Benefits of Immediate Versus Delayed Exercise in Men Initiating ADT for Prostate Cancer

Abstract

PURPOSE: To examine 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, 29.7±5.2 % fat, Gleason score 7.6±0.9) initiating ADT were randomised to immediate exercise (EX, n=54) or delayed exercise (DEL, n=50) for 12 months. EX comprised 6 months of supervised resistance/aerobic/impact exercise initiated at onset of ADT with 6-month follow-up. DEL comprised 6 months usual care followed by 6 months of resistance/aerobic/impact exercise. Muscle strength (chest press, leg press, seated row) and physical performance (6-m usual and fast walk, 6-m backwards walk, 400-m walk, stair climb, repeated chair rise) were assessed at baseline, 6 and 12 months. Data were analysed by ANCOVA using an intention-to-treat approach.

RESULTS: There was a significant difference for all strength measures at 6 months favouring EX (p<0.001), with net differences in leg press, seated row and chest press strength of 19.9 kg (95% CI, 12.3 to 27.5 kg), 5.6 kg (3.8 to 7.4 kg), and 4.3kg (2.7 to 5.8 kg), respectively. From 6-12 months DEL increased in all strength measures (p<0.001) such that there were no differences between groups at 12 months. Similarly, physical performance improved (p<0.001) in EX compared to DEL at 6 months for the 400-m walk (-9.7 s, 95% CI -14.8 to -4.6 s), stair climb (-0.4 s, -0.6 to -0.2 s) and chair rise (-1.0 s, -1.4 to -0.7 s), with no differences between groups by 12 months. CONCLUSION: Exercise either at the onset or after 6 months ADT preserves/enhances muscle strength and physical function. However, to avoid any initial treatment-related adverse effects on strength and function, exercise should be prescribed and commenced at the onset of ADT.