# Exercise and metabolic disease/prostate/Exercise Prescription

Note: All exercise guidelines are to be carried out once the client has passed a pre-exercise screening questionnaire (ESSA) and been cleared by appropriate specialists. Also note that ADT patients may also have a number of co-morbities and risk factors which exercise may be contraindicated for in certain circumstance. Refer to specific contraindications on the following “Exercise Training” page.

## Aerobic training during ADT

Aerobic training has not been investigated as much as resistance training in ADT populations. An explanation for this is that many adverse effects of ADT are more directly related to the benefits of resistance training such as increase in skeletal muscle mass, bone density, muscular endurance and strength. However, aerobic training has been studied in combination with resistance training for patients undergoing ADT producing borderline results.$^{[1]}$ This may be due to this form of training being less effective or the fact that study protocols used much lower amounts of aerobic training compared to healthy population guidelines for aerobic improvement.
Studies finding positive effects of combined aerobic and resistance training used aerobic training in the following way:
* Frequency: 2-3 times per week
* Intensity: 65-80% of maximum heart rate (11-13 Borg scale)
* Time: 15-20 minutes (for at least 6 weeks)
* Type: Cycle, walk or jog
Note: Program included 2-3 sessions of resistance training which may contribute to overall aerobic gains and functional improvement in tests such as 6 minute walk etc.

## Aerobic training for prostate cancer patients

* Frequency – Daily
* Intensity – blood lactate concentration kept at 3 ± 0.5 mmol•L-1
* Time – 30-60 minutes
* Type – treadmill walking

## Resistance training during ADT

Currently there is broad research suggesting that resistance training is a safe and effective method of reducing many of the common negative side effects experienced by patients during and after ADT. Such research has discovered that suitable resistance training will not raise serum testosterone levels but may cause a reduction in general fatigue, improvements in quality of life, increases in muscular strength / endurance and reduction in BMD losses for prostate cancer patients undergoing various forms of ADT.
The protocols used to bring about such results were all similar and all lasted for at least 12 weeks. This suggests that a suitable progressive long term program is most appropriate for ADT patients. It should be noted that many studies utilised the direct supervision of subjects by fitness professionals or exercise physiologists whilst undergoing training. $^{[1][2][3][4]}$
* Frequency: 2-4 times per week
* Intensity: 2-3 sets of 60-70 % of 1RM (or 6-12 repetitions)
* Type - Whole body machine resistance program including compound and isolated exercises. 6-9 exercises comprising of all or some of the following: leg extension, calf raises, leg curl, chest press, latissimus pull-down, overhead press, triceps extension, biceps curls, and modified curl-ups.
* Progression: Weight increased by 2kgs once more then 12 repetitions is achieved on current weight. Post 12 week assessment, exercises may be varied and difficulty may be increased but very gradual progression is advised.
For further depth on exercise for prostate cancer sufferers the following source is available. http://exerciseismedicine.org.au/wpcontent/ uploads/2011/03/Prostate-cancer_full.pdf