Exercise and benign prostatic hyperplasia (BPH)

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.

Note: Talk with your doctor before starting an exercise program. He or she can help you design a routine to meet your needs and make sure that you are exercising safely.

Assessing the evidence

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. (To read all of these studies on your own, see “Studies of exercise and BPH,” below.)

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.

Studies of exercise and BPH

Gann PH, Hennekens CH, Longcope C, et al. A Prospective Study of Plasma Hormone Levels, Nonhormonal Factors, and Development of Benign Prostatic Hyperplasia. Prostate 1995;26:40–49. PMID: 7531326.

Dal Maso L, Zucchetto A, Tavani A, et al. Lifetime Occupational and Recreational Physical Activity and Risk of Benign Prostatic Hyperplasia. International Journal of Cancer 2006;118:2632–35. PMID: 16380994.

Platz EA, Kawachi I, Rimm EB, et al. Physical Activity and Benign Prostatic Hyperplasia. Archives of Internal Medicine 1998;158:2349–56. PMID: 9827786.

Reaping the benefits

So how much exercise should you do if you’re concerned about prostate health? 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 BPH. 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?” below.)

If you want, you can jog or use the treadmill at the gym (see “Health club savvy,” below). But keep in mind that bicycling (see “Your bike seat and your health,” below), 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.

What about my heart rate?

Many people have been taught to measure their pulse during an aerobic workout to see whether they’ve reached a target heart rate. To figure your maximum heart rate, subtract your age from 220. Multiply the result by 50% for the low end of your target range or by 75% for the high end.

There are drawbacks to this technique, however. Few people take their pulse accurately enough to make the effort worthwhile. And since your pulse drops rapidly when you’re not exercising, measuring it after you’ve stopped won’t say much about your true level of exertion. Simply paying attention to your body’s signals, such as how hard you are breathing, will tell you whether you can work harder or should slow down.

Health club savvy

While you don’t need to join a health club to exercise, membership does have some advantages. You’ll have access to a wide variety of equipment and exercise classes, so it’s easy to change your routine and avoid boredom. Personal trainers can help you devise a routine and teach you how to use the equipment properly. And many people find that joining a gym motivates them to exercise frequently because they want to get their money’s worth.

On the other hand, memberships are often expensive, though some insurance companies will reimburse part or all of the cost. In addition, some gyms are so crowded that you may not get into the classes you want, or you may have to wait in line to use a piece of equipment.

Before joining, tour a gym at the times you’re likely to use it so you can see what the atmosphere will be like. Make sure the location and hours work with your schedule. If you want to work regularly with a trainer, ask about any additional fees and about the trainer’s qualifications. Look for trainers who have been certified by a professional organization, such as the American College of Sports Medicine.

Your bike seat and your health

A sustained ride on a narrow bicycle seat compresses the nerves in the perineum, the area between the scrotum and the anus, leading to numbness in the penis. Rarely, impotence occurs. The problem can last from a week to a month after a lengthy bike ride. Taking the following precautions can help you avoid these problems:

  • Pick a wide seat with plenty of padding. Look for gel-filled and anatomy-friendly seats.
  • Wear padded bike shorts.
  • Don’t tilt your seat forward. This increases pressure on the perineum.
  • Make sure the seat height is correct. Your legs should not be completely extended at the bottom of your pedal stroke.
  • Raise the handlebars so your position is more upright.
  • Be sure the top bar of the frame is at least two inches below your crotch. Cover the bar with padding to protect your genitals if you fall.

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.

Pick your favorite

Dozens of activities “count” as aerobic exercise. Choose one — or even several — that you enjoy. You’ll be more likely to stick with exercise if you make the routine fun. Consider activities like these:

  • walking
  • hiking
  • raking leaves
  • gardening
  • aerobics
  • bicycling
  • dancing
  • swimming
  • jogging/running
  • golfing
  • tennis
  • racquetball
  • rowing
  • basketball
  • cross-country skiing

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.

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.

Originally published Oct. 1, 2008; last reviewed April 26, 2011.

Comments
10
Carl Bramson, MD

My theory why BPH decreases with excercise? Increased testosterone receptors on muscle cells with excercise competively inhibits binding of DHT to prostate tissue for BPH to ensue. Would require muscle bx for titrating amount of binding sites pre and post excercise. Would be interesting to try.

MADHUSUDAN SETHI

i AM OF 61 YRS OLD. I HAVE BPH GR.II. I DO MORNING WALK FOR75 MINUTES COVERING 5 KMS DAILY I.E. 25 MINUTES BRISK WALK AT SPEED 5KMPH AND SLOW RUNNING OF 15 MINUTES AT SPEED OF 10 KMPH AND STRECHING AND FLEXIBILITY EXERCISE OF 30 MINUTES. I TAKE SILDURA- 8 AND DARILONG 7.5. SOME DOCTORS SAY I HAVE TO TAKE FOR LIFE LONG . KINDLY ADVISE.

Al

Am i the only one to suspect that too much SITTING may be the culprit? Sitting long hours, whether in front of TV, video games or a computer screen in the office, might have a lot to explain for developing BPH. Too much sitting goes hand in hand with all sorts of other diseases, obesity, diabetes, aso. If you don’t sit, you are naturally moving, burning energy/fat/calories. The body is made for movement, not sitting on one’s arse all day long.

Chauncey M. DePree, Jr., DBA

If you’re male, which includes about half the population, you’ve heard or can expect to hear from your prostate. The initial disturbance might be a sudden need to urinate. Buckle up, pal, there are more surprises to come. You’re about to be the protagonist in your very own mystery: “What the hell’s going on down there?”

My mystery started quietly enough, probably a lot like yours did or will. A physician advised me that a blood test from my annual physical showed an elevated PSA (Prostate-Specific Antigen). Urges to urinate had also begun. Without providing details, he strongly recommended I see a urologist. So, what does a PSA score mean?

A quick review of reputable medical websites, like drcatalona, mayoclinic, mdanderson, and speringprostatecenter alerted to the diagnostic ambiguity of PSA for screening of prostate cancer. Cancer? No wonder my physician sounded serious.

Diagnosis gets complicated right away. A “low” PSA, often ignored by physicians, can occur when a man suffers from aggressive prostatic cancer. At the other end of the scale, studies indicate that more often than not a “high” PSA score simply means a benign enlarged prostate, which naturally occurs in older men and is accompanied by slow flow and urges to urinate. Physicians nevertheless view a “high” PSA as sufficient reason to recommend their next step in the diagnosis of cancer, namely, a biopsy, an invasive and risky procedure, which may cause incontinence, impotence, and infection.

That seemed like a quick jump: from an ambiguous PSA screening procedure to a biopsy accompanied by significant health hazards. And not just any biopsy, but a multitude of samples, up to a dozen or more! Described as a pincushion biopsy.

I’m not alone considering PSA screening for cancer as ambiguous and a health hazard in its own right. The prevalence of false positives (“high” PSA and a biopsy that shows no cancer) led the American Urological Association to recommend against annual PSA screening for men of average risk under 55. We weren’t alone, either. The U.S. Preventative Task Force went further, recommending ending PSA screening for all men without symptoms like the urge to urinate and family history.

Medical researchers were ready with a relatively new PSA measure, which identifies three markers that more accurately signal underlying cancer than the simple PSA. Even then, the widespread presence of false positives significantly haunts the new PSA screening process.

Physicians still use the new PSA to recommend biopsy. And if annual blood tests report an elevated PSA—a doubling of the PSA score, for example—physicians argue that may indicate aggressive prostate cancer. A biopsy recommendation is bolstered by the claim that it is the gold standard for diagnosing prostate cancer. Peace of mind is the selling point. (A financial motive to rush to biopsy is the subject of another report.)

I thought there must be a better way to make a decision. The proposed biopsy was a clear and convincing motivation to investigate further. (By the way, a digital rectal exam and ultrasonography are as fraught with error as the PSA score). So, the question is, is there a diagnostic procedure that bridges the knowledge gap between PSA and biopsy?

Credible medical websites led to information about advanced multi-parametric MRI. Research supported its significantly improved diagnostic reliability over other methods. And, it’s noninvasive. The specialized MRI is not widely available but was highly recommended prior to biopsy. It offers detailed three-dimensional pictures of the prostate. Given experience and expertise of the urologist and technician, cancer can be significantly more accurately identified. Unnecessary biopsies are avoided. Furtherrmore, suspicious areas are subjected to a targeted biopsy, avoiding the traditional multitude of biopsy needles excising samples over the entire prostate. Multi-parametric MRI seemed to be the best current option for diagnosis and, if necessary, treatment.

The urologist showed me a video, which was a rapid display of pictures offering the impression of moving through the prostate. He said it looked clear except for one suspicious area. The suspicious area was a close call whether to biopsy. I chose the peace of mind a targeted biopsy would give me. Good or bad, I decided to know. If it were cancer, treatment would also be targeted, preserving essential functions of the prostate.

The samples were benign. Phew! Keep in mind, though, a false negative (the test procedure missed cancer) is possible. And I could still suffer cancer in the future. Therefore, I also chose to undergo periodic noninvasive monitoring via MRI.

Cancer tends to focus attention, directing one’s radar antenna to look for medical progress. Amazing cancer treatments are available and more are coming online in the near future. For starters, look up “liquid biopsy” and the “suicide gene.”

All in all, uncertainty reigns “down there,” but I’m pleased to say I enjoy a glass of wine from time to time, and expect to continue to in the future.

narayanakumar

Dear sir,
i have slight bph, aged 52. My friends advice me to take regular and compulsory intercourse with my wife to control bph. In what way it will be helpful.pl advice.thank you

Bob Myers

I have proven to myself that walking even at a moderate ace for 20 min. per day has made a huge difference in my urine stream for the better. It works.

I to have been the victim of an over zealous PA at a urologist’s office who was quick to pass judgement on a PSA and ordered a biopsy which resulted in 10 samples being taken via the rectum I bleed for two weeks before the bleeding entirely ceased. I will never submit to such a “rush to judgement” again.

I understand that there is a clinic in Las Vegas which performs the prostate MRI’s mentioned above.

Hope this helps.

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