Top

Journal of Cancer Survivorship

Published in:

Open Access 01-12-2016

Fitness outcomes from a randomised controlled trial of exercise training for men with prostate cancer: the ENGAGE study

Authors: Cadeyrn J. Gaskin, Steve F. Fraser, Patrick J. Owen, Melinda Craike, Liliana Orellana, Patricia M. Livingston

Published in: Journal of Cancer Survivorship | Issue 6/2016

Abstract

Purpose

The main purpose of this study was to investigate the effects of a 12-week, clinician-referred, community-based exercise training program with supervised and unsupervised sessions for men with prostate cancer. The secondary purpose was to determine whether androgen deprivation therapy (ADT) modified responses to exercise training.

Methods

Secondary analysis was undertaken on data from a multicentre cluster randomised controlled trial in which 15 clinicians were randomly assigned to refer eligible patients to an exercise training intervention (n = 8) or to provide usual care (n = 7). Data from 119 patients (intervention n = 53, control n = 66) were available for this analysis. Outcome measures included fitness and physical function, anthropometrics, resting heart rate, and blood pressure.

Results

Compared to the control condition, men in the intervention significantly improved their 6-min walk distance (M _diff = 49.98 m, p _adj = 0.001), leg strength (M _diff = 21.82 kg, p _adj = 0.001), chest strength (M _diff = 6.91 kg, p _adj = 0.001), 30-s sit-to-stand result (M _diff = 3.38 reps, p _adj = 0.001), and reach distance (M _diff = 4.8 cm, p _adj = 0.024). A significant difference (unadjusted for multiplicity) in favour of men in the intervention was also found for resting heart rate (M _diff = −3.76 beats/min, p = 0.034). ADT did not modify responses to exercise training.

Conclusions

Men with prostate cancer who act upon clinician referrals to community-based exercise training programs can improve their strength, physical functioning, and, potentially, cardiovascular health, irrespective of whether or not they are treated with ADT.

Implications for Cancer Survivors

Clinicians should inform men with prostate cancer about the benefits of exercise and refer them to appropriately qualified exercise practitioners and suitable community-based programs.

Trial registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86. doi:10.1002/ijc.29210.CrossRefPubMed

Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. Ca Cancer J Clin. 2014;64:9–29. doi:10.3322/caac.21208.CrossRefPubMed

Jung K-W, Won Y-J, Kong H-J, Oh C-M, Shin A, Lee J-S. Survival of Korean adult cancer patients by stage at diagnosis, 2006–2010: national cancer registry study. Cancer Res Treat. 2013;45:162–71. doi:10.4143/crt.2013.45.3.162.CrossRefPubMedPubMedCentral

Australian Institute of Health and Welfare. Cancer in Australia: an overview 2014 (Cancer series No 90. Cat. no. CAN 88). Canberra: AIHW2014.

Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435–48. doi:10.7326/0003-4819-148-6-200803180-00209.CrossRefPubMed

Langston B, Armes J, Levy A, Tidey E, Ream E. The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature. Support Care Cancer. 2013;21:1761–71. doi:10.1007/s00520-013-1751-5.CrossRefPubMed

Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901-e. doi:10.1136/bmjopen-2013-003901.CrossRef

Singh J, Trabulsi EJ, Gomella LG. The quality-of-life impact of prostate cancer treatments. Curr Urol Rep. 2010;11(3):139–46. doi:10.1007/s11934-010-0103-y.CrossRefPubMed

Taylor LG, Canfield SE, Du XL. Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer. 2009;115:2388–99. doi:10.1002/cncr.24283.CrossRefPubMed

10.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012;14:204–21. doi:10.1038/aja.2011.104.CrossRefPubMedPubMedCentral

11.

Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W, et al. American Cancer Society prostate cancer survivorship care guidelines. Ca Cancer J Clin. 2014;64:225–49. doi:10.3322/caac.21234.CrossRefPubMed

12.

Hasenoehrl T, Keilani M, Sedghi Komanadj T, Mickel M, Margreiter M, Marhold M, et al. The effects of resistance exercise on physical performance and health-related quality of life in prostate cancer patients: a systematic review. Support Care Cancer. 2015;23:2479–97. doi:10.1007/s00520-015-2782-x.CrossRefPubMed

13.

Baumann F, Zopf E, Bloch W. Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials. Support Care Cancer. 2012;20:221–33. doi:10.1007/s00520-011-1271-0.CrossRefPubMed

14.

Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 2014;32:335–46. doi:10.1200/jco.2013.49.5523.CrossRefPubMed

15.

Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, et al. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Support Care Cancer. 2010;18:591–9. doi:10.1007/s00520-009-0694-3.CrossRefPubMed

16.

Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, et al. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Eur Urol. 2014;65:856–64. doi:10.1016/j.eururo.2013.09.041.CrossRefPubMed

17.

Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, Catto JWF, et al. Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Eur Urol. 2014;65:865–72. doi:10.1016/j.eururo.2013.09.040.CrossRefPubMed

18.

Hansen PA, Dechet CB, Porucznik CA, LaStayo PC. Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study. PMR. 2009;1:1019–24. doi:10.1016/j.pmrj.2009.09.016.CrossRef

19.

Alberga AS, Segal RJ, Reid RD, Scott CG, Sigal RJ, Khandwala F, et al. Age and androgen-deprivation therapy on exercise outcomes in men with prostate cancer. Support Care Cancer. 2012;20:971–81. doi:10.1007/s00520-011-1169-x.CrossRefPubMed

20.

Bourke L, Boorjian SA, Briganti A, Klotz L, Mucci L, Resnick MJ, et al. Survivorship and improving quality of life in men with prostate cancer. Eur Urol. 2015;68:374–83. doi:10.1016/j.eururo.2015.04.023.CrossRefPubMed

21.

Livingston PM, Salmon J, Courneya KS, Gaskin CJ, Craike M, Botti M, et al. Efficacy of a referral and physical activity program for survivors of prostate cancer [ENGAGE]: rationale and design for a cluster randomised controlled trial. BMC Cancer. 2011;11:237. doi:10.1186/1471-2407-11-237.CrossRefPubMedPubMedCentral

22.

Livingston PM, Craike M, Salmon J, Courneya KS, Gaskin CJ, Fraser SF, et al. Effects of a clinician referral and exercise program for men who have completed active treatment for prostate cancer: a multicentre cluster randomized controlled trial (ENGAGE). Cancer. 2015;121:2646–54. doi:10.1002/cncr.29385.CrossRefPubMedPubMedCentral

23.

Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26. doi:10.1249/MSS.0b013e3181e0c112.CrossRefPubMed

24.

Hayes SC, Spence RR, Galvão DA, Newton RU. Australian association for exercise and sport science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12:428–34. doi:10.1016/j.jsams.2009.03.002.CrossRefPubMed

25.

American College of Sports Medicine. ACSM’s resource manual for guidelines for exercise testing and prescription. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

26.

American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care. 2002;166:111–7. doi:10.1164/ajrccm.166.1.at1102.CrossRef

27.

Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70:113–9. doi:10.1080/02701367.1999.10608028.CrossRefPubMed

28.

Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:M192–7. doi:10.1093/geronj/45.6.M192.CrossRefPubMed

29.

Marfell-Jones M, Olds T, Steckler A, Carter L. International standards for anthropometric assessment. Potchefstroom, South Africa: The International Society for the Advancement of Kinanthropometry. 2006.

30.

Schafer JL. Analysis of incomplete multivariate data. New York: Chapman & Hall; 1997.CrossRef

31.

Hommel G. A stagewise rejective multiple test procedure based on a modified Bonferroni test. Biometrika. 1988;75:383–6. doi:10.1093/biomet/75.2.383.CrossRef

32.

Olejnik S, Li J, Supattathum S, Huberty CJ. Multiple testing and statistical power with modified Bonferroni procedures. J Educ Behav Stat. 1997;22:389–406. doi:10.3102/10769986022004389.CrossRef

33.

Coombes JS, Law J, Lancashire B, Fassett RG. “Exercise is medicine”: curbing the burden of chronic disease and physical inactivity. Asia Pac J Public Health. 2015;27:NP600–5. doi:10.1177/1010539513481492.CrossRefPubMed

34.

Levy WC, Cerqueira MD, Harp GD, Johannessen K-A, Abrass IB, Schwartz RS, et al. Effect of endurance exercise training on heart rate variability at rest in healthy young and older men. Am J Cardiol. 1998;82:1236–41. doi:10.1016/S0002-9149(98)00611-0.CrossRefPubMed

35.

Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54:743–9. doi:10.1111/j.1532-5415.2006.00701.x.CrossRefPubMed

36.

Alibhai SMH, Breunis H, Timilshina N, Naglie G, Tannock I, Krahn M, et al. Long-term impact of androgen-deprivation therapy on physical function and quality of life. Cancer. 2015;121:2350–7. doi:10.1002/cncr.29355.CrossRefPubMed

37.

Joly F, Alibhai SMH, Galica J, Park A, Yi QL, Wagner L, et al. Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. J Urol. 2006;176:2443–7. doi:10.1016/j.juro.2006.07.151.CrossRefPubMed

38.

Norris MK, Bell GJ, North S, Courneya KS. Effects of resistance training frequency on physical functioning and quality of life in prostate cancer survivors: a pilot randomized controlled trial. Prostate Cancer Prostatic Dis. 2015;18:281–7. doi:10.1038/pcan.2015.28.CrossRefPubMed

39.

Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol. 2005;60:324–33.CrossRef

40.

Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol. 2006;61:72–7.CrossRef

41.

Cormie P, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int. 2015;115:256–66. doi:10.1111/bju.12646.CrossRefPubMed

42.

Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta‐analysis. J Am Heart Assoc. 2013;2, e004473. doi:10.1161/jaha.112.004473.CrossRefPubMedPubMedCentral

43.

Taylor BC, Wilt TJ, Welch HG. Impact of diastolic and systolic blood pressure on mortality: implications for the definition of “normal”. J Gen Intern Med. 2011;26:685–90. doi:10.1007/s11606-011-1660-6.CrossRefPubMedPubMedCentral

44.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20. doi:10.1001/jama.2013.284427.CrossRefPubMed

45.

Basaria S, Lieb J, Tang AM, DeWeese T, Carducci M, Eisenberger M, et al. Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrinol. 2002;56:779–86. doi:10.1046/j.1365-2265.2002.01551.x.CrossRef

46.

Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL. Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther. 2007;87:1325–33. doi:10.2522/ptj.20060302.CrossRefPubMed

47.

Lynch BM, Dunstan DW, Winkler E, Healy GN, Eakin E, Owen N. Objectively assessed physical activity, sedentary time and waist circumference among prostate cancer survivors: findings from the National Health and Nutrition Examination Survey (2003–2006). Eur J Cancer Care. 2011;20:514–9. doi:10.1111/j.1365-2354.2010.01205.x.CrossRef

Title: Fitness outcomes from a randomised controlled trial of exercise training for men with prostate cancer: the ENGAGE study
Authors: Cadeyrn J. Gaskin
Steve F. Fraser
Patrick J. Owen
Melinda Craike
Liliana Orellana
Patricia M. Livingston
Publication date: 01-12-2016
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 6/2016
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-016-0543-6

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Trial registration

Please log in to get access to this content

Other articles of this Issue 6/2016

Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

Employment in French young adult survivors of childhood leukemia: an LEA study (for Leucemies de l’Enfant et de l’Adolescent—childhood and adolescent leukemia)

Understanding strength exercise intentions and behavior in hematologic cancer survivors: an analysis of the intention-behavior gap

The role of the GP in follow-up cancer care: a systematic literature review

Call for manuscripts: Digital technologies and cancer survivorship

Negative information-seeking experiences of long-term prostate cancer survivors

Keynote webinar | Spotlight on antibody–drug conjugates in cancer