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Prostate Cancer

Exercise After Prostate Removal

Why is exercise important after surgery?
No matter how active and fit you were prior to surgery, you will experience reduced strength and be limited in your level of activity following your prostate removal. To return to normal activity, you will need to follow a sensible exercise program, adapted to your level of health and fitness. Realistically it will be six-eight weeks before you are back to your pre-surgical stamina and strength. However, you will be surprised that by employing a basic exercise program, as described in this article, how good you will feel in just a few weeks.

The following information is meant as a guide to help you plan your own exercise program. Prior to initiating significant post-operative exercise, you should share your plan with your physician.

When do I start exercising after prostate surgery?
You should begin almost immediately. The first 10-12 hours after surgery will be a blur and will pass quickly. However, if you have surgery first thing in the morning, by the late afternoon or early evening, the nursing staff will assist you in getting up at the side of your bed or into a chair. This is done in a specific fashion to reduce tension on your incision and prevent discomfort. This is the first form of exercise that you will perform on the road to recovery so your understanding and participation is important.

To get into a sitting position, the head of your bed will be raised. You are then helped to roll on your side. Your head is then lifted as your legs are moved down to the floor in a smooth movement. To stand, you will need someone to support you under your arm. Check how your legs feel, and if they are strong enough to support you. Tell the nursing staff and let them support you. With their help, stand and then if okay with your doctor walk to or move into a chair and sit up for a while.

Doing this exercise sounds limited, but it is important. Don’t push it but feel confident that with each day your energy and strength while in the hospital increase dramatically. The important thing is to get up and out of the bed, even if only to sit up. The benefit of getting out of bed is that it reduces the complications seen with surgery (such as fluid in your lungs or blood clots in your legs).

How will I know if I have pushed myself too far?
Weakness, dizziness, fatigue, nausea and feeling flushed are some feelings associated with doing too much. You will notice that you will tire sooner with less exercise than before. You may also feel some discomfort, warmth, or stretch down in the pelvic area. When you exercise you should try to stop and rest before these symptoms become too severe. Push yourself but be sensible. It is better to do several shorter periods of exercise rather than a few longer ones.

How much will I be doing by the time I leave the hospital?
You will be staying in the hospital for two or three nights. How long you stay depends on how quickly you are up and about and on your bowel function. By the second day in the hospital, you should be up and about the room. Things move pretty quickly the second day, and you will find your strength and stamina have improved to the point that you will want to take a walk down the hall. Remember you will need some help at first especially since you will need to bring along with your IV pole and pain control dispenser. By the third day, your discomfort will greatly improve and you will be free to move around your room and hallways.

What about pain medication and exercise?
Whether it is in the hospital or home, you will need pain medication to allow you to move around easily for the first week or so. Anticipate when you will be doing something active and pre-medicate yourself. Oral pain medications take about 20-30 minutes to take effect. Check how you respond to the medications and if they make you dizzy or unsteady, take a lower dose and have someone accompany you. You won’t need these pills for long but use them early when some discomfort may keep you from getting up and about.

What can I do once I get home?
When you get home, continue your program of rehab and recovery by developing a plan of exercising and keep to it. The foundation for this program should be frequent short periods of walking. Depending on your age and general condition of health, it may be enough the first week to walk 6 or 8 times for 5-10 minutes inside of your home. See how you feel but each time try to go a little farther. As you feel comfortable or as you need to get out of the house, move your walks outdoors, at first to the back yard. Then walk the block. In time you will be walking a block then two then a mile and so forth. Remember at first to keep the walks short and do them several times a day with rest in between. Use the rest time to read, relax, and learn something new. This is a major turning point in your life, having this surgery. This time off can become a gift. Maybe there is something out there for you to learn or to become aware of that you never considered before.

What about my foley catheter and exercising?
For two weeks following surgery you will have a catheter, which takes some getting accustomed to. When walking, remember to use the leg bag and fasten it comfortably under loose fitting pants such as sweat pants or loose running pants. Prevent rubbing of the catheter against the meatus (opening of your penis) by securing the leg bag on your lower leg in a way that the tubing doesn’t catch or move with each step. Don’t tape the tubing to your thigh but let it hang free. You should remember to drink lots of fluid while your catheter is in place. An advantage of the catheter is that you can drink all the liquids you want without worrying about finding a bathroom.

What about stretching or Yoga?
Stretching can also be started almost immediately, even while in the hospital. Again it is important to start very gently and sensibly by listening to your body. If you feel pulling or it hurts, STOP.

  • When stretching you should follow a few rules.
  • Stretch on an empty stomach. Wait at least 2 hours after a meal
  • Wear loose fitting clothing
  • Practice in a warm room after warming up the muscles, for instance, after walking.
  • Do not hold your breath during the exercises but breathe evenly throughout the stretch.
Types of stretching include modified forms of old friends you have done since your first P.E. class. The first one you may try is simply standing in place. First check your posture by standing against a wall. If standing correctly your buttock, shoulders and back of head should be pressed against the wall. Straighten your back and legs and feel the stretch. BREATHE. Gently tighten your stomach muscles by pulling them in to the wall. Stop if you feel any discomfort. Do this several times, for a couple of minutes each time. As you feel able, you can do the same stretch on the rug or floor.

With time you will be able to work on bending more during the stretch. A modified toe touch is performed by starting in the standing position and gently bending your neck then shoulders forward. Stop if it hurts, but do a little more each day. The object is bending and loosening your back and shoulders, not to touch your toes.

After the catheter is removed, try some simple yoga positions to build your muscle strength. Get down on your hands and knees on a comfortable surface like a rug. Concentrating on your lower back, gently arch your back like a cat stretching. Your hands and feet should not leave the ground. Work to feel each vertebra in your spine move upward. Breathe and then relax. Now bend your back downward like a saddle-worn horse, again feeling each vertebrae move toward the floor. Breathe and stop if any pain or discomfort.

These are enough to get you going. There are excellent books out on Yoga and stretching. The key is to go slowly and move into these smoothly and easily. Check with your doctor about what you plan to do.

What other activities can I do and when?
The following is a chart that provides a conservative general program for exercise. Check it with your doctor for how appropriate it will be for you.

Day 1 through Week 2


 Day 1 after surgery1st Week2nd Week
WalkingWalk twice in the morning, twice in the afternoon and twice in the evening for 5-10 minutes.5-6 times in house and back yard with longer periods each walk up to a total of 45 hour.5-6 times around neighborhood up to 90 min/day
GolfWatch it on TVNoNo
Lifting > 20 lbs.NoNoNo
Bicycle RidingNoNoNo
Tennis/RacquetballNoNoNo
TreadmillsTreadmills can be used in place of walking outdoors. Keep level at a comfortable pace. Follow walking times. No stair steppersSee walkingSee walking
Weight liftingNoNoLight arm exercises with elastic band or 1-2 lb weights
BowlingNoNoNo
Basketball/competitive sportsNoNoNo
Stretching5 min in the morning and evening10 min twice a day15 min twice a day
Housework/GardeningNoNoNo
SwimmingNoNoNo

Week 3-6



 3rd and 4th Weeks5th and 6th WeeksAfter 6 weeks
WalkingContinue to walk up 90 minutes per dayContinue to increase time walking up to 2 hours/dayAs tolerated no restriction
GolfWalk with buddies, short distances with frequent rests. No lifting or swinging of clubsIncrease distance walked with buddies as tolerated, no lifting or swinging of clubsStart with easy chipping and putting. No lifting. No full driving off tees until Doctor OK's.
Lifting > 20 lbs.NoNoStart light and work up as tolerated.
Bicycle RidingNoNoThis is the least desirable exercise after prostate surgery. Best to wait until 8 weeks after surgery to resume.
Tennis/RacquetballNoGentle swinging, may practice against a wall at half-speed with frequent rests.As tolerated, no restriction.
TreadmillsSee walkingSee walkingAs tolerated, no restriction
Weight liftingLight arm exercises with elastic band or 1-2 lb weightsLight arm exercises with elastic band or 1-2 lb weightsAs tolerated, start slow, move up gradually
BowlingNoNoAs tolerated
Basketball/competitive sportsShoot free throwsShoot free throwsStart slowly; increase time and activity as tolerated.
Stretching 20 min twice a dayContinue and add more stretch as toleratedNo restriction
Housework/GardeningNoGardening, light painting-no heavy stretching or lifting. No standing on ladders until 6 weeksGardening, light painting-no heavy stretching or lifting. No standing on ladders until 6 weeks
SwimmingStart with walking in shallow end as toleratedGentle kicking against wall or with float board for 10-15 minIncrease as tolerated, no restriction

Summary
Be gentle with yourself as you rehabilitate from your surgery. Give yourself time to heal but stay active with time to rest in between. Walking is the best thing to do so get out and see what is going on in the neighborhood. Add the other activities as tolerated and recommended by your doctor. Create your own exercise program from the following table with suggestions from your doctor. Find activities that are fun and get going back on the road to recovery.


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