Ask an expert: Brad Wall

PhD candidate: Topic in the field of exercise and prostate cancer, in particular the role of exercise in reversing treatment toxicities in prostate cancer patients.

1. How important is exercise to cancer sufferers and at what stage of treatment is exercise most important – pre/during/post?
The way we approach exercise and chronic disease has changed markedly over the past 20 years. Previously the common thought was people should rest once diagnosed with a chronic disease (cancer in this instance), this thought process used the incorrect rationale that patients should save their energy to ‘fight the disease’. We now know that one of the worst things you can do is remain sedentary throughout cancer treatment. Another example of this was when heart attack patients were commonly told to rest and not stress their heart after a heart attack. We now know that supervised exercise is a key component of post heart attack rehabilitation which assists in reducing risk factors associated with cardiovascular disease and the likelihood of a secondary episode occurring.
Research has shown that a lack of physical activity is considered a known risk factor for developing certain types of cancer, in particular breast and colorectal cancers. Regular and vigorous exercise has been shown to be a strong preventative medicine against cancer with the potential to reduce the incidence by as much as 40% (Newton & Galvao, 2008).
Exercise can result in improvements in psychosocial and physical outcomes as well as better compliance with treatment regimes, whether it be chemotherapy/ radiotherapy etc. as well as improved surgical outcomes. Exercise has also been shown to reduce to overall impact of the disease symptoms and treatment related side effects, one such example is research that I am currently involved in where exercise is used to successfully reverse the negative side effects associated with the use of Androgen Deprivation Therapy (ADT) for the treatment of Prostate Cancer. The exercise program these men undertake reduce the levels of fat gain, muscle and bone loss as well preserving and even enhancing physical function. This is during a time when research has shown this group of men (undergoing ADT for the treatment of prostate cancer) are commonly gaining weight, developing type II diabetes, Osteoporosis and Sarcopenia as well as increasing their risk of cardiovascular disease. A report has shown that once men develop prostate cancer they are more likely to die of cardiovascular disease than the actual cancer itself (Lu-Yao, 2004). Our work is aimed at reducing these side effects and risk factors associated with cardiovascular disease. Research also suggests that exercise may be an effective intervention for enhancing quality of life in cancer survivors, and the effects may in fact go beyond the benefit received from group psychotherapy.
Post diagnosis, prospective studies have shown regular exercise can increase survivorship by 50-60%. The strongest evidence has so far been found in breast and colorectal cancers. Initiating an exercise program immediately after being diagnosed with cancer will help prepare patients for the treatment phase of the disease both psychologically and physically. For example higher cardiorespiratory fitness improves surgical outcomes whilst lower body fat decreases risks associated with anaesthesia.


2. Generally what sort of exercise would you recommend for people diagnosed with cancer?
It is generally recommended that sufferers undertake a combination of aerobic and resistance type exercises. Aerobic exercises will usually involve large muscle groups and do not need to be restricted to just stationary machines (treadmills, cycle ergometers), this can be walking/jogging, outdoor cycling, swimming. Any kind of physical that increases your heart rate for an extended period of time in a safe manner is fine. Resistance exercises should be dynamic in nature using both concentric and eccentric muscle contractions. This can be through a combination of machine or free weights. Additionally programs can be designed to use the patients own body weight if they do not have access to a gym. Therabands are also a useful tool used by exercise physiologists when designing home based exercise programs.
Exercise in small groups supervised by trained personnel (Exercise Physiologists) will ensure the exercise is undertaken in a safe and effective manner. In my experience small groups can often be the source of unstructured support networks where other sufferers can discuss their treatment, side effects and any other concerns they have with others who are going through similar stages of the disease in a relaxed informal environment. Exercising in small groups provides motivation which assists in the adherence to exercise programs.

3. What are some of the barriers to exercise for cancer sufferers and how can these be overcome?
Exercise prescription needs to be flexible particularly during cancer treatment. Constant adjustments need to be made when factoring in treatment changes, presence of side-effects, functional and physical status and any other clinical concerns. One such example would be avoiding pools/ saunas or even densely populated areas (gyms) during chemotherapy or any other treatment where the immune system is temporarily suppressed. Both the Exercise and Sports Science Australia (ESSA) and the American College of Sports Medicine (ACSM) have released position statements that deal with exercise prescription for diseased populations. It is recommended that exercise professionals consult these position statements prior to supervising a patient with a form of chronic disease.

4. How did you become involved in this area of research?
After completing my Master’s in Exercise Physiology I decided to take a different path and get involved in exercise and chronic disease. I was fortunate to be able to work with a team that was internationally recognised in the field of exercise and prostate cancer. I have found this work to be very rewarding especially when hearing first hand accounts from patients of how the program has changed their quality of life and has given them confidence to return to doing things they thought they would no longer be able to do.

5. What is your current research focusing on?
As mentioned above my research is focussed on Exercise and Prostate Cancer; In particular investigating the role of exercise in reversing treatment toxicities in prostate cancer patients. This work is aimed at reducing the risk factors associated with cardiovascular and metabolic complications. It is hoped this simple and cost effective intervention strategy may provide similar benefits to pharmacological interventions (cholesterol and blood pressure lowering drugs etc.) without exposing patients to additional potential side effects and cost.

If you would like to get in contact with Brad Wall about his research, please email B.Wall@murdoch.edu.au