Latest / Intellectual Medicine / How Exercise Impacts Prostate Cancer Outcomes

Transcript

How Exercise Impacts Prostate Cancer Outcomes · Intellectual Medicine

• 0:00
  Just what kind of body are we building?
• 0:02
  We want the best frame that suits our life.
• 0:05
  We want sustainability. Remember the pie graph of time?
• 0:09
  You only have so many hours per day.
• 0:12
  Do not strike out on such an ambitious arc that you can't
• 0:16
  sustain it. This should just be a habit.
• 0:20
  Part of how you live, part of what you do.
• 0:23
  The real reason that I like you all to embrace a lifestyle of
• 0:26
  physical activity is because of the vitality that comes with it.
• 0:30
  You feel better, you breathe better, you can do more.
• 0:34
  That remedy for fatigue is action.
• 0:38
  The remedy for weakness is strength.
• 0:40
  Training To continue our reflective conversation on the
• 0:45
  things you can do to make cancer less likely to progress.
• 0:51
  To keep prostate cancer in the box.
• 0:54
  And yeah, I don't like live longer.
• 0:56
  And that's what we're all after. That's what I'm after.
• 0:59
  We only live once. Yeah.
• 1:01
  Might as well make it as long as you can and as good as you can.
• 1:05
  Now, there are lots of things out there, but we all know that
• 1:09
  to a degree. You've got to have some physical
• 1:11
  activity. You got to have some exercise.
• 1:13
  The question is which ones? How much?
• 1:18
  I'm going to tell you the minimum levels.
• 1:21
  Why? Because we all have the same 24
• 1:25
  hours in a day, but we really don't.
• 1:27
  Do we think of a pie graph? I was once looking at this that
• 1:31
  broke down how much time we have in a day.
• 1:34
  And by the time they backed out, sleep, basic toileting needs,
• 1:39
  eating, food preparation, clipping your nose, combing your
• 1:43
  hair, you know, shaving your beard, all the stuff that we do
• 1:48
  everyday, talking on the phone to somebody, maybe texting
• 1:53
  somebody, all that stuff, you back out those essential
• 1:56
  components. And if you work, there's another
• 1:58
  chunk, right? It comes down to about 3 hours
• 2:03
  of discretionary time per day. That's an important detail.
• 2:08
  I know a lot of guys after they retire and they have lots of
• 2:11
  time and they spend 2 hours in the gym, they get all buffed.
• 2:14
  So I'm fit, you know, 7580 years old.
• 2:17
  That's awesome. This message is for those of us
• 2:20
  that are jammed for time because it's important that we reserve
• 2:25
  time for other stuff. I remember Jack Lelaine, the
• 2:28
  great fitness leader from another generation, was asked
• 2:31
  once, you know, how do you learn to love exercise?
• 2:35
  And his answer was telling. He said, I don't.
• 2:38
  I love what it does for me. Yeah.
• 2:40
  I was in the gym this morning and I was doing squats, by the
• 2:44
  way, one of my recommended exercise for you guys.
• 2:48
  Now, why do I do squats? I don't like doing them, they're
• 2:51
  painful, but I have real weak knees and that is a superb
• 2:58
  compound exercise for global strengthening.
• 3:02
  So when it comes to exercise for longevity and exercise to
• 3:06
  prevent prostate cancer, should you cardiovascular strength
• 3:12
  training? What sports and activities seem
• 3:14
  to matter with regard to cardiovascular?
• 3:17
  There is research based evidence that cardiovascular activity
• 3:22
  makes a difference. Brisk walking three hours a week
• 3:27
  in one study reduce the rate of progression of prostate cancer
• 3:31
  significantly. In the study they quote a 57%
• 3:35
  reduction in progression as manifested by Psas and such.
• 3:42
  Well, that's kind of nice, but three hours is a lot of time.
• 3:45
  An interesting detail was another study looked at 3 hours,
• 3:48
  compared it to 1 1/2 per week. By the way, folks, that's in a
• 3:52
  week, not in a day. So 3 hours of brisk walking, 1
• 3:57
  1/2, which one was better? While the brisk was better by
• 4:00
  like 3%? Evidence of the law of
• 4:04
  diminishing returns. The most important part of the
• 4:08
  exercise activity is the beginning phase.
• 4:12
  The longer you do it, less value.
• 4:14
  In fact, there's a tipping point we'll talk about where it can
• 4:18
  become counterproductive. So physical activity matters.
• 4:23
  Moving every day makes a difference.
• 4:27
  My target. What do I do?
• 4:29
  I do 20 minutes, five times a week of intermittent
• 4:34
  cardiovascular activity. Why 20 minutes?
• 4:37
  Because I hate doing cardiovascular activity.
• 4:40
  It's kind of boring and really 20 minutes approaches the low
• 4:44
  end of the research based threshold for cardiovascular
• 4:49
  Wellness. You may get more value if you
• 4:52
  went 30 minutes or 40 minutes you might, but not much more.
• 4:57
  And yours, I'm always thinking about how to use time.
• 5:00
  So it's 10 more minutes. I like to do a rowing machine
• 5:03
  because it doesn't pound my knees, which brings me to
• 5:07
  another point I'll make about which type.
• 5:09
  But I do 20 minutes and I vary intensity.
• 5:13
  Row, light, row, heavy. Row, light, row, heavy.
• 5:15
  Why is that? Because that intermittent
• 5:17
  intensity appears to correlate with better cardiovascular
• 5:21
  health. That's important to you guys
• 5:24
  because most men with prostate cancer are going to die from
• 5:27
  heart disease. Our goal is to diminish the risk
• 5:32
  of premature death. OK, we got to define premature.
• 5:36
  Anything below the age of 100 I'd consider premature.
• 5:40
  Let's go for the longest potential vinyl life.
• 5:44
  Now 100 is the current goal. Hey, when I get to be 99, I'm
• 5:50
  going to set a new goal. Now you'll hear anti aging
• 5:54
  specialist and experts like me talk about human longevity. 120
• 5:59
  years realistic, but really you got to get through 101st.
• 6:05
  So anyhow, back to the issue at hand, Cardiovascular.
• 6:08
  What if you want to do more? Certainly you can have at it.
• 6:11
  Some people just enjoy it. How about if you don't go to a
• 6:16
  gym but you just go out for a walk?
• 6:18
  Totally cool. In fact, probably even better.
• 6:22
  Now I've heard some men talk about bike riding and how they
• 6:25
  avoid it because it may irritate the prostate.
• 6:28
  That's silly. Go after it.
• 6:31
  You can. You're not going to damage the
• 6:32
  prostate by riding a bike You'll temporarily.
• 6:36
  It can elevate APSA because of the friction directed in that
• 6:41
  perineal area. So be sure not to do a vigorous
• 6:45
  bike ride a day or two before your PSA test.
• 6:49
  You want to take it easy, take a little day off, but then any
• 6:52
  vigorous exercise can transiently elevate PSA.
• 6:56
  It does not mean, however, that it's a risk factor for
• 7:00
  progressing your prostate cancer.
• 7:02
  It's not. How about if you do abdominal
• 7:05
  crunches, other specific exercises and movements that you
• 7:10
  should do for global prostate health?
• 7:13
  There are not. Now I know.
• 7:16
  I've read other books. I've seen chapters on the stuff
• 7:19
  you should do, the pelvic, the kegels.
• 7:23
  If you like doing that stuff, have a ball, but it doesn't
• 7:27
  amount to anything. When it comes to preventing
• 7:30
  prostate, global strength training has value.
• 7:33
  How much minimum? We're talking minimalism twice a
• 7:37
  week, twice a week. Compound strength training,
• 7:42
  building muscle, building bone correlates with better vitality,
• 7:47
  better balance, better walking speed, better going up and down
• 7:51
  the stairs, potential preservation of your vitality.
• 7:56
  That's part of fighting cancer like a man.
• 7:58
  It's maintaining your manly capabilities, your human
• 8:01
  capabilities of moving through space with confidence so that
• 8:06
  you're not wobbling, afraid you're going to fall because
• 8:08
  your hip flexors are nice and strong.
• 8:12
  Compound exercises are those which engage all different
• 8:16
  muscles at one time. King of the road.
• 8:20
  There are two, one for the upper body and one for the lower body.
• 8:23
  And if you do nothing else except for these two exercises
• 8:27
  twice a week, you're going to grow some muscle, right?
• 8:31
  You're going to grow some muscle.
• 8:32
  You're going to gain and preserve skeletal health.
• 8:35
  So the first one, a compound exercise, upper body is a bench
• 8:38
  press, any kind of bench pressing motion.
• 8:42
  Do push ups count? Absolutely.
• 8:46
  Although my bias is heavyweight, low Rep.
• 8:50
  I know people talk about this all the time.
• 8:53
  How many sets should I do? How many reps should I do?
• 8:56
  I'm in the gym, I see some people, they're doing like this,
• 9:00
  they're doing their curl, maybe they got 5 lbs and they're just
• 9:04
  doing a bazillion repetitions, right?
• 9:07
  What? It's a waste of time.
• 9:10
  Put some weight on there for goodness sake, since it is the
• 9:13
  intensity that stimulates the muscle growth.
• 9:17
  When I do my bench press activity, I do it on a Smith
• 9:21
  machine. It's got a piston on it so that
• 9:23
  it spots your itself spotting in case you know something gives
• 9:27
  way. If you have a spotter and a gym,
• 9:29
  that's awesome. But I like to do three sets of
• 9:34
  not greater than 6 repetitions and often on my last set of the
• 9:39
  bench press, I'll maybe get two or three reps and then I'm
• 9:42
  exhausted. That's all I can get.
• 9:45
  High intensity more stimulates more muscle than high repetition
• 9:50
  with low intensity. Why three sets?
• 9:55
  It's a reasonable frequency. It's a reasonable amount that
• 9:59
  correlates with good muscle development.
• 10:01
  The first set is low weight. I'll I'll Max out my bench press
• 10:07
  at about 2:50 give or take. So my first repetition, my first
• 10:14
  set is 135 lbs point here. That first set should be just a
• 10:18
  warm up. Second set, increase weight.
• 10:22
  You're going to get more intensity in the third set.
• 10:24
  That's where the money is. That's the one where you're
• 10:26
  going to fail at the last repetition.
• 10:30
  Can you do push ups? You can.
• 10:32
  Will you grow a muscle? You will.
• 10:35
  So if you hate going to a gym, don't feel obliged.
• 10:37
  But I love compound upper body activity.
• 10:40
  Bench press, push ups, king of the hill.
• 10:43
  How about the lower body? Lower body squats are great, but
• 10:47
  they're not for everybody. Putting the weight on the back
• 10:50
  of your head, the back of your neck, that can be an invitation
• 10:53
  for injury. But on the other hand, a
• 10:56
  deadlift is wonderful compound if you have access to it.
• 11:01
  There's something called a hexagonal squat.
• 11:04
  It looks like a like a stop sign and you stand in the middle of
• 11:07
  it and it's a fantastic total body workout.
• 11:11
  How about if you have no equipment at all?
• 11:13
  Body weight squats are totally cool.
• 11:16
  They will help. They will stimulate compound
• 11:19
  activity. Squat, thrust 1 foot forward,
• 11:23
  the relative foot forward. Totally cool.
• 11:25
  Three sets, about a minute and a half rest between each set.
• 11:30
  You do the upper, you do the lower.
• 11:32
  Done. Can you do more?
• 11:34
  You can, but we're talking Doc. What's the minimum that
• 11:38
  correlates with my best effect. Now, it's interesting that
• 11:41
  testosterone levels go up after you exercise.
• 11:46
  Well, if you've been listening to my podcast long enough, you
• 11:48
  know not to fear that that the old belief that testosterone was
• 11:54
  pouring gas on the fire we got to blow to that is really
• 11:58
  starting to unravel under the scrutiny of new evidence.
• 12:03
  Credit to Doctor Morgan Taylor as a thought leader in this
• 12:06
  space. There are others, but he's one
• 12:08
  of the one of the main characters that have been
• 12:11
  challenging that notion. So don't be afraid of some
• 12:14
  testosterone boosting. It's good for you.
• 12:16
  In twice a week. How about cardiovascular 20
• 12:19
  minutes, five times a week interval interval training.
• 12:23
  Is there such a thing as too much exercise?
• 12:27
  It appears there is comes a point when that exercise which
• 12:32
  instigates free radicals, it's an inflammatory event if you
• 12:37
  take it to the highest, most intense level may be
• 12:41
  counterproductive. There are studies showing that
• 12:44
  people who do super intense long, like Ninja Warrior, you
• 12:48
  know, those type of high intensity workouts, the
• 12:52
  triathletes of the world, those of you that are pushing for
• 12:56
  conditioning purposes, you're raising free radical overload.
• 13:01
  It doesn't mean you shouldn't do it.
• 13:03
  If you love doing it, then you do it, right?
• 13:06
  It's vitality, man. It's not exquisitely a
• 13:10
  scientific experiment. For those of you who love
• 13:13
  training for training's sake or you're training for a sport,
• 13:18
  totally cool. But my advocacy is after that
• 13:21
  high intensity exercise, 1000 milligrams of vitamin C to help
• 13:25
  neutralize the free radical overload.
• 13:28
  And if you think that pushing really hard will make you live
• 13:32
  longer or less prone toward cancer, it won't.
• 13:38
  That high intensity activity has been shown increased risk of
• 13:42
  irregular heartbeats like atrial fibrillation.
• 13:46
  So once again, if you like it, have at it.
• 13:49
  But if you think you need to do it because you're going to live
• 13:52
  longer, you're not going to get what you hope out of it.
• 13:56
  So, you know, modest activity, like I say, I do the minimalist
• 14:00
  activity when it comes to the cardiovascular.
• 14:03
  I enjoy weightlifting. I do that just about every day.
• 14:06
  You don't need to do that every day.
• 14:08
  Twice a week is going to get it done.
• 14:10
  I like to say we're all bodybuilding.
• 14:13
  Just what kind of body are we building?
• 14:15
  We want the best frame that suits our life.
• 14:19
  We want sustainability. Remember the pie graph of time?
• 14:23
  You only have so many hours per day.
• 14:26
  Do not strike out on such an ambitious arc that you can't
• 14:30
  sustain it. This should just be a habit,
• 14:34
  part of how you live, part of what you do.
• 14:37
  As much as you can weave in micro exercising.
• 14:41
  Micro exercising refers to the activities you do that don't
• 14:46
  cost time, that don't make you change your clothes.
• 14:50
  I had a patient would, whenever they were on a phone call, they
• 14:54
  would just do squat, thrust, just generally back and forth.
• 14:58
  A woman in my practice, whenever she was blow drying her hair,
• 15:01
  she would do toe raises. So these are the little things
• 15:04
  that you can do in the course of a day, simple activity.
• 15:07
  Don't orbit the parking lot looking for a space close to the
• 15:11
  store, park far away, enjoy the walk.
• 15:14
  So these things make a difference and they're things
• 15:18
  that you can weave into the routine of your life.
• 15:21
  It's not something you do at super intensity for a short
• 15:25
  period of time and expect to have lifetime of benefit.
• 15:28
  So if testosterone levels go up from strength training, we're
• 15:31
  not worried about it. By now, we're no longer
• 15:34
  afflicted with testosterone phobia.
• 15:38
  Now, as much as we talk about containing prostate cancer
• 15:42
  preventing its progression, that has merit.
• 15:44
  Of course, the real reason that I like you all to embrace a
• 15:48
  lifestyle of physical activity is because of the vitality that
• 15:52
  comes with it. You feel better, you breathe
• 15:55
  better, you can do more. That remedy for fatigue is
• 16:00
  action. The remedy for weakness is
• 16:02
  strength training. All right, Well, guys, I hope
• 16:06
  this helps you a little bit. One parting word.
• 16:09
  Well, at least one in order to grow a muscle, if you're in the
• 16:12
  gym, you're doing the strength training.
• 16:14
  Remember your protein. You have to eat, in my view,
• 16:18
  three times a day as a minimum frequency.
• 16:22
  Then you want to be thinking about how much protein per day.
• 16:28
  A rule of thumb you can think about maybe 1/2 gram of protein
• 16:35
  per pound of body weight per day.
• 16:38
  So a £200 man would have 100 grams of protein per day divided
• 16:44
  out over multiple feeding times. You can't get that much protein
• 16:47
  at once, your body wouldn't be able to process it.
• 16:50
  That's important for maintaining and helping to grow muscle.
• 16:54
  Perhaps another time we'll talk about what kind of protein and
• 16:57
  how much in more detail, but for now, don't think too hard.
• 17:01
  Just do. Don't worry about if what your
• 17:04
  exercise is the best one or not. Just get started.
• 17:08
  Make it your habit. Don't over shoot.
• 17:12
  Don't look to do a one hour workout every day if you only
• 17:16
  have three hours of free time every day, unless you happen to
• 17:20
  like really love that sort of thing.
• 17:22
  I wonder about any of you guys out there doing marathons,
• 17:26
  marathon training. Yikes.
• 17:28
  Hey, honey, I'm going to go for a run.
• 17:30
  I'll be back in two hours. I don't know if that'd play
• 17:34
  anyhow, but if you, if you love it, that's that makes a
• 17:37
  difference. My team, thanks for your time.
• 17:40
  We'll look forward to our next conversation.
• 17:42
  Stay strong, stay vital. Keep fighting cancer like a man.