Immediate Versus Delayed Exercise In Patients Initiating Androgen Deprivation Therapy: Effects On Quality Of Life

Androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) results in a range of treatment-related toxicities, compromising function and quality of life (QoL). Exercise is one treatment that has been demonstrated to counter a number of these adverse effects including QoL. However, the timing of exercise is less clear, that is, should exercise commence when ADT is initiated to prevent/attenuate the adverse effects or commence when patients are on established ADT regimens and undertaken with rehabilitative intent? PURPOSE: To examine whether it is more efficacious to commence exercise at the onset of ADT rather than later during treatment to counter adverse effects on QoL. METHODS: One-hundred and two men with PCa (48-84 years, BMI 27.9 ± 4.2 kg/m2) initiating ADT were randomized to immediate exercise (IMEX, n = 54) or delayed exercise (DEL, n = 48) for 12 months. IMEX consisted of 6 months supervised resistance/aerobic/impact exercise initiated at the onset of ADT with 6 months follow-up while DEL underwent 6 months usual care followed by 6 months of the same resistance/aerobic/impact exercise program. Health-related QoL was assessed using the 36-Item Short Form Health Survey at baseline, 6, and 12 months. Intention-to-treat was utilised for the analyses which included group x time repeated measures ANOVA using log transformed data, with Bonferroni-corrected post-hoc tests. RESULTS: There were no significant differences between groups at baseline. There was a significant group x time interaction for the physical functioning domain (p = 0.030) and physical component summary score (p = 0.006), and a significant time effect for role physical (p = 0.001), bodily pain (p < 0.001), and vitality domains (p < 0.001) with QoL being maintained in IMEX and declining in DEL at 6 months. Exercise in DEL reversed the decline in role physical and vitality domains, and in the physical component summary score such that there were no differences compared to baseline at 12 months. CONCLUSION: Commencing exercise at the onset of ADT in patients with PCa preserves QoL. Although exercise initiated while on established ADT regimens reverses declines in some QoL domains, to avoid initial treatment-related adverse effects on QoL exercise medicine should be initiated at the start of treatment. Cancer Australia, Prostate Cancer Foundation of Australia and Beyond Blue