Effects of Different Exercise Modalities on Fatigue in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-long Randomised Controlled Trial

Dennis R Taaffe; Robert U Newton; Nigel Spry; David Joseph; Suzanne K Chambers; Robert A Gardiner; Brad A Wall; Prue Cormie; Kate A Bolam; Daniel A Galvão

doi:10.1016/j.eururo.2017.02.019

Effects of Different Exercise Modalities on Fatigue in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-long Randomised Controlled Trial

Eur Urol. 2017 Aug;72(2):293-299. doi: 10.1016/j.eururo.2017.02.019. Epub 2017 Feb 27.

Authors

Affiliations

¹ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia. Electronic address: d.taaffe@ecu.edu.au.
² Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Institute of Human Performance, The University of Hong Kong, Hong Kong, China; University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia.
³ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; Genesis CancerCare, Joondalup, WA, Australia; Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia.
⁴ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
⁵ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia; Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.
⁶ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁷ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.
⁸ Institute for Health & Ageing, Australian Catholic University, Melbourne, VIC, Australia.
⁹ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; Astrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
¹⁰ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.

PMID: 28249801
DOI: 10.1016/j.eururo.2017.02.019

Abstract

Background: Physical exercise mitigates fatigue during androgen deprivation therapy (ADT); however, the effects of different exercise prescriptions are unknown.

Objectives: To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT.

Design, setting, and participants: Between 2009 and 2012, 163 prostate cancer patients aged 43-90 y on ADT were randomised to exercise targeting the musculoskeletal system (impact loading+resistance training; ILRT; n=58), the cardiovascular and muscular systems (aerobic+resistance training; ART; n=54), or to usual care/delayed exercise (DEL; n=51) for 12 mo across university-affiliated exercise clinics in Australia.

Intervention: Supervised ILRT for 12 mo, supervised ART for 6 mo followed by a 6-mo home program, and DEL received a printed booklet on exercise information for 6 mo followed by 6-mo stationary cycling exercise.

Outcome measurements and statistical analysis: Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 36 and vitality using the Short Form-36. Analysis of variance was used to compare outcomes for groups at 6 mo and 12 mo.

Results and limitations: Fatigue was reduced (p=0.005) in ILRT at 6 mo and 12 mo (∼5 points), and in ART (p=0.005) and DEL (p=0.022) at 12 mo. Similarly, vitality increased for all groups (p≤0.001) at 12 mo (∼4 points). Those with the highest levels of fatigue and lowest vitality improved the most with exercise (p_trend<0.001). A limitation was inclusion of mostly well-functioning individuals.

Conclusions: Different exercise modes have comparable effects on reducing fatigue and enhancing vitality during ADT. Patients with the highest levels of fatigue and lowest vitality had the greatest benefits.

Patient summary: We compared the effects of different exercise modes on fatigue in men on androgen deprivation therapy. All exercise programs reduced fatigue and enhanced vitality. We conclude that undertaking some form of exercise will help reduce fatigue, especially in those who are the most fatigued.

Keywords: Aerobic exercise; Androgen deprivation therapy; Exercise; Exercise prescription; Fatigue; Prostate cancer; Resistance exercise.

Publication types

Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Androgen Antagonists / adverse effects*
Antineoplastic Agents, Hormonal / adverse effects*
Bicycling
Exercise Therapy / methods*
Exercise Tolerance
Fatigue / diagnosis
Fatigue / etiology
Fatigue / physiopathology
Fatigue / therapy*
Humans
Male
Middle Aged
Muscle Strength
Pamphlets
Patient Education as Topic / methods
Prostatic Neoplasms / drug therapy*
Prostatic Neoplasms / pathology
Queensland
Resistance Training
Surveys and Questionnaires
Time Factors
Treatment Outcome
Western Australia

Substances

Androgen Antagonists
Antineoplastic Agents, Hormonal

Associated data

ANZCTR/ACTRN12609000200280