Exercise medicine for advanced prostate cancer

Hart, Nicholas; Galvão, Daniel A.; Newton, Robert U.

doi:10.1097/spc.0000000000000276

Cited by 61 publications

(65 citation statements)

References 95 publications

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“…These are of clinical importance given that many mCRPC patients will develop or have bone metastatic lesions. Furthermore, the multimodal and modular components of the exercise prescription support the exercise intervention of a phase 3 trial in mCRPC, for which the primary outcome is overall survival ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

Galvão¹,

Taaffe

Spry

et al. 2018

Medicine &Amp; Science in Sports &Amp; Exercise

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159

248

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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.

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Section: Discussionmentioning

confidence: 99%

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

Galvão¹,

Taaffe

Spry

et al. 2018

Medicine &Amp; Science in Sports &Amp; Exercise

Self Cite

159

248

View full text Add to dashboard Cite

show abstract

“…The inclusion of patients with bone metastases in exercise studies would have greatly increased the generalizability of results to all patients at this stage of disease. In addition, a number of exercise trials in advanced cancer did not specify whether patients with metastatic bone disease were included [117‐119] or specify the site of metastases [120]. Further detail regarding patients' disease status would enable clinicians to ascertain the applicability of study results to specific patient populations in practice.…”

Section: Discussionmentioning

confidence: 99%

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

Sheill

Guinan

Peat

et al. 2018

PM&R

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“…The initial 48 weeks of the programme (year 1) will be supervised in an exercise clinic setting, with a gradual tapered transition to self-management, and the subsequent 48 weeks of the programme (year 2) will be self-managed with one exercise visit required at the beginning of each cycle (every 4 weeks). This exercise prescription critically uses periodisation to maximise training stimulus and physiological adaptation while also reducing the risk of injury, overtraining or staleness, 11 26 autoregulation to allow patients with advanced mCRPC to self-determine their capabilities at each session collaboratively with the supervising clinical exercise physiologist, thereby lowering intensity or volume if the patient is fatigued or unwell, or raising intensity or volume if the patient is energetic and motivated. 11 26 Furthermore, the exercise programme will be modified for any patients with mCRPC with bone metastases depending on the size and location of metastases ( table 5 ), performed individually or in small groups (of up to 4–6 patients per session).…”

Section: Methodsmentioning

confidence: 99%

Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol

et al. 2018

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IntroductionPreliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).Methods and analysisParticipants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant’s fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.Ethics and disseminationValidation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.Trial registration numberNCT02730338.

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Exercise medicine for advanced prostate cancer

Abstract: Exercise oncology is rapidly evolving, with impressive possibilities that may directly improve patient outcomes in advanced prostate cancer. Research must focus on translating preclinical trials into human clinical trials and investigate the direct effect of exercise on overall survival.

Cited by 61 publications

References 95 publications

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases

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

Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol

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