Supervised exercise and prevention of ADT-related side effects


A small, randomized trial in a group of 60+ Australian patients has demonstrated that a supervised exercise program started at the same time as initiation of androgen deprivation therapy (ADT) can have multiple beneficial results, including (at least temporary) avoidance of known side effects of ADT. However, this study was focused exclusively on the first 3 months of ADT among the patients being studied. Whether these effects can be maintained over time for the majority of patients is a far harder question to answer.

Cormie et al. enrolled a total of 63 men who had been scheduled to receive ADT and randomized them to either 3 months in a supervised exercise program (n = 32) or to “usual care” (n = 31). The study outcomes included a variety of relevant measures of health and fitness, including such things as bone mineral density, physical function, general and prostate cancer-specific quality of life, fatigue, and psychological distress. However, the primary study endpoint was body composition (i.e., lean and fat mass).

Here are the core finding of their study:

  • Compared to the men receiving “usual care”, the participants in the supervised exercise program
    • Preserved their appendicular lean mass (p = 0.019)
    • Prevented gains in whole body fat mass (group difference, –1.4 kg; p = 0.001)
    • Prevented gains in trunk fat mass (group difference, –0.9 kg; p = 0.008)
    • Prevented gains in percent fat (group difference, –1.3% (p < 0.001)
  • Additional health-related between-group differences also favored the exercise group for
    • Cardiovascular fitness (V02 peak 1.1 ml/kg/min, p = 0.004)
    • Muscular strength (4.0 to 25.9 kg, p ≤ 0.026)
    • Lower body function (–1.1 sec, p < 0.001)
    • Total cholesterol to HDL cholesterol ratio (–0.52, p = 0.028)
    • Sexual function (15.2, p = 0.028)
    • Fatigue (3.1, p = 0.042)
    • Psychological distress (–2.2, p = 0.045)
    • Social functioning (3.8, p = 0.015)
    • Mental health (3.6 to 3.8, p ≤ 0.022)

Cormie et al. conclude that:

Commencing a supervised exercise program involving aerobic and resistance exercise when initiating ADT significantly reduced treatment toxicity while improving social functioning and mental health. Concurrent prescription of supervised exercise when initiating ADT is therefore advised to minimize morbidity associated with severe hypogonadism.

This small study is obviously of considerable interest. However, the real question is whether maintenance of such a supervised exercise program over the long-term would still be able to maintain such benefits. The chances are that it could, which then leads to the question of whether it is cost-beneficial. There is certainly a significant cost associated with this type of supervised exercise regimen, and we know that the majority of people are unable to maintain such exercise regimens over time without the external supervision of some type of trainer.

2 Responses

  1. As you point out, Mike, the study period is way too short, making the results somewhat meaningless. For starters, it takes a good 6 weeks for the LHRH drugs to kick in and for testosterone to drop. Anecdotally, many men I have counseled, including myself, did not see serum testosterone (T) reach castrate levels until well beyond 3 months and there are studies on this response time. The abstract does not indicate whether the researchers correlated their results with serum T measurements along the way.

    As you well know, I am a firm proponent of exercise and believe it can achieve the goals suggested. This study, however, does little to support that hypothesis. Notwithstanding, I will add this link to the research page at http://www.medafit.org.

  2. Rick:

    The way I look at this study is simply as an initial “proof of concept” trial. The researchers probably do too. It justifies application(s) for a larger grant to conduct a larger, longer-term study that may be able to start demonstrating the beneficial effects of exercise that many believe to be available (you and me included).

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