Exercise for Managing Hormone Therapy Side Effects & Improving Bone Health
Featuring: Dr. Kerri Winters-Stone, PhD, Professor, Exercise Scientist
In short
Exercise scientist Dr. Kerri Winters-Stone explains how regular exercise can help people on hormone deprivation therapy for prostate or breast cancer protect their bones, maintain muscle strength, support heart health, and potentially slow disease progression. Her research found that a bone-loading exercise program can completely stop spine bone loss in men on androgen deprivation therapy. The session also covers safe exercise modifications for people with bone metastases and practical supplement guidance for bone health.
- •Aim for aerobic exercise 3–5 days a week (30–60 minutes), resistance training 2–3 days a week, and daily stretching — these are the doses shown to be effective.
- •If you have bone metastases, avoid twisting, rapid loading, hyperflexion or hyperextension, and exercises where weights are held far from your body's midline; bodyweight exercise with correct form carries relatively low risk.
- •For bone health, both men on androgen deprivation therapy and postmenopausal women may benefit from 1,500 mg of calcium daily, taken in doses no larger than 500 mg at a time; calcium citrate is the most absorbable form.
- •Ask your care team about a referral to an exercise program after treatment — exercise is not yet standard care, but Dr. Winters-Stone's research supports it as one of the most powerful tools available to cancer patients.
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“There is potentially a 50% reduction in prostate cancer specific mortality and prostate cancer recurrence [from exercise]. It's more powerful than chemo.
Meeting Summary
Advanced cancer patients, especially patients on hormone therapy, want to learn more about how exercise can help treat their disease. Advanced prostate cancer and breast cancer patients on hormone deprivation therapy often suffer a decline in their muscle and bones. Their heart is a muscle, and declines in cardio health are a common side effect. Another side effect can be weight gain or weight loss.
Prostate cancer patients often have metastases in their bones, which weakens them. Exercise is an intervention patients can use to control or offset their cancer and the side effects of hormone therapy and other therapies. It is one of the best anti-cancer therapies, strengthening the heart, bones, and the immune system, and generally enabling resiliency in response to harsh treatments.
For example, men with prostate cancer on androgen deprivation therapy need to preserve bone health through resistance training. Dr. Kerri Winters-Stone is uniquely qualified to discuss muscle and bone toxicities and non- cancer threats to survival, such as falling, especially in relation to prostate cancer.
She is an exercise scientist and professor and co-lead of Cancer Population Science in the Division of Oncological Sciences at Oregon Health and Science University. She is also co-director of the Knight Community Partnership Program and Co-program leader of the Cancer Prevention and Control Program for the OHSU Knight Cancer Institute, an NCI-designated comprehensive cancer center based in Portland, Oregon. As a scientist, Dr.
Winters-Stone’s research focuses on the effects of cancer treatment on musculoskeletal health and cancer recurrence risk and the ability of exercise to improve health and longevity in cancer survivors. Her work has extended to consider the impact of cancer treatment on the health of intimate partners and relationships by innovating a partnered approach to resistance exercise that builds teamwork. More recently Dr.
Winters-Stone received new NCI funding to determine the patterns and predictors of chemotherapy-induced neuropathy and mobility impairment during neurotoxic chemotherapy and several NCI supplements to integrate digital technology as a tool for continuous passive monitoring of symptoms, mobility and quality of life in aging cancer patients. What are the complex health challenges that advanced cancer patients face?
People with cancer are often older and face problems from aging, as well as other conditions besides cancer. Cancer treatment side effects can either accelerate functional declines or add “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” new problems that accelerate functional decline. It changes body composition, causes extreme fatigue, and can result in slowness, weakness, and instability.
Hormone therapy adversely affects bone health and strength. The condition of "frailty" leads to falls, combined with bone weakness, that can cause fractures, and those end up creating significant morbidity and mortality. Other side effects from cancer treatments include cardiovascular disease, diabetes, and loss of independence. What are the benefits of exercise? Dr.
Winters-Stones’ research projects have established that an exercise program using bone loading is able to completely stop bone loss in the spine for men on androgen deprivation therapy. The broader benefits of exercise, such as resistance training, include the ability to do more activities without any assistance, cardiovascular and metabolism improvements, and reductions in circulating insulin levels and body fat.
What exercise program should you do? You should work towards aerobic exercise three to five days a week, 30 to 60 minutes at a time; resistance training two to three days a week; and flexibility, stretching, and mobility every day. This isn't any different than the public health guidelines. But each one of those have different benefits and an ideal program would contain those different modalities, and these are the doses that are effective.
How should cancer patients with bone metastases exercise? If you do exercises without weights and your form is correct, the risk is relatively low. As you start to increase weights, and if you do things incorrectly, the risk is going to increase. You should avoid highly dynamic, rapid loading kind of exercises, twisting exercises, hyperflexion hyperextension, or any extreme loading on the bone.
You should be careful of exercises where the weights are away from the midline of your body. Any advice on supplements?
•Calcium: For women who are hormone deficient, e.g., postmenopausal, the recommendation is about 1500 milligrams of calcium a day. For men, it’s 1500 milligrams a day and you should break up your doses throughout the day, with no more than about 500 milligram per dose, e.g., at breakfast, lunch and dinner. Calcium citrate tends to be the most absorbable followed by calcium carbonate. Oyster shell calcium is not as good as Citric Cal or some other supplements that are on the market.
•Vitamin D: It depends on where you live. For those in Oregon, who don't get vitamin D in the wintertime, you might benefit from a supplement. What do we need to do in the future? Our goal is to make the patient’s quality of life as high as possible, for as long as possible. We know that exercise has the potential to control disease progression and to improve treatment side effects, but it is not yet part of standard care. Patients should have a warm handoff after treatment to an exercise program. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. SUMMARY KEYWORDS exercise, adt, bone, trial, people, kerri, program, cancer, called, whole body vibration, men, bone loss, frailty, study, test, prostate cancer, improve, work, funded, guidelines SPEAKERS Amit Gattani, Mike Yancey, Jeff Krolick, Kevin Fordney, Brad Power, Brian McCloskey, Russ Hollyer, Rick Stanton, Kerri Winters Brad Power We're honored to have Kerri Winters-Stone with us today. I met Kerri through Cathy Skinner, who previously led a discussion with us on exercises for cancer patients. Kerri Winters 00:16 Cathy Skinner connected us through Katie Schmitz (a professor and leader in exercise for cancer patients).. Brad Power 00:22 All cancer patients should have an interest in exercise, especially those on hormone deprivation therapy. Exercise is an approach to keeping your muscles in shape generally, and for resilience, musculoskeletal strength, and just being generally healthy and having a strong immune system. Kerri is not only an expert, but she is also involved in clinical trials, which means there's an opportunity to potentially participate in some of the things that she's got going. It's a "twofer." Kerri is at OHSU. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” Kerri Winters 02:11 Thanks for the invitation. I was excited to talk to all of you and to learn about your group and what you're aiming to do, and how I can potentially be helpful. Brad said prepare a couple of slides. Well, you say that to an academic, it's like I'll take my slide deck of 45 down to 10. I will walk you through who I am and my research program. I would love to get a little bit more in depth, but I know that this isn't quite the forum for that quite yet. As Brad mentioned, a lot of my work is focused more broadly on exercise oncology. But I'd say probably 50% of the work that I've done since moving into this field has been in prostate cancer and specifically on using exercise as a countermeasure to ADT (androgen deprivation therapy). Hopefully, I'll be able to provide you with some helpful information today. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” I’ll start by giving you a little bit of an idea of who I am and how I got into exercise oncology. I started out at UC Davis. I heard someone was from the SAC area. I started out in California, and I am a human performance major. This is a field that may be unfamiliar to some people. But it's the more sophisticated version of physical education. It was really where we moved the field toward using exercise to study how to make people stronger and faster and more competitive and harnessing those adaptations that happen from exercise training and using it to actually help either prevent disease in the first place, or to help manage disease when somebody has it either by controlling disease or managing the side effects. I did my PhD at Oregon State University down in Corvallis in human performance. At that time, I moved from working with athletes to working with women to use exercise as a way to prevent osteoporosis. My work was funded by NASA because they were looking for ways to use some of the research that was being applied to prevent bone loss when people go up into zero gravity to actually benefit the general public. Some of my work was funded through that mechanism. We were really trying to figure out the training principles and the ways that we can manipulate exercise to preserve bone due to deconditioning, or due to aging and hormone changes. In my work at OSU, we actually used athletes as a model. We tried to characterize the bone strength across different types of athletes and figure out what is it about the athletes who have really high bone density and their training regimens that we could harness in a way that we could use it as a either preventive strategy or a treatment strategy to address bone health in people back in one-G environments. That is the principle of the work that I do which is around this kind of training concept called specificity. How do we take some specific principles around exercise training around different exercise modalities and then manipulate that in a way that can treat human health? When I came to OHSU, I used a lot of that work to start addressing problems that people were incurring because of their treatment for cancer. That started with some work in prostate cancer where we were using these bone loading programs that we developed to see whether or not they could be effective at preventing bone loss that was associated with hormone therapy for prostate cancer. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” To give you an idea of kind of how my journey evolved into exercise oncology and at OHSU, I am a professor here in the Division of Oncological Sciences. I oversee a division called Cancer Population Sciences. I also co-lead the cancer prevention and control program for the Knight Cancer Institute. That's a scientific portfolio of work in cancer prevention and control. We have a very strong cancer survivorship program of which I oversee and am a part of, and I also co- direct a program called the Knight Community Partnership Program, which is a granting program funded by the Knight that was actually a result of a huge philanthropic effort, in partnership with Phil Knight from Nike, to raise funds for the cancer center and a portion of those were allocated to go back to the community. We run a granting program to put funds back into the community to address cancer related issues about which they're concerned. “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” Our vision for my research program is to use exercise as medicine for cancer. I work in a cancer center that is very strong, and very focused on precision medicine and on developing therapeutic approaches for cancer. One thing that we have to keep in mind is that even with therapeutic advances, aging is a part of cancer. As those therapeutic strategies are being developed, people like me also have their eyes on how they are altering the trajectory of someone's aging, what other additional problems may they be incurring that actually create additional health problems. A large proportion of people with cancer, as you guys know, are older and a lot of people are concerned about their quality of life. If treatments are going to compromise their quality of life, then that makes it difficult in terms of decision-making. Some people would just avoid treatment altogether if it significantly affects their quality of life. We know that exercise has the potential to control disease progression, and it has the potential to improve treatment side effects, but it is not yet part of standard care. A lot of people struggle to become active enough to know what to do to feel like they're exercising safely. This is part of my vision, to develop a strong enough evidence base and contribute to the evidence so that exercise does become part of standard care for people with cancer. That's really the ultimate goal of the work that I'm doing. From Dr. Winter-Stone’s bio: Dr. Winters-Stone has been funded by the National Cancer Institute, National Heart Blood and Lung Institute, the American Cancer Society, and the Susan G. Komen for the Cure, Livestrong, and Movember Foundations. This work has supported over 14 controlled clinical exercise trials that have trained over 2000 cancer survivors in different exercise modalities including resistance, aerobic, flexibility and tai ji quan training. She has also co-led the update of the American College of Sports Medicine Exercise Guidelines for Cancer Survivors, released in October 2019. The long-term goal of Dr. Winters-Stone’s research is to develop prescriptive exercise programs for cancer survivors that meets their needs and preferences, optimizes their health outcomes, and “Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” provides the support and encouragement they need to stay active so that they can live better and longer with cancer. After developing new virtual approaches to the delivery of exercise training during the COVID-19 pandemic, she is now exploring how supervised
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