Exercise = Happy Prostate, Kidney, and Father’s Day?!

Happy belated Father’s Day! Also, happy prostate and kidney day if you like to be physically active. I am sorry to inundate you with yet another reason to be physically active in any manner, but another wonderful study came across my treadmill, so I could not ignore it. Yet before we actively (Get it? “Actively” refers to exercise) talk about it, let me let you in on another observation. In my career I can remember talking about the importance of exercise from the brain-to-toes and almost everywhere in between. Yet, I do not recall spending much time on the prostate and kidneys together as one beautiful unit … kind of like peanut butter and jelly (I know, that was a weird analogy, but my column was late this month so it was the best I could do). Why? I have no idea but, for some reason, the prostate, and especially the kidneys together were not receiving enough love when it came to exercise. 

Is this a conspiracy? Not really (but I do believe Bigfoot, Elvis, and the Loch Ness Monster live near each other in Michigan). The prostate, the bladder, and almost everything else anatomically close to the prostate get plenty of attention, but not the kidneys. Epidemiologic studies have suggested a reduced rate of prostate issues, including BPH (benign prostatic hyperplasia), with exercise, and separately a reduced risk of kidney decline with age with increasing physical activity. But there was no large clinical trial that appeared to address either issue. Well, thanks to a group of fabulous researchers things have changed for the kidneys. But this study should have received a little more fanfare, or at least a kidney emoji or shoutout (by the way, I had to ask my kid if “shoutout” is two words or one). 

The study was called the “Lifestyle Interventions and Independence for Elders” (LIFE) phase 3 randomized trial, which included approximately 1,200 not so active adults (men and women) aged 70 to 89 years of age, and this was an added analysis of this study of a two-year moderately intense physical activity intervention compared to a control group.¹ In the exercise group there was a bit of surprise when the researchers found a statistically significant “lower decline” in the glomerular filtration rate (GFR) over those two years compared to the control group! GFR is one of the most accepted methods of assessing kidney function (essentially as the estimated GFR declines there is increased potential risk of kidney and other problems).² Even modest increases in exercise over the two years demonstrated a benefit in preserving healthy kidney function. The benefits for improved kidney health also appeared to favor numerous sub-groups in the study such as female, male, younger, older, those with or without hypertension or diabetes, etc.  

Finally, the researchers concluded by suggesting physical activity should be considered one treatment to slow the decline of kidney function in older adults! YEAH! I LOVE IT! Yet, more than a third of adults 70 and older have chronic kidney disease (CKD). CKD can be subtle, and it can be not so nice to the rest of your body (not just your kidneys). CKD can cause complications from anemia, high blood pressure, nerve injury, weak bones, cardiovascular disease (CVD), etc.  

So, now here comes the nexus with the prostate! Men receiving hormonal therapy for prostate cancer (aka ADT) for example, often gain weight and become more metabolically/heart unhealthy, which can increase blood pressure, cholesterol and sugar values which can put extra strain on the kidneys (as does weight/waist gain itself). So, part of the reason you want to be as heart healthy as possible during prostate cancer treatment (and in life, of course) is because some forms of ADT can fight prostate cancer very well, but unfortunately could make other parts of the body less healthy. It is another reason why you want to work with your medical team to be as heart healthy as possible during treatment, which will make your kidneys happy too! Finally, as the prostate enlarges (BPH) and urinary function becomes less than adequate, this can also put excessive strain or back pressure on the kidneys, which is why CKD, for example, could also be associated with unhealthy prostate changes! Basically, the only point I am trying to get across today is that the impact of exercise is remarkable and it is not only prostate healthy, but also kidney healthy. I guess I could have just said that at the beginning of this column, but I wanted to make sure I left the dramatic conclusion for the end.

Anyhow, the next time you exercise with a friend, please tell that person right when you are done that your kidneys feel better than ever, and then your friend will wonder what the heck you are talking about, and then you will drop this new research on your friend, and they will be so impressed by your prostate and kidney knowledge that they will want to buy you an expensive dinner! These are the kind of wonderful and twisted exercise dreams I have at night.  

References: 

1. Shlipak MG, et al. for the LIFE investigators. JAMA Intern Med 2022;182:650-659. doi: 10.1001/jamainternmed.2022.1449
2. National Kidney Foundation. https://www.kidney.org/atoz/content/gfr