Responsiveness to Resistance-Based Multimodal Exercise Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy

Restricted access

Background: Androgen deprivation therapy (ADT) in the management of prostate cancer (PCa) results in an array of adverse effects, and exercise is one strategy to counter treatment-related musculoskeletal toxicities. This study assessed the prevalence of exercise responsiveness in men with PCa undergoing ADT in terms of body composition, muscle strength, and physical function. Methods: Prospective analyses were performed in 152 men (aged 43–90 years) with PCa receiving ADT who were engaged in resistance exercise combined with aerobic or impact training for 3 to 6 months. Whole-body lean mass and fat mass (FM), trunk FM, and appendicular skeletal muscle were assessed with dual x-ray absorptiometry; upper and lower body muscle strength were assessed with the one-repetition maximum; and physical function was assessed with a battery of tests (6-m usual, fast, and backward walk; 400-m walk; repeated chair rise; stair climb). Results: Significant improvements were seen (P<.01) in lean mass (0.4±1.4 kg [range, −2.8 to +4.1 kg]), appendicular skeletal muscle (0.2±0.8 kg [range, −1.9 to +1.9 kg]), and all measures of muscle strength (chest press, 2.9±5.8 kg [range, −12.5 to +37.5 kg]; leg press, 29.2±27.6 kg [range, −50.0 to +140.0 kg]) and physical function (from −0.1±0.5 s [range, +1.3 to −2.1 s] for the 6-m walk; to −8.6±15.2 s [range, +25.2 to −69.7 s] for the 400-m walk). An increase in FM was also noted (0.6±1.8 kg [range, −3.6 to +7.3 kg]; P<.01). A total of 21 men did not exhibit a favorable response in at least one body composition component, 10 did not experience improved muscle strength, and 2 did not have improved physical function. However, all patients responded in at least one of the areas, and 120 (79%) favorably responded in all 3 areas. Conclusions: Despite considerable heterogeneity, most men with PCa receiving ADT responded to resistance-based multimodal exercise, and therefore our findings indicate that this form of exercise can be confidently prescribed to produce beneficial effects during active treatment.

Submitted October 4, 2018; accepted for publication April 12, 2019.

Author contributions: Study concept and design: All authors. Data acquisition: All authors. Data analysis: Taaffe. Manuscript preparation: All authors. Manuscript approval: All authors.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Dennis R. Taaffe, PhD, DSc, MPH, Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia. Email: d.taaffe@ecu.edu.au
  • 1.

    Parker C, Gillessen S, Heidenreich A, . Cancer of the prostate: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26(Suppl 5):v6977.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Keating NL, O’Malley AJ, McNaughton-Collins M, . Use of androgen deprivation therapy for metastatic prostate cancer in older men. BJU Int 2008;101:10771083.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Smith MR, Saad F, Egerdie B, . Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol 2012;30:32713276.

  • 4.

    Galvão DA, Spry NA, Taaffe DR, . Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008;102:4447.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Galvão DA, Taaffe DR, Spry N, . Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis 2009;12:198203.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Nguyen PL, Alibhai SM, Basaria S, . Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2015;67:825836.

  • 7.

    Spry NA, Kristjanson L, Hooton B, . Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer. Eur J Cancer 2006;42:10831092.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Segal RJ, Reid RD, Courneya KS, . Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003;21:16531659.

  • 9.

    Galvão DA, Nosaka K, Taaffe DR, . Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc 2006;38:20452052.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Galvão DA, Taaffe DR, Spry N, . Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol 2010;28:340347.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Taaffe DR, Galvão DA, Spry N, . Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition. BJU Int 2019;123:261269.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Taaffe DR, Newton RU, Spry N, . Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: a year-long randomised controlled trial. Eur Urol 2017;72:293299.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cormie P, Newton RU, Taaffe DR, . Exercise maintains sexual activity in men undergoing androgen suppression for prostate cancer: a randomized controlled trial. Prostate Cancer Prostatic Dis 2013;16:170175.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Segal RJ, Reid RD, Courneya KS, . Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. J Clin Oncol 2009;27:344351.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Cormie P, Galvão DA, Spry N, . Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int 2015;115:256266.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Heymsfield SB, Smith R, Aulet M, . Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr 1990;52:214218.

  • 17.

    Taaffe DR, Duret C, Wheeler S, . Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J Am Geriatr Soc 1999;47:12081214.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Galvão DA, Taaffe DR. Resistance exercise dosage in older adults: single- versus multiset effects on physical performance and body composition. J Am Geriatr Soc 2005;53:20902097.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Fisher G, Bickel CS, Hunter GR. Elevated circulating TNF-α in fat-free mass non-responders compared to responders following exercise training in older women. Biology (Basel) 2014;3:551559.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Churchward-Venne TA, Tieland M, Verdijk LB, . There are no nonresponders to resistance-type exercise training in older men and women. J Am Med Dir Assoc 2015;16:400411.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Böhm A, Weigert C, Staiger H, . Exercise and diabetes: relevance and causes for response variability. Endocrine 2016;51:390401.

  • 22.

    Corli O, Roberto A, Bennett MI, . Nonresponsiveness and susceptibility of opioid side effects related to cancer patients’ clinical characteristics: a post-hoc analysis. Pain Pract 2018;18:748757.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Ruiz JR, Sui X, Lobelo F, . Association between muscular strength and mortality in men: prospective cohort study. BMJ 2008;337:a439.

  • 24.

    Kohrt WM, Malley MT, Coggan AR, . Effects of gender, age, and fitness level on response of VO2max to training in 60-71 yr olds. J Appl Physiol (1985) 1991;71:20042011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Bouchard C, An P, Rice T, . Familial aggregation of VO2max response to exercise training: results from the HERITAGE Family Study. J Appl Physiol (1985) 1999;87:10031008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Hubal MJ, Gordish-Dressman H, Thompson PD, . Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc 2005;37:964972.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Booth FW, Laye MJ. The future: genes, physical activity and health. Acta Physiol (Oxf) 2010;199:549556.

  • 28.

    Spry NA, Taaffe DR, England PJ, . Long-term effects of intermittent androgen suppression therapy on lean and fat mass: a 33-month prospective study. Prostate Cancer Prostatic Dis 2013;16:6772.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Slentz CA, Duscha BD, Johnson JL, . Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE—a randomized controlled study. Arch Intern Med 2004;164:3139.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Duscha BD, Slentz CA, Johnson JL, . Effects of exercise training amount and intensity on peak oxygen consumption in middle-age men and women at risk for cardiovascular disease. Chest 2005;128:27882793.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Montero D, Lundby C. Refuting the myth of non-response to exercise training: ‘non-responders’ do respond to higher dose of training. J Physiol 2017;595:33773387.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Bonafiglia JT, Rotundo MP, Whittall JP, . Inter-individual variability in the adaptive responses to endurance and sprint interval training: a randomized crossover study. PLoS One 2016;11:e0167790.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Esmarck B, Andersen JL, Olsen S, . Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol 2001;535:301311.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Buford TW, Roberts MD, Church TS. Toward exercise as personalized medicine. Sports Med 2013;43:157165.

  • 35.

    Buford TW, Anton SD, Clark DJ, . Optimizing the benefits of exercise on physical function in older adults. PM R 2014;6:528543.

  • 36.

    Barnes KA, Ball LE, Galvão DA, . Nutrition care guidelines for men with prostate cancer undergoing androgen deprivation therapy: do we have enough evidence? Prostate Cancer Prostatic Dis 2019;22:221234.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Fairman CM, Kendall KL, Hart NH, . The potential therapeutic effects of creatine supplementation on body composition and muscle function in cancer. Crit Rev Oncol Hematol 2019;133:4657.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Schmitz KH, Courneya KS, Matthews C, . American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010;42:14091426.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Rock CL, Doyle C, Demark-Wahnefried W, . Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012;62:243274.

  • 40.

    Hayes SC, Spence RR, Galvão DA, . Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport 2009;12:428434.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Beydoun N, Bucci JA, Chin YS, . Prospective study of exercise intervention in prostate cancer patients on androgen deprivation therapy. J Med Imaging Radiat Oncol 2014;58:369376.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1281 1281 77
PDF Downloads 600 600 71
EPUB Downloads 0 0 0