Effects of a clinician referral and exercise program for men who have completed active treatment for prostate cancer: A multicenter cluster randomized controlled trial (ENGAGE)

Abstract

BACKGROUNDThe purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer.METHODSThis was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12-week exercise program comprising 2 supervised gym sessions and 1 home-based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self-reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression.RESULTSA significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09-0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, −0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, −0.02 to 0.70; P = .06) and depression symptoms (effect size: d, −0.35; 95% CI, −0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program.CONCLUSIONSThe clinician referral and 12-week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations. Cancer 2015;121:2646–2654. © 2015 American Cancer Society.

Fitness outcomes from a randomised controlled trial of exercise training for men with prostate cancer: the ENGAGE study

“…A detailed description of the study methods is available from the published protocol [21] and the main outcomes have been published [22]. In brief, 15 clinicians were randomised to intervention and control conditions.…”

“…Clinician adherence to the referral process was monitored weekly with emails and personal contact with clinicians at the clinics, checking that they were following the protocol and answering any queries that they may have had. The patients in both conditions completed measures associated with the primary outcomes of the main study [22], and were also invited to take part in measurements of their fitness and physical function, anthropometrics, resting heart rate, and blood pressure. Assessments were conducted before the exercise training program begun (baseline) and following the program (12 weeks).…”

“…Sample size calculations were based on the primary outcome of the main study (self-reported involvement in moderate and strenuous physical activity) [21, 22], rather than the secondary analysis reported here.…”

Depression in cancer: The many biobehavioral pathways driving tumor progression

“…Since physical exercise has been recognized as a powerful modulator of neuroplasticity and immune response with immunosurveillance-enhancing properties 179 184 . In keeping with this view, in another RCT on patients with lung cancer, an adjunctive 12-week exercise intervention, consisting in moderate-intensity walking for 40 min per day, 3 days per week, was feasible and effective in reducing depressive symptoms and anxiety as assessed by the Hospital Anxiety and Depression Scale (HADS) 185 .…”

Muscle, fat and performance during androgen deprivation for prostate cancer

“…The greater efficacy of these approaches, when compared to our study, is difficult to explain and whilst counterintuitive may stem from the greater focus of resources on a singular recruitment pathway as opposed to several. Moreover, previous research has supported the importance of a clinician referral to an exercise program, with 80% of 47 men who recently received active treatment for PCa having cited that clinician involvement influenced their decision to participate in 12-week intervention [374] . Notably, these observations supported our findings that clinician referral led to a greater proportion of eligible participants, compared to those screened from other recruitment pathways.…”