Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systematic review of randomised controlled trials

Abstract

Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) are likely to develop metabolic conditions such as diabetes, cardiovascular disease, abdominal obesity and osteoporosis. Other treatment-related side effects adversely influence quality of life (QoL) including vasomotor distress, depression, anxiety, mood swings, poor sleep quality and compromised sexual function. The objective of this study was to systematically review the nature and effects of dietary and exercise interventions on QoL, androgen deprivation symptoms and metabolic risk factors in men with PCa undergoing ADT. An electronic search of CINAHL, CENTRAL, Medline, PsychINFO and reference lists was performed to identify peerreviewed articles published between January 2004 and December 2014 in English. Eligible study designs included randomised controlled trials (RCTs) with pre-and post-intervention data. Data extraction and assessment of methodological quality with the Cochrane approach was conducted by two independent reviewers. Seven exercise studies were identified. Exercise significantly improved QoL, but showed no effect on metabolic risk factors (weight, waist circumference, lean or fat mass, blood pressure and lipid profile). Two dietary studies were identified, both of which tested soy supplements. Soy supplementation did not improve any outcomes. No dietary counselling studies were identified. No studies evaluated androgen-deficiency symptoms (libido, erectile function, sleep quality, mood swings, depression, anxiety and bone mineral density). Evidence from RCTs indicates that exercise

Interventions for prostate cancer survivorship: A systematic review of reviews

“…There was some evidence that particular diets and supplements can impact prostate cancer progression. Nutrition interventions that were reported to stabilise or decrease serum PSA levels tended to be low in fat and include plant‐based supplements (pomegranate, flaxseed, lycopene, and soy); however, soy supplementation did not improve any outcomes in one review . The overall impact of nutrition interventions on PSA levels could not be reliably estimated due to limited and low‐quality trials.…”

“…Two reviews excluded men with advanced stage of disease due to the different treatment and outcome pathways . Additionally, eight of the included reviews focused only on men undergoing androgen deprivation therapy (ADT), while three focused only on those undergoing radical prostatectomy, undertaking an evaluation of the effect of exercise interventions on differing treatment‐related side effects and adverse events. For the reviews investigating interventions to assist men undergoing ADT, seven reviews focused on body composition, weight gain, and cardiometabolic risk outcomes, while one review focused on depression, anxiety, and quality of life .…”

“…One review of diet and exercise interventions reported reductions in body weight, with diet having more effect on weight loss than exercise alone. One review reported the efficacy of exercise interventions to preserve and improve lean body mass particularly in the setting of ADT, while another review reported no effect in other parameters of body composition . There was some evidence that particular diets and supplements can impact prostate cancer progression.…”

“…Five reviews suggested that a combination of aerobic and resistance training delivered during or after treatment for prostate cancer survivors could be effective in improving cardiorespiratory fitness and peak oxygen capacity, with resistance training demonstrating improvements to muscular strength . Exercise interventions were less effective in improving other markers of cardiovascular health such as lipid profile, blood pressure, glucose, and cardiometabolic risk among men undergoing ADT . Very few appropriately designed studies included long‐term duration (eg, 12‐mo duration) and implementation of osteogenic specific exercise programmes (eg, impact loading) on outcomes of bone health, and as a result, limited information exists on the effects of exercise on bone mineral density.…”

“…Evidence from eight reviews suggested that aerobic and resistance exercise interventions show some benefit in improving health‐related quality of life outcomes, both during and after treatment, particularly with supervised interventions . Other reviews reported an unclear impact of exercise on quality of life or insufficient data for analysis .…”