What’s being presented at ASCO this year: II


A “first-of-its kind” quality of life study to be presented at ASCO this year is a year-long, randomized, three-arm trial of the value of “purposeful” physical exercise in the management of men on androgen deprivation therapy (ADT) for progressive prostate cancer.

This study by Galvao et al. (see abstract no. 5037) is a multi-center, controlled study, carried out at a number of Australian centers. The intent was to build on data from earlier, smaller, and shorter-term studies by evaluating the impact of two varying exercise regimens, one targeting the musculoskeletal system (impact loading + resistance training; ILRT) and the other the cardiovascular and muscular systems (aerobic + resistance training; ART), on body composition, lower body muscle strength and physical function in men currently undertaking ADT. The data from the men in these two arms of the trial were then compared to data from men in a control group (CON) who were randomized to delayed exercise.

The trial enrolled 163 men aged between 42 and 90 years of age. For the men in the two immediate training arms of the trial, supervised training was conducted for ~1 hour twice weekly at a moderate-to-high intensity level. The lean and fat masses of the patients were determined by DEXA, muscle strength by the 1-RM test, and lower body physical function by a battery of tests (6-m walk, 6-m backwards walk, 400-m walk, chair rise, stair climb).

Here are the core findings of the study:

  • There were no significant differences among the groups for any variable at baseline.
  • Between pre- and post-intervention study data,
    • Lean mass increased in the ILRT group by 1.4 kg (p < 0.001).
    • Lean mass increased in the ART group by 0.6 kg (p = 0.030).
    • There was no change in lean mass in the CON group.
    • Fat mass increased in the ILRT group by 1.1 kg (p < 0.001).
    • Fat mass increased in the ART group by 0.6 kg (p = 0.156), but this was not statistically significant.
    • Fat mass increased in the CON  group by 1.1 kg (p < 0.001).
    • Upper and lower body muscle strength increased by 17 to 45 percent in the ILRT group.
      • This increase was greater than that observed in the ART and CON groups (p < 0.001).
  • Compared to pre-intervention, members of the ILRT and ART groups generally improved in most physical function tasks (p < 0.050).

Galvao et al. conclude that,

The combination of impact loading and resistance training produced superior gains in lean mass and muscle strength compared to aerobic plus resistance exercise in prostate cancer survivors on ADT. Strategies to implement this novel training protocol are warranted.

For US-based readers, it is important to know that an increase in lean or fat mass by 1 kg is equivalent to an increase in lean or fat mass by about 2.2 lb, so we are not talking huge changes in lean or fat body mass over the course of the year. By comparison, the increase in upper and lower body muscle strength among the members of the ILRT group is considerable, and this change in strength and related vitality may be a crucial factor in managing the side effects of ADT.

It is clearly far to early to know whether this type of exercise program might also have impact on survival and long-term quality of life. However, the fact that this study has been able to show these types of outcomes for a specific category of exercise offer us strong suggestions about recommendations for exercise in men on ADT at a relatively limited cost.

 

2 Responses

  1. What we need to know is how long the men had been on ADT at baseline. The response if they had just started is likely to be significantly different than if they had been on ADT for some period of time. The fact that fat mass in the control group only increased by 1.1 kg (approx. 2.4 lb) suggests that the men were not in their first year of hormone therapy.

  2. It is certainly true that it would be helpful to know exactly how long these men had been on ADT. I assume that this will be part of the full presentation at the ASCO meeting.

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