that takes more than a few minutes to go away; or pain in the bones or joints.

Admittedly, highlighting the risks of exercise and suggesting various precautions might make you think that getting a daily dose of physical activity is risky business or an utter chore, but it’s not. It can actually be great fun. And it can help keep you — and your prostate — in top shape.

Strength training exercises

You can build strength in a number of ways. Some popular options are systems such as the Nautilus, Cybex, or Universal machines found at gyms and health clubs. But you can design an effective strength training program at home with a sturdy chair (preferably with armrests), athletic shoes with nonskid soles, an exercise mat, ankle weights, and dumbbells. The 12 exercises outlined here work each of the major muscle groups and can easily be performed at home. When doing them, begin with the ones that are performed while standing, then move on to sitting exercises, and finally, the floor exercises.

Some people perform all of their strength training exercises during a single session that they repeat two or three times a week. Others prefer to break strength training into smaller chunks, working different groups of muscles each day. For example, they might work their arm and shoulder muscles one day and then work leg and abdominal muscles the next. Just make sure that you work different groups of muscles on successive days, allowing at least 48 hours between workouts for the affected muscles to recover.

As you work through your strength training program, keep these guidelines in mind:

• If you’re just beginning, start by lifting small amounts of weight to avoid straining a muscle or injuring yourself. Choose a weight that’s comfortable, but challenging. If you can’t comfortably do eight repetitions of an exercise, the weight is too heavy. If you can do more than 15 repetitions, it is too light.

• Move only the part of your body that you’re trying to exercise. Don’t rock or sway.

• Lift the weight slowly. Take about three seconds to lift it, hold the position for a second, and then take another three seconds to lower it.

• Breathe slowly, inhaling as you lift and exhaling as you lower the weight.

• Never hold your breath.

• Rest for a minute or two between each set of eight to 15 repetitions.

Stretching exercises

 Because stretching cold muscles can lead to injury, it’s best to stretch after your muscles have been adequately warmed up — either at the end of your workout or after you’ve completed your warm-up. Stretching at the end of your workout can be a good way to cool down. Stretch several times a week for maximum benefit, and include stretches that work all major muscle groups. As you stretch, keep these guidelines in mind:

• Hold each stretch for 30 seconds.

• Never bounce as you stretch.

• Extend the muscle to the point where you feel mild tension and hold that position. Don’t extend the muscle to the point that you feel pain.

• Don’t hold your breath. Breathe deeply and freely through your nose.

Balance exercises

Balance plays no role in preventing prostate problems or major diseases. Still, balance is important for health. A good sense of balance can keep you steady on your feet and reduce your risk of falling. This special set of exercises can be done at any time, every day of the week or just a few times a week.