Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

Abstract

PurposeThe presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases.MethodsBetween 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m−2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention.ResultsThere was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4–6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6–12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507).ConclusionsMultimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain.Trial Registration: ACTRN12611001158954.

Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

“…Lastly, our exclusion criteria included men with established metastatic disease. As a result, our present results do not apply to men with metastatic disease; however, we have recently reported on the findings from an exercise trial in men with bone metastases that utilised a modular multimodal exercise programme that resulted in the preservation of physical function with no adverse skeletal complications [47].…”

Considerations for Exercise Prescription in Patients With Bone Metastases: A Comprehensive Narrative Review

“…The intervention involved 30 minutes of exercises that were performed on each day of radiotherapy treatment over a 2‐week period and continued 3 times a week for 6 months. Pain scores had reduced from 48 of 100 at baseline to 16 of 100 postintervention in the intervention arm compared with no change (51/100 to 50/100) in the control group ( P < .001) [102]. There were no differences in fracture rate between groups after either 3 ( P = .59) or 6 months ( P = .60) and no difference in overall survival or progression‐free survival between the 2 study arms [103].…”

“…Eleven studies, described in 18 papers, relating to exercise prescription in patients with bone metastases were considered eligible for inclusion; 7 randomized controlled trials, 3 single‐arm studies and 1 multiarm interventional study (Table 3) [10,11,20,64,76,77,95‐105]. Aerobic and/or resistance exercise training was prescribed by all studies.…”

Powikłania terapii hormonalnej (ADT – androgen deprivation therapy) a układ ruchu u pacjentów z rakiem prostaty

“…Niestety, jak pokazuje codzienna praktyka lekarska jedynie 12-50% pacjentów z rakiem stercza stosuje się do tych zaleceń. Autorzy kilku prac oceniających postęp sarkopenii po wprowadzeniu ćwiczeń fizycznych zauważyli, że trening fizyczny może znacząco poprawiać siłę i masę mięśniową, odwracać utratę mięśni, a tym samym poprawiać jakość życia pacjentów [29,30]. Dodatkowo, Storer [31] oraz Galvão [29] i Buffart [30] w swoich badaniach zaobserwowali, że trening pod nadzorem trenera przynosił znacząco lepsze efekty niż trening samodzielny pacjentów.…”

“…Autorzy kilku prac oceniających postęp sarkopenii po wprowadzeniu ćwiczeń fizycznych zauważyli, że trening fizyczny może znacząco poprawiać siłę i masę mięśniową, odwracać utratę mięśni, a tym samym poprawiać jakość życia pacjentów [29,30]. Dodatkowo, Storer [31] oraz Galvão [29] i Buffart [30] w swoich badaniach zaobserwowali, że trening pod nadzorem trenera przynosił znacząco lepsze efekty niż trening samodzielny pacjentów. Wśród ćwiczeń proponowanych pacjentom zazwyczaj stosowano ćwiczenia mieszane -aerobowo-oporowe, typu prostowanie nóg w siadzie, uginanie nóg leżąc, brzuszki, przyciąganie drążka, ściąganie mięśni brzucha, podnoszenie obciążeń nad głowę i inne [32].…”