The impact of exercise on side effects of ADT

It has long been known that androgen deprivation therapy (ADT), when used in the long-term treatment of men with prostate cancer, is accompanied by not only hot flashes and effects on cognition but also by bone loss, increased risk for fracture, loss of muscular strength, mood disturbances, and fat-based weight gain, all of which affect physical functioning, independence, and quality of life. It has also long been known that exercise regimens appear to help some men to avoid or manage this latter group of side effects.

A group of Australian researchers has now put together a multicenter, randomized, controlled Phase III clinical trial to study the effects of long-term exercise on reversing musculoskeletal-related side effects, and on cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. In a report on the development of this study, Newton et al. state that their intent is to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on six primary endpoints:

  • Bone mineral density
  • Cardiorespiratory function and maximal oxygen capacity
  • Body composition (lean mass and fat mass)
  • Blood pressure and cardiovascular function
  • Lipid levels and glycemic control
  • Quality of life and psychological distress

The trial will enroll 65 men into each of three study arms (195 patients in total) in the cities of Perth and Brisbane. All patients must be receiving ADT as part of their treatment for prostate cancer. The three different study arms to which patients may be randomized are:

  • Resistance/impact loading exercise
  • Resistance/cardiovascular exercise
  • Usual care/delayed exercise

The participants in the first two groups will undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline and at 6 and 12 months (the end of the study).

The primary endpoint of this trial will be the determination of the impact of exercise on the well-established musculoskeletal, cardiovascular, and insulin metabolism side effects of ADT in prostate cancer patients.

This study is being conducted over a much longer term,  with more patients, and with a more detailed structure than previous investigations of ther impact of exercise on prostate cancer. It should therefore provide greater knowledge about the continuing effects of exercise in this patient population, specifically with respect to the effects of exercise on bone density, cardiovascular function, lean and fat mass, physical function and risk for falls and fractures.

The authors express the hope that the results of this study will help to reduce fracture risk, improve physical and functional ability, improve quality of life, and perhaps improve survival rates in men with prostate cancer who need ADT.

The “New” Prostate Cancer InfoLink believes that this study (albeit still small) represents an important attempt to provide more evidence of the clinical value of structured exercise regimens in the management of selected groups of prostate cancer patients. We would like to see planning put in place for a larger, confirmatory study if this trial shows positive results.

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