Mind-body interventions, such as tai chi, are commonly applied to chronic pain conditions, such as fibromyalgia. So are direct physical interventions targeting muscles, such as global therapeutic massage.
One of the treatments proposed for chronic prostatitis/chronic pelvic pain syndrome is physical therapy including pelvic trigger point release. Like many other generalized mind-body and/or physical interventions, pelvic trigger point release is often not a solitary: It is often provided as one of several concurrent treatments, which can include relaxation, flexibilityexercise, and aerobic exercise. This is in contrast to many other treatments for chronic prostatitis that are given as a solitary treatment:Patients are commonly given an antibiotic as a solitary treatment.
The application of mind-body and/or physical treatments as part of multi-modality interventions can make it difficult to dissect out which modality contributed how much to the therapeutic effect. This becomes a relevant bedside consideration because not all modalities of multi-modality interventions are equally well tolerated by patients; low tolerance can be a barrier to compliance and thus to therapeutic result.
For example, nearly all patients will tolerate global therapeutic massage but fewer will tolerate trans-anal pelvic trigger point release. As such, it may become useful to understand the therapeutic potential of individual treatments that make up multi-modality intervention and that are cheap, easy, convenient, and well tolerated.
Among the most easily administered and tolerated individual components of multi-modality interventions are aerobic exercise and flexibility exercise. Nearly all patients have had some experience conducting this form of activity. Many are sufficiently fit and able to conduct aerobic exercise. This makes exercise a theoretically attractive treatment.
In 2007, a study was published that involved Italian men age 20 to 50 who had been ineffectively treated for chronic prostatitis. They were randomized to receive aerobic exercise orflexibility exercise. The program lasted for 18 weeks and included 3 sessions weekly, in the aerobic group consisting of
A warmup period
Postural muscle and isometric strengthening exercises
40 minutes of vigorous walking at 70-80% of maximal heart rate
A cooldown period
The general characteristics of the two groups (body-mass index, employment, education, marital status) were similar in the two groups, with average age approximately 36 years. The Chronic Prostatitis Symptom Index (CPSI) scores responded as follows (baseline, 6 weeks, 18 weeks):
Aerobic group changed from 21.9 to 17.5 to 14.6 (net change of - 7.3)
Flexibility group changed from 23.0 to 20.0 to 18.0 (net change of -5.0)
Previous studies of other prostatitis treatments have shown CPSI changes of 3-8 points with placebo alone. The effect of aerobic and stretching exercises as administered in this study are within this range. In any event, be it a placebo-type psychological effect on the perception of symptoms or a true physiological effect, as a component of multi-modality treatments that may also include trigger point release, relaxation, and the like, aerobic and/or flexibility exercise may individually explain any observed therapeutic response.
The study leaves open many questions. From a practical point of view, it does not inform about the durability of response. In other words, do patients who stop exercising relapse? Do patients who continue to exercise? How quickly does relapse happen? How commonly? Would exercise as described here provide any therapeutic response to patients with more severe forms of the disease, for example patients whose baseline CPSI scores are in the 35-40 range? Also, given that the therapeutic response increased from 6-18 weeks, is it possible that a further threapeutic effect is possible with treatment lasting longer than 18 weeks? What about the effect of daily exercise, not just 3 times per week exercise?
From a theoretical point of view, one wonders about the mediators of the therapeutic response. Are they related to the effect of exercise on central endorphins? Are they related to regional increased blood flow to affected pelvic and/or back muscles?
Given the simplicity of exercise intervention, these questions would seem worth answering. In the meantime, given its effect on the symptoms of chronic prostatitis, one must take the effect of exercise into account in assessing the effects of multi-modality interventions that also include exercise.