Optimising Aerobic And Resistance Emphasis In Exercise Trials In Prostate Cancer: A Feasibility Trial

Those with intermediate or high-risk prostate cancer typically receive androgen deprivation therapy (ADT), which suppresses testosterone. The side effects of ADT include reduced muscle, bone density, strength, physical function and increased fatigue, fat mass and cardiovascular risk. Many of these side effects can be alleviated by exercise, both resistance training and aerobic training. However, the optimum combination of each remains unclear. PURPOSE: To determine the feasibility of an aerobic-emphasised (AE) versus a resistance-emphasised (RE) exercise intervention in improving health and functional outcomes in men with prostate cancer undergoing ADT. METHODS: A 6-month two-armed feasibility study was undertaken. Prostate cancer patients (n=24, age 71±7 yrs) undergoing ADT and radiation therapy were randomised to either an AE or RE programme (3:1 breakdown between the major and minor modality based on time). The primary outcome was feasibility, assessed via recruitment, retention, safety, adherence and acceptability. RESULTS: In total, 141 patients were medically cleared and referred to the programme between August 2021 and October 2022. Thirty patients (21%) agreed to take part but only 24 (17%) met all eligibility criteria, completed baseline testing and were randomised. The main reason for declining to participate was travel (46%). Retention rate was 79% (AE 75%, RE 83%). Attendance was 91% (AE 91%, RE 92%). Attendance during radiation therapy was 95% (AE 96%, RE 92%). Of those randomised, 67% had hypertension and 25% had cardiovascular disease. No serious adverse events were recorded. Of the participants who took part in exit interviews, 100% would recommend the programme to other prostate cancer patients. CONCLUSION: Preliminary results show that an exercise trial that carefully varies both resistance and aerobic elements with high and moderate intensities of each is a feasible undertaking with acceptable retention, safety and adherence. However, recruitment rate was lower than expected. A randomized controlled trial with a larger sample size is warranted though careful monitoring of cardiovascular issues is important. This study was co-funded by the Irish Research Council (IRC) and the UPMC Hillman Cancer Center, Whitfield Hospital, Waterford (EBPPG/2020/103).