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

Abstract

Objectives To examine whether it is more efficacious to commence exercise medicine in men with prostate cancer at the onset of androgen‐deprivation therapy (ADT) rather than later on during treatment to preserve bone and soft‐tissue composition, as ADT results in adverse effects including: reduced bone mineral density ( BMD ), loss of muscle mass, and increased fat mass (FM). Patients and methods In all, 104 patients with prostate cancer, aged 48–84 years initiating ADT, were randomised to immediate exercise ( IMEX , n = 54) or delayed exercise ( DEL , n = 50) conditions. The former consisted of 6 months of supervised resistance/aerobic/impact exercise and the latter comprised 6 months of usual care followed by 6 months of the identical exercise programme. Regional and whole body BMD , lean mass (LM), whole body FM and trunk FM, and appendicular skeletal muscle ( ASM ) were assessed by dual X‐ray absorptiometry, and muscle density by peripheral quantitative computed tomography at baseline, and at 6 and 12 months. Results There was a significant time effect ( P < 0.001) for whole body, spine and hip BMD with a progressive loss in the IMEX and DEL groups , although lumbar spine BMD was largely preserved in the IMEX group at 6 months compared with the DEL group (−0.4% vs −1.6%). LM, ASM , and muscle density were preserved in the IMEX group at 6 months, declined in the DEL group at 6 months (−1.4% to −2.5%) and then recovered at 12 months after training. FM and trunk FM increased ( P < 0.001) over the 12‐month period in the IMEX (7.8% and 4.5%, respectively) and DEL groups (6.5% and 4.3%, respectively). Conclusions Commencing exercise at the onset of ADT preserves lumbar spine BMD , muscle mass, and muscle density. To avoid treatment‐related adverse musculoskeletal effects, exercise medicine should be prescribed and commenced at the onset of ADT .

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.…”

“…The heterogeneity in terms of the duration of ADT exposure is another important limitation. Previous research has shown that initiating exercise early on ADT preserves BMD at lumbar spine, skeletal muscle mass, and density [14]. BMD was assessed at twelve months (six months after the intervention) according to the standard of care for men on ADT in Canada [21].…”

“…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.…”

“…Taaffee et al found that six months of combined aerobic, resistance, and impact training was associated with preserved spinal BMD in men undergoing training immediately after initiating ADT compared to men undergoing training six months after ADT initiation. 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].…”

Daily exercise is daily medicine

“…Taaffe et al. in this issue of the BJUI discuss the value of exercise medicine – Immediate vs delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition.…”