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Lopez P, Taaffe DR, Newton RU, Spry N, Joseph D, Tang C, Buffart LM, Galvão DA. Reporting Attendance and Resistance Exercise Compliance in Men with Localized Prostate Cancer. Med Sci Sports Exerc 2023; 55:354-364. [PMID: 36374564 DOI: 10.1249/mss.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Resistance exercise is a well-established intervention to counteract musculoskeletal and metabolic toxicities from prostate cancer treatment. In this study, we reported resistance exercise attendance and compliance, and examined if these variables can influence changes in outcomes of interest in men with localized or locally advanced prostate cancer. METHODS A total of 83 prostate cancer patients (age, 68.2 ± 7.0 yr; body mass index, 27.7 ± 3.8 kg·m -2 ) who had undergone 6 months of resistance-based exercise and had data available on exercise training from logbook records were examined. Attendance outcomes such as missed sessions, interruptions and permanent discontinuation, and metrics such as dosage completed (sessions × number of exercises × sets × repetitions × external load), compliance, tolerance, reductions, and escalations were assessed. Outcomes assessed were body composition, physical function, and muscle strength. RESULTS Median resistance exercise attendance was 80.6%, with a median resistance exercise compliance of 88.5% (interquartile range [IQR], 61.1%-107.1%) per participant. A median of 11 (IQR, 1-26) and 0 (IQR, 0-2) sessions were escalated or reduced, respectively. Significant improvements were observed in whole-body lean mass, 400-m walk, repeated chair rise, leg press, and chest press strength after 6 months of intervention ( P < 0.05) regardless of resistance exercise compliance ( Ptrend = 0.199-0.950). Participants with higher levels of resistance exercise compliance presented greater improvements in trunk fat mass ( Ptrend = 0.026) and appendicular lean mass ( Ptrend = 0.047). CONCLUSIONS A higher resistance exercise compliance led to greater improvements in regional fat and lean mass, whereas physical function and muscle strength improvements were achieved with lower compliance. In addition, patients experienced a high number of dose escalations during the intervention. These findings are important to improve the reproducibility/precision of exercise medicine prescription.
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Affiliation(s)
| | | | | | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, AUSTRALIA
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2
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Cagliari M, Bressi B, Bassi MC, Fugazzaro S, Prati G, Iotti C, Costi S. Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review. Phys Ther 2022; 102:pzab288. [PMID: 34972863 PMCID: PMC8970430 DOI: 10.1093/ptj/pzab288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/30/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) experience the loss of bone mineral density (BMD) and lean body mass, which can increase their risk of falls and fractures. Physical exercise programs with appropriate components and dosage are suggested to preserve BMD and muscle strength, thereby potentially reducing accidental falls and fractures and associated morbidity and mortality. These benefits can be obtained if exercise programs are feasible and safe and if patient adherence is adequate. This systematic review investigates the feasibility and safety of exercise programs aimed at preventing the risk of accidental falls and fractures and BMD loss in men with PCa undergoing ADT. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from database inception to June 7, 2021. Randomized controlled trials were included when they analyzed the feasibility and safety of experimental exercise programs targeting bone health in men with PCa receiving ADT. Two reviewers independently selected the studies, assessed their methodological quality, and extracted the data. Exercise feasibility was measured through recruitment, retention, and adherence rates. Exercise safety was measured through the number, type, and severity of adverse events. Furthermore, the components, setting, intensity, frequency, and duration of exercise programs were extracted. RESULTS Ten studies were included, with a total of 633 participants. Exercise consisted of a combination of aerobic, resistance, and impact-loading exercise or football training. Exercise is feasible in men with PCa undergoing ADT, although football training should be prescribed with caution for safety reasons. CONCLUSION Multicomponent exercise programs targeting bone health seem feasible and safe in this population; however, adverse events should be systematically documented according to current guidelines. IMPACT The study shows that men with PCa receiving ADT can safely perform exercise programs to preserve bone health and supports that those programs should become part of lifestyle habits. LAY SUMMARY Men with PCa who are receiving ADT can safely perform exercise programs to preserve bone health and should make exercise an important part of their lifestyle.
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Affiliation(s)
- Maribel Cagliari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Bressi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Prati
- Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Department of Oncology and Advanced Technologies, Radiotherapy Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Scientific Directorate, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Rendeiro JA, Rodrigues CAMP, de Barros Rocha L, Rocha RSB, da Silva ML, da Costa Cunha K. Physical exercise and quality of life in patients with prostate cancer: systematic review and meta-analysis. Support Care Cancer 2021; 29:4911-4919. [PMID: 33649920 DOI: 10.1007/s00520-021-06095-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prostate cancer leads to worse quality of life due to treatment and consequences of disease; benefits of physical exercise remain unclear on the improvement of quality of life in this population. The aim of this study is to evaluate the effectiveness of physical exercise in improving quality of life in patients with prostate cancer. METHODS A systematic review and meta-analysis was carried out. For the search of studies, we used electronics databases such as Cochrane Library, MEDLINE via PUBMED, Regional Health Portal, and EMBASE, without language restrictions or year of publication. The descriptors used were as follows: "prostatic neoplasms," "exercise," and "quality of life." The risk analysis of bias in the meta-analysis was based on the Cochrane Collaboration Tool. For statistical analysis, the fixed effects model was used. Randomized controlled trials were included, which had a sample of patients with stage I-IV prostate cancer and that the intervention was aerobic physical exercise (AE) or resistance physical exercise (RE) or combined AE and RE. RESULTS Five thousand six hundred nineteen studies were identified, but only 12 studies were selected. The quality of life of the patients was measured using instruments (SF 36, EORTC, AQoL-8D, IPSS and FACT-P), which served to divide the studies in groups where they presented the same instrument used. The analysis carried out shows that the quality of life of patients with prostate cancer submitted to aerobic training regimens had a protective effect in relation to the others. CONCLUSION Most studies show an improvement in the quality of life of patients when they practice physical exercise, perceived by increasing the score of the instrument in question. However, methodological and heterogeneous differences between the studies increase the analysis bias.
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Affiliation(s)
- Júlio Araújo Rendeiro
- State University of Pará, Campus VIII/Marabá, Av. Hiléia, Agrópolis do Incra s/n - Amapá, Marabá, PA, 68502-100, Brazil
| | | | | | | | - Marianne Lucena da Silva
- Federal University of Goiás, Campus Jatobá BR 364 km 195 - Setor Parque Industrial n° 3800, Jataí, GO, 75801-615, Brazil
| | - Katiane da Costa Cunha
- State University of Pará, Campus VIII/Marabá, Av. Hiléia, Agrópolis do Incra s/n - Amapá, Marabá, PA, 68502-100, Brazil
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Timing of exercise for muscle strength and physical function in men initiating ADT for prostate cancer. Prostate Cancer Prostatic Dis 2020; 23:457-464. [PMID: 32020032 PMCID: PMC7423590 DOI: 10.1038/s41391-019-0200-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) results in adverse effects, including reduced muscle strength and physical function, potentially compromising daily functioning. We examined whether it was more efficacious to commence exercise at the onset of ADT rather than later in treatment to counter declines in strength and physical function. METHODS One-hundred-and-four men with PCa (68.3 ± 7.0 years) initiating ADT were randomised to immediate exercise (IMX, n = 54) or delayed exercise (DEL, n = 50) for 12 months. IMX comprised 6 months of supervised resistance/aerobic/impact exercise initiated at the onset of ADT with a 6-month follow-up. DEL comprised 6 months of usual care followed by 6 months of resistance/aerobic/impact exercise. Upper and lower body muscle strength and physical function were assessed at baseline, 6 and 12 months. RESULTS There was a significant difference for all strength measures at 6 months favouring IMX (P < 0.001), with net differences in leg press, seated row and chest press strength of 19.9 kg (95% CI, 12.3-27.5 kg), 5.6 kg (3.8-7.4 kg) and 4.3 kg (2.7-5.8 kg), respectively. From 7 to 12 months, DEL increased in all strength measures (P < 0.001), with no differences between groups at 12 months. Similarly, physical function improved (P < 0.001) in IMX compared with DEL at 6 months for the 6-m fast walk (-0.2, 95% CI -0.3 to -0.1 s), 400-m walk (-9.7, -14.8 to -4.6 s), stair climb (-0.4, -0.6 to -0.2 s) and chair rise (-1.0, -1.4 to -0.7 s), with no differences between groups by 12 months, except for the 6-m fast walk (P < 0.001). CONCLUSION Exercise either at the onset or after 6 months of ADT preserves/enhances muscle strength and physical function. However, to avoid initial treatment-related adverse effects on strength and function, exercise therapy should be implemented with initiation of ADT.
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Cormie P, Zopf EM. Exercise medicine for the management of androgen deprivation therapy-related side effects in prostate cancer. Urol Oncol 2020; 38:62-70. [DOI: 10.1016/j.urolonc.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
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Kralik M, Cvecka J, Buzgo G, Putala M, Ukropcova B, Ukropec J, Killinger Z, Payer J, Kollarik B, Bujdak P, Raastad T, Sedliak M. Strength training as a supplemental therapy for androgen deficiency of the aging male (ADAM): study protocol for a three-arm clinical trial. BMJ Open 2019; 9:e025991. [PMID: 31492775 PMCID: PMC6731925 DOI: 10.1136/bmjopen-2018-025991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Androgen deficiency of the ageing male is a clinical syndrome resulting from the low production of androgens (testosterone levels <6.9 nmol/L) with symptoms including decline in lean mass, muscle strength, increases in body mass and overall fat mass. The aim of the study is to examine the effect of a 12 week strength training intervention on body composition, physical function, muscle cellular and molecular and selected biochemical markers of metabolic health in hypogonadal patients. METHODS AND ANALYSIS The study is three-group controlled 12-week experiment to assess the effect of strength training on hypogonadal patients with testosterone replacement therapy and newly diagnosed males without testosterone replacement therapy. Age matched healthy eugonadal males are also engaged in strength training. Lean mass is used to determine sample size indicating, that 22 subjects per group will be sufficient to detect intervention related changes at the power of 0.90. All outcomes are collected before the intervention (pre-intervention assessments) and after the intervention (post-intervention assessments). Clinical outcomes are body composition (lean mass, fat mass and total body mass) measured by dual-energy X-ray absorptiometry, physical functioning assessed by physical tests and psychosocial functioning. The most important haematological and biochemical parameters included are glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, testosterone, luteinizing hormone, follicle-stimulating hormone, sexhormone-binding globulin, insulin and prostate-specific antigen. Muscle cellular and molecular outcomes are muscle fibre size and regulators of muscle fibre size. Muscle cellular outcomes are measured from muscle biopsies obtained from musculus vastus lateralis. ETHICS AND DISSEMINATION This trial is approved by Ethics Committee of the University Hospital in Bratislava, Slovakia, (ref. trial number: 127/2017) and all subjects will be fully informed on the rationale, risks and benefits of the study and sign the written informed consent prior to entering the study. Results will be published in peer-reviewed journals and presented in scientific conferences. TRIAL REGISTRATION NUMBER NCT03282682.
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Affiliation(s)
- Michal Kralik
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jan Cvecka
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Gabriel Buzgo
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Matus Putala
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Barbara Ukropcova
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
- Obesity Section, Laboratory of Diabetes and Metabolic Disease, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
- Institute of Pathophysiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jozef Ukropec
- Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zdenko Killinger
- 5th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, University Hospital, Bratislava, Slovakia
| | - Juraj Payer
- 5th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, University Hospital, Bratislava, Slovakia
| | - Boris Kollarik
- Department of Urology, University Hospital - Petrzalka, Bratislava, Slovakia
| | - Peter Bujdak
- Department of Urology, Slovak Medical University Bratislava, Bratislava, Slovakia
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Milan Sedliak
- Deparment of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
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Fang D, Zhou L. Androgen deprivation therapy in nonmetastatic prostate cancer patients: Indications, treatment effects, and new predictive biomarkers. Asia Pac J Clin Oncol 2019; 15:108-120. [PMID: 30729683 PMCID: PMC6850478 DOI: 10.1111/ajco.13108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/27/2018] [Indexed: 12/17/2022]
Abstract
Men with prostate cancer with positive margins, extraprostatic extension, positive lymph nodes, high prostate‐specific antigen, or high Gleason Score are at high risk of recurrence following primary therapy. Androgen deprivation therapy (ADT), which includes medical/surgical castration, antiandrogen therapy, and combined androgen blockade, can be combined with primary therapy to shrink the tumor, reduce margin positivity, and reduce the risk of recurrence. However, many problems still remain, such as optimizing the application of ADT in the treatment of prostate cancer, for example, ideal patient population and optimal timing and duration of therapy. To investigate these problems, we searched PubMed for relevant publications on clinical studies of deprivation therapy for nonmetastatic prostate cancer. In this review, we discuss our findings on the role of ADT in the treatment of castrate‐sensitive nonmetastatic prostate cancer and the adverse effects associated with ADT. We also examine the recent advances in new predictive biomarkers for ADT, many of which are currently in the exploratory phase. Overall, the addition of ADT to primary therapy improves outcomes for patients with intermediate‐ or high‐risk prostate cancer.
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Affiliation(s)
- Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center of China, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center of China, Beijing, China
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Hart NH, Galvão DA, Saunders C, Taaffe DR, Feeney KT, Spry NA, Tsoi D, Martin H, Chee R, Clay T, Redfern AD, Newton RU. Mechanical suppression of osteolytic bone metastases in advanced breast cancer patients: a randomised controlled study protocol evaluating safety, feasibility and preliminary efficacy of exercise as a targeted medicine. Trials 2018; 19:695. [PMID: 30572928 PMCID: PMC6302473 DOI: 10.1186/s13063-018-3091-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Skeletal metastases present a major challenge for clinicians, representing an advanced and typically incurable stage of cancer. Bone is also the most common location for metastatic breast carcinoma, with skeletal lesions identified in over 80% of patients with advanced breast cancer. Preclinical models have demonstrated the ability of mechanical stimulation to suppress tumour formation and promote skeletal preservation at bone sites with osteolytic lesions, generating modulatory interference of tumour-driven bone remodelling. Preclinical studies have also demonstrated anti-cancer effects through exercise by minimising tumour hypoxia, normalising tumour vasculature and increasing tumoural blood perfusion. This study proposes to explore the promising role of targeted exercise to suppress tumour growth while concomitantly delivering broader health benefits in patients with advanced breast cancer with osteolytic bone metastases. METHODS This single-blinded, two-armed, randomised and controlled pilot study aims to establish the safety, feasibility and efficacy of an individually tailored, modular multi-modal exercise programme incorporating spinal isometric training (targeted muscle contraction) in 40 women with advanced breast cancer and stable osteolytic spinal metastases. Participants will be randomly assigned to exercise or usual medical care. The intervention arm will receive a 3-month clinically supervised exercise programme, which if proven to be safe and efficacious will be offered to the control-arm patients following study completion. Primary endpoints (programme feasibility, safety, tolerance and adherence) and secondary endpoints (tumour morphology, serum tumour biomarkers, bone metabolism, inflammation, anthropometry, body composition, bone pain, physical function and patient-reported outcomes) will be measured at baseline and following the intervention. DISCUSSION Exercise medicine may positively alter tumour biology through numerous mechanical and non-mechanical mechanisms. This randomised controlled pilot trial will explore the preliminary effects of targeted exercise on tumour morphology and circulating metastatic tumour biomarkers using an osteolytic skeletal metastases model in patients with breast cancer. The study is principally aimed at establishing feasibility and safety. If proven to be safe and feasible, results from this study could have important implications for the delivery of this exercise programme to patients with advanced cancer and sclerotic skeletal metastases or with skeletal lesions present in haematological cancers (such as osteolytic lesions in multiple myeloma), for which future research is recommended. TRIAL REGISTRATION anzctr.org.au , ACTRN-12616001368426 . Registered on 4 October 2016.
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Affiliation(s)
- Nicolas H. Hart
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Christobel Saunders
- St John of God Hospital, Perth, WA Australia
- Royal Perth Hospital, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
| | - Dennis R. Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
| | - Kynan T. Feeney
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- St John of God Hospital, Perth, WA Australia
- School of Medicine, University of Notre Dame Australia, Perth, WA Australia
| | - Nigel A. Spry
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Daphne Tsoi
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- St John of God Hospital, Perth, WA Australia
- School of Medicine, University of Notre Dame Australia, Perth, WA Australia
| | | | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Tim Clay
- St John of God Hospital, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Andrew D. Redfern
- School of Medicine, University of Western Australia, Perth, WA Australia
- Fiona Stanley Hospital, Perth, WA Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
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Taaffe DR, Galvão DA, Spry N, Joseph D, Chambers SK, Gardiner RA, Hayne D, Cormie P, Shum DHK, Newton RU. Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition. BJU Int 2018; 123:261-269. [PMID: 30239116 PMCID: PMC6635752 DOI: 10.1111/bju.14505] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives To examine whether it is more efficacious to commence exercise medicine in men with prostate cancer at the onset of androgen‐deprivation therapy (ADT) rather than later on during treatment to preserve bone and soft‐tissue composition, as ADT results in adverse effects including: reduced bone mineral density (BMD), loss of muscle mass, and increased fat mass (FM). Patients and methods In all, 104 patients with prostate cancer, aged 48–84 years initiating ADT, were randomised to immediate exercise (IMEX, n = 54) or delayed exercise (DEL, n = 50) conditions. The former consisted of 6 months of supervised resistance/aerobic/impact exercise and the latter comprised 6 months of usual care followed by 6 months of the identical exercise programme. Regional and whole body BMD, lean mass (LM), whole body FM and trunk FM, and appendicular skeletal muscle (ASM) were assessed by dual X‐ray absorptiometry, and muscle density by peripheral quantitative computed tomography at baseline, and at 6 and 12 months. Results There was a significant time effect (P < 0.001) for whole body, spine and hip BMD with a progressive loss in the IMEX and DEL groups, although lumbar spine BMD was largely preserved in the IMEX group at 6 months compared with the DEL group (−0.4% vs −1.6%). LM, ASM, and muscle density were preserved in the IMEX group at 6 months, declined in the DEL group at 6 months (−1.4% to −2.5%) and then recovered at 12 months after training. FM and trunk FM increased (P < 0.001) over the 12‐month period in the IMEX (7.8% and 4.5%, respectively) and DEL groups (6.5% and 4.3%, respectively). Conclusions Commencing exercise at the onset of ADT preserves lumbar spine BMD, muscle mass, and muscle density. To avoid treatment‐related adverse musculoskeletal effects, exercise medicine should be prescribed and commenced at the onset of ADT.
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Affiliation(s)
- Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland,, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Genesis CancerCare, Joondalup, Western Australia,, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, Western Australia,, Australia
| | - David Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, Western Australia,, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland,, Australia.,Centre for Research in Cancer, Cancer Council, Queensland, Brisbane, Queensland, Australia.,Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Robert A Gardiner
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland,, Australia.,University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Dickon Hayne
- UWA Medical School, University of Western Australia, Crawley, Western Australia,, Australia.,Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David H K Shum
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland,, Australia.,Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland,, Australia.,Institute of Human Performance, The University of Hong Kong, Hong Kong, China
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10
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Hart NH, Newton RU, Spry NA, Taaffe DR, Chambers SK, Feeney KT, Joseph DJ, Redfern AD, Ferguson T, Galvão DA. Can exercise suppress tumour growth in advanced prostate cancer patients with sclerotic bone metastases? A randomised, controlled study protocol examining feasibility, safety and efficacy. BMJ Open 2017; 7:e014458. [PMID: 28559456 PMCID: PMC5777463 DOI: 10.1136/bmjopen-2016-014458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Exercise may positively alter tumour biology through numerous modulatory and regulatory mechanisms in response to a variety of modes and dosages, evidenced in preclinical models to date. Specifically, localised and systemic biochemical alterations produced during and following exercise may suppress tumour formation, growth and distribution by virtue of altered epigenetics and endocrine-paracrine activity. Given the impressive ability of targeted mechanical loading to interfere with metastasis-driven tumour formation in human osteolytic tumour cells, it is of equal interest to determine whether a similar effect is observed in sclerotic tumour cells. The study aims to (1) establish the feasibility and safety of a combined modular multimodal exercise programme with spinal isometric training in advanced prostate cancer patients with sclerotic bone metastases and (2) examine whether targeted and supervised exercise can suppress sclerotic tumour growth and activity in spinal metastases in humans. METHODS AND ANALYSIS A single-blinded, two-armed, randomised, controlled and explorative phase I clinical trial combining spinal isometric training with a modular multimodal exercise programme in 40 men with advanced prostate cancer and stable sclerotic spinal metastases. Participants will be randomly assigned to (1) the exercise intervention or (2) usual medical care. The intervention arm will receive a 3-month, supervised and individually tailored modular multimodal exercise programme with spinal isometric training. Primary endpoints (feasibility and safety) and secondary endpoints (tumour morphology; biomarker activity; anthropometry; musculoskeletal health; adiposity; physical function; quality of life; anxiety; distress; fatigue; insomnia; physical activity levels) will be measured at baseline and following the intervention. Statistical analyses will include descriptive characteristics, t-tests, effect sizes and two-way (group × time) repeated-measures analysis of variance (or analysis of covariance) to examine differences between groups over time. The data-set will be primarily examined using an intention-to-treat approach with multiple imputations, followed by a secondary sensitivity analysis to ensure data robustness using a complete cases approach. ETHICS AND DISSEMINATION Ethics approval was obtained from the Human Research Ethics Committee (HREC) of Edith Cowan University and the Sir Charles Gairdner and Osborne Park Health Care Group. If proven to be feasible and safe, this study will form the basis of future phase II and III trials in human patients with advanced cancer. To reach a maximum number of clinicians, practitioners, patients and scientists, outcomes will be disseminated through national and international clinical, conference and patient presentations, as well as publication in high-impact, peer-reviewed academic journals. TRIAL REGISTRATION NUMBER ACTRN 12616000179437.
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Affiliation(s)
- Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Nigel A Spry
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kynan T Feeney
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Medical Oncology, St John of God Hospital, Perth, Australia
- School of Medicine, University of Notre Dame Australia, Perth, Australia
| | - David J Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Andrew D Redfern
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Tom Ferguson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
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Moyad MA, Newton RU, Tunn UW, Gruca D. Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy. Res Rep Urol 2016; 8:133-43. [PMID: 27574584 PMCID: PMC4993404 DOI: 10.2147/rru.s107852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses in English using such search terms as "prostate cancer" and "androgen deprivation therapy", "cardiovascular risk", "lean body mass", "exercise", and "diet". The initial searches produced 379 articles with dates 2005 or more recent. Articles published after 2004 were favored. This review utilizes the latest data to provide a status update on the effects of exercise and diet on patients with prostate cancer, focusing on ADT-associated side effects, and it discusses the evidence for such interventions. Since the evidence of large-scale trials in patients with prostate cancer is missing, and an extrapolation of supporting data to all patient subgroups cannot be provided, individualized risk assessments remain necessary before the initiation of exercise and diet programs. Exercise, diet, and nutritional supplementation interventions have the potential to provide effective, accessible, and relatively inexpensive strategies for mitigating ADT-associated toxicities without introducing additional adverse effects.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Ulf W Tunn
- Urological Clinic, Facharztzentrum Academic Hospital Sana Klinikum Offenbach, Offenbach/Main
| | - Damian Gruca
- Global Medical Affairs, AbbVie Deutschland, Ludwigshafen, Germany
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Nguyen PL, Alibhai SMH, Basaria S, D'Amico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2014; 67:825-36. [PMID: 25097095 DOI: 10.1016/j.eururo.2014.07.010] [Citation(s) in RCA: 510] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 07/11/2014] [Indexed: 01/11/2023]
Abstract
CONTEXT Androgen-deprivation therapy (ADT) is a key component of treatment for aggressive and advanced prostate cancer, but it has also been associated with adverse effects on bone, metabolic, cardiovascular, sexual, and cognitive health as well as body composition. OBJECTIVE To review the current literature on the adverse effects of ADT and strategies for ameliorating harm from ADT. EVIDENCE ACQUISITION The Medline database (through PubMed) was searched from inception to August 1, 2013, for studies documenting the side effects of ADT and for randomized and prospective trials of interventions to mitigate those side effects. EVIDENCE SYNTHESIS Adverse effects of ADT include decreases in bone mineral density; metabolic changes such as weight gain, decreased muscle mass, and increased insulin resistance; decreased libido and sexual dysfunction; hot flashes; gynecomastia; reduced testicle size; anemia; and fatigue. Several observational studies suggest an increased risk of diabetes and cardiovascular events, although most published studies report that ADT is not linked to greater cardiovascular mortality. Randomized trials have found value in treatments for some adverse effects including bone loss (bisphosphonates, denosumab, selective estrogen receptor modulators), markers of metabolic syndrome (exercise, diet, metformin), gynecomastia (tamoxifen, prophylactic radiation), muscle loss (resistance and aerobic exercise), and hot flashes (venlafaxine, medroxyprogesterone, cyproterone acetate, gabapentin). CONCLUSIONS ADT is often a necessary component of the treatment of aggressive prostate cancer, yet it has known harms that can impair health and quality of life. Clinicians should be aware of interventions that can help mitigate these adverse effects. PATIENT SUMMARY Androgen deprivation therapy is a critical component of the management of aggressive and advanced prostate cancer, but it causes adverse effects including bone loss, metabolic changes, gynecomastia, muscle loss, hot flashes, and possibly increased cardiovascular events. Clinicians should be aware of interventions that can help mitigate these adverse effects.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
| | | | - Shehzad Basaria
- Section on Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Philip W Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy L Keating
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - David F Penson
- Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN, USA
| | - Derek J Rosario
- Academic Urology Unit, Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Bertrand Tombal
- Division of Urology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Matthew R Smith
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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13
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Allan CA, Collins VR, Frydenberg M, McLachlan RI, Matthiesson KL. Androgen deprivation therapy complications. Endocr Relat Cancer 2014; 21:T119-29. [PMID: 24872511 DOI: 10.1530/erc-13-0467] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Androgen deprivation therapy (ADT) is increasingly used to treat advanced prostate cancer and is also utilised as adjuvant or neo-adjuvant treatment for high-risk disease. The resulting suppression of endogenous testosterone production has deleterious effects on quality of life, including hot flushes, reduced mood and cognition and diminished sexual function. Cross-sectional and longitudinal studies show that ADT has adverse bone and cardio-metabolic effects. The rate of bone loss is accelerated, increasing the risk of osteoporosis and subsequent fracture. Fat mass is increased and lean mass reduced, and adverse effects on lipid levels and insulin resistance are observed, the latter increasing the risk of developing type 2 diabetes. ADT also appears to increase the risk of incident cardiovascular events, although whether it increases cardiovascular mortality is not certain from the observational evidence published to date. Until high-quality evidence is available to guide management, it is reasonable to consider men undergoing ADT to be at a higher risk of psychosexual dysfunction, osteoporotic fracture, diabetes and cardiovascular disease, especially when treated for extended periods of time and therefore subjected to profound and prolonged hypoandrogenism. Health professionals caring for men undergoing treatment for prostate cancer should be aware of the potential risks of ADT and ensure appropriate monitoring and clinical management.
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Affiliation(s)
- Carolyn A Allan
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Veronica R Collins
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Robert I McLachlan
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Kati L Matthiesson
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
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14
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Sexuality and exercise in men undergoing androgen deprivation therapy for prostate cancer. Support Care Cancer 2014; 23:133-42. [DOI: 10.1007/s00520-014-2327-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
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15
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Editors T. CIR-Myo News: Proceedings of the 2014 Spring Padua Muscle Days: Terme Euganee and Padova (Italy), April 3-5, 2014. Eur J Transl Myol 2014; 24:3299. [PMID: 26913130 PMCID: PMC4749006 DOI: 10.4081/ejtm.2014.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Not available.
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16
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Improving sexual health in men with prostate cancer: randomised controlled trial of exercise and psychosexual therapies. BMC Cancer 2014; 14:199. [PMID: 24641777 PMCID: PMC3995188 DOI: 10.1186/1471-2407-14-199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/28/2014] [Indexed: 11/17/2022] Open
Abstract
Background Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men with prostate cancer; 2) determine if combining exercise and brief psychosexual intervention results in more pronounced improvements in sexual health; and 3) assess if any benefit of exercise and psychosexual intervention on sexual dysfunction is sustained long term. Methods/Design A three-arm, multi-site randomised controlled trial involving 240 prostate cancer survivors will be implemented. Participants will be randomised to: 1) ‘Exercise’ intervention; 2) ‘Exercise + Psychosexual’ intervention; or 3) ‘Usual Care’. The Exercise group will receive a 6-month, group based, supervised resistance and aerobic exercise intervention. The Exercise + Psychosexual group will receive the same exercise intervention plus a brief psychosexual self-management intervention that addresses psychological and sexual well-being. The Usual Care group will maintain standard care for 6 months. Measurements for primary and secondary endpoints will take place at baseline, 6 months (post-intervention) and 1 year follow-up. The primary endpoint is sexual health and secondary endpoints include key factors associated with sexual health in men with prostate cancer. Discussion Sexual dysfunction is one of the most prevalent and distressing consequences of prostate cancer. Despite this, very little is known about the management of sexual dysfunction and current health care services do not adequately meet sexual health needs of survivors. This project will examine the potential role of exercise in the management of sexual dysfunction and evaluate a potential best-practice management approach by integrating pharmacological, physiological and psychological treatment modalities to address the complex and multifaceted aetiology of sexual dysfunction following cancer. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001179729.
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Buffart LM, Galvão DA, Brug J, Chinapaw MJM, Newton RU. Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev 2013; 40:327-40. [PMID: 23871124 DOI: 10.1016/j.ctrv.2013.06.007] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 01/22/2023]
Abstract
Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. This paper aims to discuss the existing physical activity guidelines for cancer survivors and to describe future research directions to optimize prescriptions. Studies on physical activity during and after cancer treatment were searched in PubMed, Clinicaltrials.gov, Australian New Zealand Clinical Trials Registry, and Dutch Trial registry. Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining 'for whom' or 'under what circumstances' interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines.
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Affiliation(s)
- L M Buffart
- EMGO Institute for Health and Care Research and the VU University Medical Center, Department of Epidemiology and Biostatistics, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Zimmer P, Jäger E, Bloch W, Zopf EM, Baumann FT. Influence of a six month endurance exercise program on the immune function of prostate cancer patients undergoing Antiandrogen- or Chemotherapy: design and rationale of the ProImmun study. BMC Cancer 2013; 13:272. [PMID: 23731674 PMCID: PMC3681550 DOI: 10.1186/1471-2407-13-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/29/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Exercise seems to minimize prostate cancer specific mortality risk and treatment related side effects like fatigue and incontinence. However the influence of physical activity on the immunological level remains uncertain. Even prostate cancer patients undergoing palliative treatment often have a relatively long life span compared to other cancer entities. To optimize exercise programs and their outcomes it is essential to investigate the underlying mechanisms. Further, it is important to discriminate between different exercise protocols and therapy regimes. METHODS/DESIGN The ProImmun study is a prospective multicenter patient preference randomized controlled trial investigating the influence of a 24 week endurance exercise program in 80-100 prostate cancer patients by comparing patients undergoing Antiandrogen therapy combined with exercise (AE), Antiandrogen therapy without exercise (A), Chemotherapy with exercise(CE) or Chemotherapy without exercise (C). The primary outcome of the study is a change in prostate cancer relevant cytokines and hormones (IL-6, MIF, IGF-1, Testosterone). Secondary endpoints are immune cell ratios, oxidative stress and antioxidative capacity levels, VO2 peak, fatigue and quality of life. Patients of the intervention group exercise five times per week, while two sessions are supervised. During the supervised sessions patients (AE and CE) exercise for 33 minutes on a bicycle ergometer at 70-75% of their VO2 peak. To assess long term effects and sustainability of the intervention two follow-up assessments are arranged 12 and 18 month after the intervention. DISCUSSION The ProImmun study is the first trial which primarily investigates immunological effects of a six month endurance exercise program in prostate cancer patients during palliative care. Separating patients treated with Antiandrogen therapy from those who are additionally treated with Chemotherapy might allow a more specific view on the influence of endurance training interventions and the impact of different therapy protocols on the immune function. TRIAL REGISTRATION German Clinical Trials Register: DRKS00004739.
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Affiliation(s)
- Philipp Zimmer
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Elke Jäger
- Department for Oncology and Hematology, Clinic Northwest, Steinbacher Hohl 2-26, Frankfurt am Main 60488, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Eva Maria Zopf
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Freerk T Baumann
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
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