Surprise: exercise is good for men on ADT!

According to a review article recently published in the Journal of Clinical Oncology, “Among patients … treated with androgen-deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects.”

Now that’s going to come as a real shocker to regular readers of this blog! (NOT!)

The role of exercise in helping to manage the known side effects of androgen deprivation therapy (ADT) has been widely recognized for years. And while a review of the available literature is by no means a bad thing, one would have hoped that the authors of such a review could have some up with slightly more insightful conclusions than the one above (along with the obligatory “more research is needed”).

According to Gardner et al., based on the data from the 10 studies that met their standards for a reasonably well designed and informative trial:

  • Exercise interventions tested have included aerobic and/or resistance training.
  • Exercise training have demonstrated benefits in
    • Muscular strength
    • Cardiorespiratory fitness
    • Functional task performance
    • Lean body mass
    • Fatigue
  • Exercise training has shown inconsistent effects on adiposity.
  • The effects of exercise are not clear with respect to
    • Bone health
    • Cardiometabolic risk markers
    • Quality of life

One might reasonably wonder how something that had the benefits abovementioned would not not be having a clear impact on quality of life, but then that would depend how one was measuring quality of life.

7 Responses

  1. I do believe* in the benefits of exercise, and in the 12 months that I’ve been on ADT, I’ve been on an exercise regimen for the last 6.
    * – “I DO believe in spooks. I do, I do, I do, I DO believe in spooks.”
    — Cowardly Lion.

    However, speaking for myself only, …

    • Yes, my muscular strength is better. But it was fine before.
    • Yes, I get winded slightly less easily. But I was fine before.
    • I have no idea what “functional task performance” means.
    • I am unaware of any change in my lean body mass.
    • I sleep better; hence less fatigue. But I feel sore and achy all the time; hence more fatigue.
    • My adiposity is somewhat worse. This may be ADT-related, but the trend is no greater or less than during the first 6 months on ADT without exercise.
    • My quality of life feels worse. Although my overall mood is also better, I now greatly dislike the 8 hours a week I spend feeling angry and bored at the mindless sweat and tedium. This unpleasant activity now robs me of about 8% of my waking time and about 15% of my discretionary time.

    Nonetheless, having sustained a leg fracture in the past due to ADT-related osteopenia, I do believe in exercise as a means to reduce the severity and/or to delay the onset of ill-health in several systems: cardiovascular, musculoskeletal, and psychological.

    “I do it! It revolts me, but I do it.”
    — Pooh-Bah.

  2. Exercise no doubt is good, but when I was in ADT therapy anything more than very moderate exercise was not difficult. However, it left me feeling like I had been run over by a steam roller, especially when a hot flash hit. I also discovered a tendency to run low on potassium after heavy sweating from hot flashes and exercise further contributing to aches and pains. Finally, after 2 years off ADT, I’m returning to something closer to my old self … just 20 lbs heavier!

  3. @Paul C. Let me take a stab at the meaning of “functional task performance.” In the UK and the Netherlands, assessments for incapacity benefits (that’s the old but accurate term) are made using a list of simple bodily tasks, like walking 20 metres, or raising your middle finger. Granting or withholding of benefits partly depends on how many of these you can accomplish, how highly each task is ranked on a numerical scale, and some interactions among them. In the UK these are called “descriptors,” in the Netherlands the set of them is called a “functional possibility list,” in my translation.


    I am now in the 14th month of my 4th round of intermittent triple androgen deprivation therapy (14 years and counting), headed toward stopping therapy after month 18 (last shot for 1 month at 17 months, putting radiation this year to the test), and I have the records that convince me that aerobic and strength exercise, coupled with lifestyle tactics (diet, nutrition) and supportive medications, have been highly beneficial. I’m posting some detail about my own experience in hopes of helping others as I have been helped myself. While a lot of us are not at all surprised by the findings in this study, it is very clear that many patients on ADT do not devote adequate attention to exercise; this study can only help in reversing that.

    After diagnosis in December 1999 at age 56, I did not realize the importance of exercise while on ADT and slacked off from a regular and vigorous racewalking regimen, though I kept up a NordicTrak ski machine routine and walked a lot at normal speed. During that first round with Lupron, shortly Casodex, and Proscar started in September with Fosamax in support (and diet/nutrition, soy supplements too), I lost considerable upper body strength as well as some endurance, and I gained weight as well, despite the aerobic exercise and a good diet, averaging a 7 to 8 pound gain for most of that 31-month-long first round from my weight prior to diagnosis. The value of exercise for ADT patients was not as well understood back then, especially what appears to be special value for strength exercise. In fact I remember some “expert” advising (falsely) that you could not build muscle while having extremely low testosterone due to ADT. While my strength clearly declined, I credit my aerobic activity with helping me sleep well, function well physically, and maintain a good quality of life and outlook despite a prognosis of 5 years from two respected doctors at well-known institutions.

    During my second round of ADT3, I had become aware of the importance of strength and aerobic exercise, and I had heard Dr. Mark Scholz, whom I consider a true expert on ADT and its side effects, emphasize the importance of strength exercise and claim that patients could build muscle while on ADT. Dr. Myers was also regularly advocating exercise. I joined a gym, mainly to add strength exercise, in December 2005, about 7 months after starting my second round of therapy. I rapidly gained considerable strength, probably just due to getting some regular strength exercise for the first time. However, I gained weight steadily during that round despite the aerobic and strength work, gaining about 12 pounds from the low point I achieved shortly after starting the round. That high point was about 14 pounds heavier than my pre-diagnosis weight, giving me a body mass index (BMI) of about 26.5 (“overweight”). While I attended the gym fairly often, I was far from a “gym rat,” but I had a good balance of time at the gym and time for the rest of my life.

    During the third round, after hearing more good things about what could be achieved with exercise, I deliberately tried to increase my strength from the respectable level I had achieved during the off-therapy vacation period, and I succeeded. It took much effort, but I did it. I convinced myself I could build muscle while having almost no testosterone. I used the “slow burn” method with resistance machines: 12 reps to a slow six count (0-3 out, 4-6 return), aiming for fatigue and difficulty for the final rep. I usually did 8 to 12 machines. However, I again gained weight, this time averaging a few pounds above the average of the second round, after starting from a higher initial point after the previous off-therapy period.

    However, about 14 months into that third round I learned about the importance of not overdoing carbohydrates in the diet. I first reduced bread to almost none, and later I cut down the rather large amount of cereal I had been consuming. My weight started dropping substantially, and at the end of the round I was about 10 lb above my pre-diagnosis weight.

    My weight continued to fall during the off-therapy period. From Dr. Charles Myers I learned of using branch chain amino acid with a fast until after vigorous exercise in the morning, and I credit that, along with the other tactics including carbohydrate management, with putting me back in control of my weight. During this current fourth period on ADT, I have reduced my weight to well below my pre-diagnostic average, realizing that even that was a bit high. My BMI is now normal at a desirable 23, and based on fat analysis, I was actually advised to add a few pounds, which I have done. I have substituted trans-dermal estradiol patches as bone density protection (also great for eliminating hot flashes) instead of a bisphosphonate, but, while that may have helped me maintain desired strength, I started that well after gaining control of my weight.

    (My lipids and glucose tolerance results are enviable, which has pretty much been true ever since I added simvastatin some years ago. My blood pressure has always been excellent.)

    I hope this helps.

  5. Thanks Jim Waldenfels for the detailed report on your experience with ADT and overall health. I have had surgery (RALP) + “salvage radiation” 2.5 years later, and now, 1.5 years after radiation, may be on the verge of needing ADT to deal after very small (but doubling) PSA readings (0.2 to 0.7 in 6 months).

    I had one course of Lupron prior to surgery (a 3-month dose) and had uncomfortable weight gain afterwards, which I have subsequently reduced somewhat but not totally — of course, I was 67 years old at time of surgery and I am now 72, so weight control takes a lot more effort lately. I am quite active (cardio and weights plus hiking and outdoor work) and plan to continue that. Nevertheless, it was quite heartening to have your report and to see that you are paying attention to Dr. Myers’ work on these issues as well.

    Thanks again — I may be launched onto the same course that you have experienced and your insights are very helpful in planning for all that!

  6. You are welcome, Reed.

    I’m now 70, and I’m a bit in awe of the weight control I’ve now achieved. Knowing it is possible, at least for some of us, is part of the solution.

  7. Jim:

    I would be interested to learn more about your exercise and diet regimen. I have been on Lupron for 2 years after having prostatectomy and radiation. My workout and diet routines have been sporadic at best and my BMI is 36. BMI wasn’t too much better before cancer but it is way out of control now. I ordered Snuffy Myers new nutrition book calling for a Mediterranean diet, but all of the recipes take 2 or 3 hours to prepare. I don’t have the time, patience or inclination to become a chef and I can’t afford to hire it out. Any suggestions would be helpful.


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