Get off your duffs and exercise

[dshoskes]

J Urol. 2007 Jan;177(1):159-65.

Physical Activity of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome Not Satisfied With Conventional Treatments-Could it Represent a Valid Option? The Physical Activity and Male Pelvic Pain Trial: A Double-Blind, Randomized Study.

Giubilei G, Mondaini N, Minervini A, Saieva C, Lapini A, Serni S, Bartoletti R, Carini M.

Departments of Urology, University of Florence, Careggi Hospital, Florence, Italy.

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome is a major healthcare burden. Affected patient quality of life is poor and currently no investigated treatments have significant long-term benefit. We performed a preliminary investigation of the role of physical activity and its effects on select patients with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS: Between 2002 and 2004 we recruited a volunteer sample of 231 eligible males 20 to 50 years old with chronic prostatitis/chronic pelvic pain syndrome who were unresponsive to conventional treatments and free of any contraindication for moderate intensity physical exercise. This group was screened and, if in accordance with study inclusion/exclusion criteria, patients were randomized into 2 groups. Participants were randomly assigned to the aerobic exercise group (52) and the placebo/stretching and motion exercises group (51). Main outcome measures were the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index, Beck Depression Inventory, State Anxiety Inventory-Y and a pain intensity visual analog scale administered at baseline, and 6 and 18 weeks.

RESULTS: At 18 weeks 36 subjects (75%) in the aerobic exercise group vs 40 (81.63%) in the placebo/stretching and motion exercises group completed the 18-week program and evaluation. Differences between the 2 groups were found in total National Institutes of Health Chronic Prostatitis Symptom Index, pain and quality life impact subscales, and pain visual analog score (ANCOVA p = 0.006, 0.0009, 0.02 and 0.003, respectively).

CONCLUSIONS: Improvements in the aerobic exercise group were significantly superior compared to those in the placebo/stretching and motion exercises group. Aerobic exercise represents a valid treatment option and it should be further investigated in a larger study with longer followup.

[GP2]

I have often wondered how many of us are the kids at school who preferred computers to sport if you know what I mean?

I really do believe personally that the sooner you can get back into exercise / sport the btter. And whats more once you have lengthened those muscles and perhaps released some trigger points I think that even if you are not a sporty person you should become one!

[carld]

This is one thread I have to comment on. I for one have always been active my whole life such as surfing, swimming, weight lifting, drumming etc.... It makes perfect sense that being real active would promote more blood flow to the muscles and organs, improve mood etc...This is the most inspirational post I could of read. It means go out there and live. So this is just an additional thing to make you pro-active in our condition. Add it to our protocal. Everytime I have done something active I have not had LUTS symptoms. Maybe it's because I'm not thinking about this wretched condition, I don't know. Thank you Dr. S

[GP2]

Obviously those sufferers who suffer from CFS are ruled out & I understand that heavy exercise does promote flares in some.

I'm also sporty although I have long periods where I choose (or did in the past) a lazy, boozing lifestyle instead. Swimming (again chlorine can be an issue) is a great all round workout which is not strenuous. I swim 3 times a week.

Remember Carl its as wretched as we let it be

[webslave]

Exercise improves mood and helps with depression and anxiety. Exercise also improves the state of pelvic musculature, and may help to lessen spasm and trigger points. So exactly how it's helping CP/CPPS is not clear.

BTW, for many years I have walked for one hour daily with my dear wife (a recipe for a happy marriage, IMO).

[carld]

Remember Carl its as wretched as we let it be

That's right brother! Thank you for that...

[So. Cal. Accountant]

Dr. Shoskes' posting reminds me of another previous posting that I read somewhere on this website that says something to the effect of, "I have noticed that you never hear about athletes getting this condition."

[carld]

That's True Andrew! Think about all the stretching and activity they do. That leaves the pelvic environment really open for excellent blood flow. Plus they don't have to get up every morning and go to "work" . They don't have the blue collar/white collar stress. Their stress is what to do with all that ##*%#@!232!!!money and what model/actress there going to bang!!

Carl...

[scoobysnacks]

that is simply not true...

i played soccer in college and all my life. I was an avid bodybuilder, mountain biker, and climber.

Tim Sawyer told me this weekend he is currently treating an Olympic hopeful, and has seen men from professional soccer teams as well.

This is not just a computer junky condition.

At the clinic with me was a football player from a DI school out east. He is only 19 and has this....

Athletes get this too. I was an overdoer of exercise, so it stands to reason that until I get these TPs worked out exercise, the main cause, is going to flare me.

I can walk and that helps, but anything else flares me right now.

Good Luck,

SS

[Paso]

Exercise is probably the one thing that helps me the most. Whenever I am having a flareup that's how I get back to my 90+ recovery stage. I used to be a professional athlete 4-5 years ago and got this crap about 2 years after winding down. Moderate aerobic (running, soccer, basketball etc) helps me the most. Even moderate weight training helps as long as I do not overdo my abdominal or inner thigh muscles. I would strongly recommend trying this. Start VERY slowly and then build up the intensity level gradually. For me 3-5 times per week seems to be magic, going above that just makes me tight. Another benefit is of course that you look great after a while

I have also started racing cars since I got this (track based) and that helps me as much as the exercise above. And it is a BLAST too

Patrick

[alprost]

If only it were that straighforward. I was very active prior to CPPS, but exercise is the one thing guaranteed to give me a flare up. I'd point out that I am a sport scientist who specialises in the physical preparation of athletes for competition at the highest level, and therefore have knowledge of effective programme design and exercise prescription. I've tried everything as I hate being inactive. However, for me, it has always made things much worse when I have active trigger points - something the Travell and Simons textbook says is common.

I'm doing much better since seeing Tim Sawyer again recently, and hope to be able to resume exercise in the not-too distant future. For the time being, It is a brisk 3-5 mile walk each day!

The message we should take from this study should not be that we should all go out and exercise - that's yet another overly simplistic conclusion resulting from a superficial analysis. The message is that we should be as physically active as possible but should be aware and be careful not to exacerbate symptoms.

Also, it is NOT a 'treatment option' - they don't state the underlying problem and by which mechanism exercise might help (although this is probably discussed in the full paper). Exercise, when it helps, should be thought of as a supplementary factor which helps with symptom management, as part of a general programme of healthy living.

My feeling is that exercise, when it helps, does so not because it 'treats' the underlying problem, but because the increased endorphin levels and feel-good factor related to exercise lessens a persons pain symptoms.

I've said this many times before, and the comments above bear this out, that exercise with CPPS is an individual thing.

[GP2]

Wise Words Alan

I agree - its the same with intense stretching isn't it? But I guess thats what many sport do.

This makes me wonder how many men who stretched it out at the start of treatment using muscles possibly loaded with TPs gained relief from stretching? Maybe it's a hit & miss scenario & you can't really tell for many months what's helping and what's not. I personally I won't stretch my stomach muscles out until I've worked on the TPs in that area - I know I need to do that at some point. I am stretching the glutes, abductors however.

Personally I believe it a severity issues i.e. the worse & more widespread your TPs are the worse heavy exercise / sport effects you.

I can't really think of any other explanation

[scoobysnacks]

If only it were that straighforward. I was very active prior to CPPS, but exercise is the one thing guaranteed to give me a flare up. I'd point out that I am a sport scientist who specialises in the physical preparation of athletes for competition at the highest level, and therefore have knowledge of effective programme design and exercise prescription. I've tried everything as I hate being inactive. However, for me, it has always made things much worse when I have active trigger points - something the Travell and Simons textbook says is common.

I'm doing much better since seeing Tim Sawyer again recently, and hope to be able to resume exercise in the not-too distant future. For the time being, It is a brisk 3-5 mile walk each day!

The message we should take from this study should not be that we should all go out and exercise - that's yet another overly simplistic conclusion resulting from a superficial analysis. The message is that we should be as physically active as possible but should be aware and be carefull not to exacerbate symptoms.

Also, it is NOT a 'treatment option' - they don't state the underlying problem and by which mechanism exercise might help (although this is probably discussed in the full paper). Exercise, when it helps, should be thought of as a supplementary factor which helps with symptom management, as part of a general programme of healthy living.

My feeling is that exercise, when it helps, does so not because it 'treats' the underlying problem, but because the increased endorphin levels and feel-good factor related to exercise lessens a persons pain symptoms.

I've said this many times before, and the comments above bear this out, that exercise with CPPS is an individual thing.

Exactly!

I also believe that if you got this thing from overdoing exercise as I did, then what caused your condition will, at first, until the TPs are worked out, will only make it worse. So for me, I go pick up a dumbell, and bam, peeing issues and tight perineum.

Others who know they got this from tension and anxiety disorders, put them in front of an audience and ask them to speak, and they say, boom, I get all my symptoms. So for them, they need to avoid this situation until their TPs are worked out.

I realize this is more of a theory, but its how I see this based on my situation. I'm a lawyer, I'm used to socializing, speaking in public, it doesnt bother me, but tell me to give my best 40 yard dash time, and I'm flared.

This is just intuitive thinking to me, and I'm sure some will disagree.

Regards,

SS

[dshoskes]

This makes me wonder how many men who stretched it out at the start of treatment using muscles possibly loaded with TPs gained relief from stretching?

Remembering that this is NOT my study and I haven't read the entire paper since it comes out next month BUT, the control/sham arm of this study included stretching and motion. Hopefully the study design had the aerobic group do the same stretches as the sham.

[GP2]

I dont really think mild to moderate stretching can do anything other than positive things for CPPS. And once Tps are slowly removed stretching becomes of paramount importance to keep those muscles stretched out.

Claire Davies & David Wise talk of stretching from the very start of treatment so it can't be that much of an issue. I personally do TP work then stretch immediately after. I read somewhere that the theory is you take advantage of that small window of opportunity when the TPs are de-activated to stretch out the tight muscles as much as possible.