Novel physical activity interventions for older patients with prostate cancer on hormone therapy: A pilot randomized study

Sajid, Saleha; Dale, William; Mustian, Karen M.; Kotwal, Ashwin; Heckler, Charles E.; Porto, Michelle; Fung, Chunkit; Mohile, Supriya G.

doi:10.1016/j.jgo.2016.02.002

Cited by 49 publications

(164 citation statements)

References 47 publications

(53 reference statements)

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“…Of ADTtreated men excluded in our study, vitamin D supplementation greater than 1,000 IU/day (16%) and PRT greater than one session/week (8.0%) were the most common reasons. Comparisons between our exclusion criteria and that of previous trials is difficult given the omission [225,228,241] or lack of detail [234,238,244,246] when reporting these reasons, as well as the differences in primary outcomes. Exclusions based on current vitamin D supplementation and PRT align with current lifestyle guidelines for men treated with ADT for PCa that suggest these interventions to overcome the myriad of treatment-induced adverse effects [195] .…”

Section: Recruitmentmentioning

confidence: 99%

“…In addition to the benefits in men diagnosed with PCa, the effects of various modalities of exercise training, including aerobic, resistance and impact exercises, on muscle health in men treated with ADT has been assessed in multiple RCTs [225,[227][228][229][232][233][234][235][236][237][238][239][240][241][242][243][244] ( Table 6) and reviewed [60,245] . Although the optimal training load and exercise programming variables for eliciting improvements in muscle, fat and performance are unknown, it appears that aerobic training, PRT and the combination of both over periods of 12-52 weeks may improve outcomes, such as total body lean mass (0.7 kg [227,246] ) and ALM (0.5 kg [227,238] ), total body (-0.6 kg [234] ) and trunk fat mass (-0.2 to -0.5 kg [234,246] ), upper (4.0-26% [227,232,234,238,243] ) and lower body muscle strength (17-37% [227,232,234,238,243] ), upper (47% [227] ) and lower body muscle endurance (69% [227] ) and gait speed (6.4% [227] ), when compared to usual care (Table 2.9).…”

Section: The Role Of Exercise Training On Muscle Fat and Performancementioning

confidence: 99%

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Muscle, fat and performance during androgen deprivation for prostate cancer

Owen¹

2018

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Introduction: Prostate cancer (PCa) is one of the most frequently diagnosed male cancers worldwide. One treatment, androgen deprivation therapy (ADT), is often accompanied with a myriad of adverse effects, including those that negatively impact muscle, fat and performance outcomes. Therefore, ADT-treated men may be living longer, but are at risk of both age- and treatment-related complications. The overall aim of this thesis was to quantify outcomes of muscle, fat and performance in men treated with ADT when compared to PCa (men diagnosed with PCa, not treated with ADT) and healthy controls (men not diagnosed with PCa), and assess the feasibility of implementing a multi-component exercise program combined with protein, calcium and vitamin D supplementation (Ex+ProCaD) compared to usual care in ADT-treated men. Methods: This thesis presents two studies that form part of a larger 52-week randomised controlled trial (RCT), which examined the efficacy of Ex+ProCaD compared to usual care in men treated with ADT for PCa. The first study presented was a nested cross-sectional study performed parallel to the baseline assessment of the RCT and examined differences in muscle, fat and performance outcomes between men treated with ADT when compared to PCa and healthy controls. The second study presented examined the feasibility of implementing the first 26 weeks of the RCT. Results: The cross-sectional study showed that height, weight, body mass index and diet were similar between the three groups, but ADT-treated men were four years older and tended to be less physically active (23-30%; P=0.054). After adjusting for age and physical activity, total body fat mass was 3.3-5.0 kg (P < 0.05) greater in men treated with ADT compared to PCa controls, but there was no difference in total body and regional lean mass. When adiposity was considered, ADT-treated men had 10-12% (P < 0.05) lower appendicular lean mass adjusted for body mass index and 5.6-6.4% (P < 0.05) lower forearm percent muscle cross-sectional area compared to controls. Absolute muscle strength was similar between groups, but when expressed relative to body weight, men treated with ADT had 13-21% (P < 0.05) lower muscle strength compared to controls. Whilst only two ADT-treated men had sarcopenia, these men had a higher proportion (P < 0.001) of pre-sarcopenia when appendicular lean mass was adjusted for body mass index (42%) compared to PCa (15%) and healthy (7%) controls. Men treated with ADT had 15-36% (P < 0.05) greater storage of fat within subcutaneous depots when compared to controls, whereas visceral and intermuscular fat was similar. The majority of subcutaneous fat depots (excluding android region) were shown to be positively associated with ADT duration (P < 0.05). Forearm muscle density was shown to negatively correlate with ADT duration (P < 0.05). The RCT had a high participant retention rate (96%). Adherence was high for the supplement (mean, 92-93%) and modest for the exercise program (mean, 60%). A relatively high proportion (81%) of men in the intervention group reported an adverse event, although only 16% were confirmed to be related to the intervention and the vast majority (97%) were determined to be mild or moderate in terms of severity. Across the ten separate recruitment pathways considered, clinician referral (43%) and PCa support groups (29%) yielded the greatest proportion of enrolled participants. A total of 149 potential participants were screened, which resulted in 42 participants at the time of write up for this thesis. Among the first 28 participants to complete the 26-week intervention, 21-50% were unable to complete at least one measure of muscle strength due to pre-existing comorbidities. Data from the initial 28 participants tended to show that when compared to usual care, Ex+ProCaD led to net improvements in lean mass (0.2-1.4 kg), fat mass (-0.1 to -0.9 kg), muscle strength (8.0-19%), functional muscle power (8.6%) and functional capacity (12-14%). Conclusions: The following key themes emerged from this thesis and may be used to guide clinical practice guidelines and future research: 1) Men treated with ADT for PCa had greater amounts of fat when compared to non-ADT counterparts, 2) Current definitions of sarcopenia and sarcopenic obesity were limited in men treated with ADT for PCa, 3) The greater amounts of fat observed in men treated with ADT for PCa tended to be stored in subcutaneous depots and supersede age-related plateaus/losses, 4) The recruitment of men treated with ADT for PCa into a lifestyle intervention was challenging, and 5) Men treated with ADT for PCa tended to respond positively to a multi-modal exercise training combined with multi-nutrient supplementation.

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Section: Recruitmentmentioning

confidence: 99%

Section: The Role Of Exercise Training On Muscle Fat and Performancementioning

confidence: 99%

Muscle, fat and performance during androgen deprivation for prostate cancer

Owen¹

2018

Preprint

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“…Several studies have been conducted to examine the relationship between exercise and psychological outcomes in cancer survivors . For example, a randomized controlled trial (RCT), conducted among 116 patients with lung cancer, found improvement in anxiety after a home‐based walking exercise program .…”

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confidence: 99%

“…Several studies have been conducted to examine the relationship between exercise and psychological outcomes in cancer survivors. [10][11][12][13][14][15][16][17] For example, a randomized controlled trial (RCT), conducted among 116 patients with lung cancer, found improvement in anxiety after a homebased walking exercise program. 15 In a systematic review by Craft and colleagues, exercise was found to have positive effects on mood disturbances in cancer survivors; most of the programs were conducted in community facilities, laboratories, or gyms.…”

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confidence: 99%

Effects of a Home‐based Exercise Program on Anxiety and Mood Disturbances in Older Adults with Cancer Receiving Chemotherapy

Loh

Kleckner

Lin

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Exercise interventions improve anxiety and mood disturbances in patients with cancer. However, studies are limited in older adults with cancer. We assessed the effects of exercise on anxiety, mood, and social and emotional well‐being in older patients with cancer during their first 6 weeks of chemotherapy. DESIGN Exploratory secondary analysis of a randomized controlled trial (RCT). SETTING Community oncology practices. PARTICIPANTS Older patients (aged 60 years or older) undergoing chemotherapy (N = 252). INTERVENTION Patients were randomized to Exercise for Cancer Patients (EXCAP) or usual care (control) for the first 6 weeks of chemotherapy. EXCAP is a home‐based, low‐ to moderate‐intensity progressive walking and resistance training program. MEASUREMENTS Analysis of covariance, with study arm as the factor, baseline value as the covariate, and study arm × baseline interaction, was used to evaluate arm effects on postintervention anxiety (State Trait Anxiety Inventory [STAI]), mood (Profile of Mood States [POMS]), and social and emotional well‐being (Functional Assessment of Cancer Therapy–General subscales) after 6 weeks. RESULTS Median age was 67 years; 77% had breast cancer. Statistically significant group differences were observed in the STAI score (P = .001), POMS score (P = .022), social well‐being (P = .002), and emotional well‐being (P = .048). For each outcome, EXCAP patients with worse baseline scores had larger improvements at 6 weeks; these improvements were clinically significant for STAI score and social well‐being. CONCLUSIONS Among older cancer patients receiving chemotherapy, a 6‐week structured exercise program improved anxiety and mood, especially among those participants with worse baseline symptoms. Additional RCTs are needed to confirm these findings and evaluate the appropriate exercise prescription for managing anxiety, mood, and well‐being in this patient population. J Am Geriatr Soc 67:1005–1011, 2019.

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“…Indeed, these investigators have spearheaded exercise programs in cancer patients. Completing a three-arm randomized, small pilot study that recruited older patients with prostate cancer, these investigators tested a home-based walking and resistance training intervention versus technology-mediated walking and resistance intervention versus standard of care [9]. These exercise interventions generated some very early signals of promise compared to standard care – but, first and foremost, these investigators demonstrated feasibility.…”

mentioning

confidence: 99%