Customized Exercise Programming – Testicular Cancer
Jim received a referral for a client with testicular cancer. He’s been a Cancer Exercise Specialist for a little over a year, but this is his first client with testicular cancer. He asked if he could hire me to help him with and teach him how to put together Eric’s exercise program. He completed his initial assessment and health history and shared the following information with me:
- Eric is 34 years old and in excellent health prior to his cancer diagnosis
- Eric is 6’2 and currently 180 lbs. (he’s lost 20 lbs. from treatment) He has 15% bodyfat (up from 9%).
- He has been a marathon runner since his 20’s and has run in over 20 marathons. Prior to his cancer diagnosis he typically ran 10 miles a day 5 times per week. He has not exercised in 2 months and is anxious to get back to his running.
- He was diagnosed with testicular cancer in February 2022
- He underwent a radical inguinal orchiectomy and retroperitoneal lymph node dissection on 2/16/2022
- He completed external beam radiation to the pelvic area on 3/30/2022
- He is currently undergoing chemotherapy
- Slight upper-crossed syndrome
- Both feet supinate
- Lateral knee rotation on both legs (noticed on squat test)
Jim told me that Eric has excellent balance and muscular endurance with minor postural deviations. Jim took baseline measurements for lower extremity lymphedema and explained to Eric how to look for “pitting” edema.
Jim was concerned about working with Eric because he has not exercised since he was diagnosed and he is dealing with extreme fatigue, vomiting/diarrhea, chemo brain, and neuropathy in his feet from the chemotherapy. He is also concerned about his risk for lymphedema and wants to keep him safe.
I started by compiling my own notes and breaking everything down for Jim one step at a time.
- Because Eric underwent a radical inguinal orchiectomy, he is very likely to lose some of his lean muscle mass and have a difficult time building new lean muscle due to the reduction of testosterone.
- Because he had a retroperitoneal lymph node dissection 2 months ago, he has another four weeks before full recovery can be expected. Since he is two months out, however, he can begin to lift weights. He is at risk for lower extremity lymphedema also, with the risk increasing due to the pelvic radiation.
- Eric has regular bouts of vomiting/diarrhea, typically the day after chemotherapy. On days when he has vomiting/diarrhea, he should be advised to stay home and refrain from exercising for 24-26 hours. He needs to drink plenty of water and replenish his electrolytes. If he is struggling with chemo brain, you should keep the exercises very simple and exercise in an area with minimal distractions.
- Long-term side effects of chemotherapy and radiation include diabetes, heart and lung damage, osteoporosis, and an increased risk of future cancers. He should work up to 150 minutes of low to moderate intensity, or 75 minutes of high-intensity cardiovascular exercise to strengthen his heart and lungs and incorporate strength training to prevent osteoporosis and improve his body composition.
- Because of the extreme fatigue he is dealing with from the radiation and chemotherapy, his goal should be to exercise only 20-30 minutes 3-4 times per week. He should be encouraged to do this incrementally on days that he can’t do 20-30 minutes. He should never leave a session feeling more exhausted than when he started.
- Because of the upper-crossed syndrome, Eric needs to stretch both his pecs and lats while strengthening the scapular stabilizers to help correct round shoulder syndrome and the winged scapula. He should avoid pushing exercises like push-ups and chest press and focus on shoulder retraction/depression, rowing, and maybe reverse flys. He should do shoulder protraction exercises like ceiling punches or wall push-ups for his winged scapula.
- Because of the neuropathy in his feet, Jim should avoid high-impact activities and those with the risk of falling.
- Jim is recommending that Eric be fitted for running shoes that will cater to his over-supination. He will also include exercises that will include stretches for the plantar fascia, calves, and achilles tendons.
- After Jim completed the Modified Thomas Test on Eric he was able to determine that both his left and right IT Bands are tight. Therefore, he would need to focus on hip adduction and avoid hip abduction-type exercises.
- Because Eric wants to get back into running long distances, but he is at risk for lower extremity lymphedema, he must regularly perform lymph drainage exercises and slowly and gradually progress both cardio and strength training for his lower body.
Once I gathered my thoughts, I was able to come up with the following workout routine for Jim to facilitate with Eric for his initial 6-8 weeks.
Begin with the upper extremity lymphatic drainage card and finish with the lower extremity lymphatic drainage card – these should be done every day.
Following the lymph drainage exercises Eric can do a variety of core exercises that Jim will instruct him to do safely and effectively. Eric will also include door stretches (chest), head retractions (forward head), calf, achilles, and plantar fascia stretches.
2 x PER WEEK
Upper-body strength training – starting very basic. Eric can do chest flys, focusing on broad range of motion and opening up the chest; beginning with very light weight and just focusing on ROM. He should avoid any time of “pushing” exercise until his posture is ‘corrected.’ Jim will incorporate some rowing and lat pull downs to his chest to strengthen the opposing back muscles. There is no risk of lymphedema with his upper body so Jim can start him with light weights, cables, or resistance bands and gradually increase them as his energy level and muscle soreness dictate.
Lower-body strength training – squats are critical for activities of daily living. Jim will work with Eric on form and correcting lateral knee rotation and tight ITB. He can try alternating traditional squats with wall squats with Eric’s legs pressing against one another. This will help to strengthen adductors and stretch ITB. He needs to remember that Eric can not use bands or have any compression on his legs (such as a foam roller) because it may increase the risk of lymphedema. Start with only one or two repetitions of each and gradually add more as tolerated. Jim will re-assess Eric in 8 weeks and either continue with this routine, or progress to longer duration of cardio, more repetitions, and the addition of more strength training exercises.
ALTERNATING DAYS (or as tolerated) – begin with 1/2 a mile of just walking. Each session should end with lower body lymph drainage exercises. If there is no swelling, Eric may increase the duration – in very small increments. He should not begin jogging until he has a noticeable improvement in the neuropathy. Jim may also want to incorporate water jogging for Eric. The buoyancy of the water may help prevent and/or manage lymphedema.
He should not wear tight fitting clothing on his lower body or exercise in very hot/humid temperatures. He should also stay well-hydrated. If at any point there is swelling in his pelvic area, either leg, feet or toes, he needs to notify his doctor right away. Upon returning to exercise with his doctor’s permission, it is recommended that he wear a compression stocking on the swollen leg while he exercises. He should go back to the level of intensity and duration that he was at prior to any swelling.
Jim is also suggesting that Eric work with a registered dietitian, who specializes in working with cancer patients, that can put together a healthy plan for Eric to gain back healthy weight and lean muscle mass. This is out of Jim’s scope of practice as a personal trainer and Cancer Exercise Specialist while Eric is undergoing cancer treatment.
If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help in with custom exercise programming.
If you are a cancer patient and survivor and would like to hire Andrea to conduct a comprehensive assessment and create an individualized exercise program for you, click the link below.