Exercise Mode Specificity for Preserving Spine and Hip Bone Mineral Density in Prostate Cancer Patients

Abstract

Purpose Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects, including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine the effects of targeted exercise modes on BMD in men with PCa undergoing ADT. Methods Between 2009 and 2012, 154 PCa patients 43–90 yr old on ADT were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training [ImpRes], n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training, n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). End points were lumbar spine, hip and whole-body BMD measured by dual-energy x-ray absorptiometry with secondary end points of lean and fat mass, appendicular skeletal muscle mass, and neuromuscular strength. ANOVA was used to compare the exercise groups with DelAer at 6 and 12 months. Results There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months, P = 0.039; 12 months, P = 0.035) and femoral neck (6 months, P = 0.050), with decline attenuated in ImpRes (~−1.0% vs ~−2.0%). Compared with DelAer, ImpRes increased appendicular skeletal muscle at 6 months (0.3 kg, P = 0.045) and improved muscle strength at 6 and 12 months (P ≤ 0.012) by 9%–34%. A limitation was inclusion of well-functioning patients. Conclusion Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT.

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

“…sation models. 25,72 Variation in volume and intensity across the week or within treatment cycles may stimulate greater physiological adaptation, and reduce boredom and risk of over-training. Further, periodised plans designed for optimal preparation for specific events, such as surgery or commencement of chemotherapy or radiation therapy, or to specifically address particular health issues should be considered.…”

Effects of six months of aerobic and resistance training on metabolic markers and bone mineral density in older men on androgen deprivation therapy for prostate cancer

“…However, the lack of a control group precludes drawing firm conclusions. Studies that combined resistance with impact training demonstrated a preserved spinal [13][14][15] and femoral [15] BMD in men on ADT. Indeed, mechanical loading induced by resistance and impact training appears to be a precipitating factor in upregulating osteoblastic activity.…”

“…Five RCTs examined the effect of exercise on BMD in men (mean age N 65 years) during ADT [7,[12][13][14][15]. Three RCTs found no improvements in bone health in response to a resistance [12,13] or multimodal training intervention [7] compared to usual care.…”

“…However, these effects were not sustained six months after the intervention [14]. Recent evidence from another RCT suggests that a combined impact and resistance training intervention significantly attenuates BMD losses in spine and femoral neck (FN) after six months, compared to participants undergoing aerobic exercise-training preceded by six months of usual care [15]. At twelve months, only spine BMD was preserved in response to impact and resistance training whereas the effect on BMD at the FN was blunted [15].…”

“…Recent evidence from another RCT suggests that a combined impact and resistance training intervention significantly attenuates BMD losses in spine and femoral neck (FN) after six months, compared to participants undergoing aerobic exercise-training preceded by six months of usual care [15]. At twelve months, only spine BMD was preserved in response to impact and resistance training whereas the effect on BMD at the FN was blunted [15]. Collectively, the findings have led some to suggest that longer duration or more intensive interventions may be required to elicit a skeletal improvement in this population [7].…”