Androgen deprivation therapy is one of the most common treatments for individuals diagnosed with prostate cancer. While broadly effective, it has several common side-effects, including an increased risk of obesity and being overweight. Each of these conditions independently increase this population’s morbidity and mortality and lead to worse outcomes related to their prostate cancer. Identifying effective ways to reduce prostate cancer patients’ weight and cardiovascular treatment side-effects is a major concern to address the long-term health and survivorship needs of these patients.
While exercise interventions for individuals with prostate cancer have been researched in controlled clinical trials, few studies have tested the broad, community implementation of these interventions. Also, similar self-management interventions have inconsistent results at addressing side effects like increased fat mass. A team of researchers, led by Oliver Schumacher, MSc from the Exercise Medicine Research Institute at Edith Cowan University in Australia, recently reported the results of a nationwide exercise and support program for men with prostate cancer receiving androgen deprivation therapy in JCO Oncology Practice.
“The Man Plan” is an ongoing community-based exercise program for men with prostate cancer. The program’s primary goal was to improve participants’ body weight, cardiovascular health, and physical function. The program has several noteworthy qualities, including that it was conducted throughout the country of Australia, integrated into patients’ clinical care, and use of industry partners to deliver the exercise therapy.
Eligible patients included individuals diagnosed with locally advanced, relapsed, or metastatic prostate cancer receiving leuprorelin acetate, one of the most common androgen deprivation treatments. Once enrolled in the trial, participants received one of three interventions:
- supervised group exercise
- home-based exercise
- a support program for patients unable to exercise
Group allocation was based on participant preferred in consultation with their clinical team.
For the current study, the researchers looked at data from patients enrolled in The Man Plan between 2014 and 2020 who received the supervised group exercise treatment. In this intervention, an accredited exercise physiologist led group exercises either weekly or biweekly, with a total of 16 exercise sessions over 10 to 18 weeks. Each group exercise session combined (1) aerobic exercise for 20 minutes at 65-80% of maximum heart rate and (2) progressive resistance training for upper and lower body muscle groups. The exercise physiologist would tailor the intervention to each patient’s specific needs using their professional judgment.
To determine if this supervised group exercise impacted participants’ health outcomes, measures of participants’ cardiac and overall fitness were collected at the start and end of The Man Plan program. These outcome assessments included: weight, body mass index, waist circumference, systolic and diastolic blood pressure, push-ups, a walking test, and leg press, chest press, and rowing exercises. Each of the measurements for the exercise tests had specific protocols to help ensure the measures were objectively and consistently calculated.
Half of the 1,515 participants in the program completed outcome assessments and were included in the analysis. These 760 participants were between 48 to 94 years old, with a mean age of 72 years. Most were either overweight (42.1%) or obese (38.1%), and the median time from start of androgen deprivation therapy to baseline measures was 0.85 months with most participants receiving injections every three months.
Adherence to the program was extremely strong. Across participants who completed both the initial and final assessments (n=731; 96%), 98% of the planned exercise sessions were completed, and only four participants attended less than half of the sessions. Across participants who completed the initial but not the final assessment, 53% of the planned exercise sessions were completed and the median number of completed sessions was eight.
Participants in the supervised group exercise program did not report significant changes in weight or body mass index, though they did demonstrate a slight decrease in waist circumference (median = -0.9 cm, p < 0.001). Participants with higher measurements at baseline reported significantly greater improvements at the end of the program.
While participants did not report significant changes in resting heart rate at the end of the program, they did report significant reductions in both systolic and diastolic blood pressure (-3.7 mmHg and –1.7 mmHg, respectively). Participants with higher blood pressure and resting heart rate at baseline reported significantly greater improvements at the end of the program.
Finally, participants reported significant improvements in their post-program walking test, and leg press, chest press, and rowing exercise values. These had small to medium effect sizes. Older participants reported greater improvements in these measures, as did participants with lower values at the beginning of the program.
These results are notable not only because the study was conducted throughout the country of Australia in a non-controlled setting and still demonstrated significant improvements in many anthropometric, cardiovascular health and fitness, and strength outcomes. Moreover, these outcomes were especially strong among participants with poorer health at the beginning of the program, indicating that those most at risk for the poor outcomes gained the most during The Man Plan supervised group exercise program.
The researchers discuss that the study results may be slightly biased because participants could select which group based on their personal preference. Also, there was no control group to determine the relative improvement in outcomes over time.
Oncology nurses caring for patients with prostate cancer who are receiving androgen deprivation therapy should consider identifying community programs that promote group-based exercise with aerobic and resistance training. Working with community partners, individuals can find nearby facilities that they can easily attend. When integrated into standard clinical care, this type of intervention can be normalized to limit the treatment side effects of androgen deprivation therapy and promote individuals’ long-term health.