Impact Of Exercise On Cardiac Remodelling In Men With Prostate Cancer Undergoing Androgen Deprivation Therapy

Androgen deprivation therapy (ADT) has been linked to an elevated risk of cardiovascular disease in men with prostate cancer (PCa). While exercise training is known to reduce ADT-related side effects, its potential to prevent adverse cardiac remodelling remains uncertain. PURPOSE: To evaluate the impact of exercise training on cardiac remodelling, cardiorespiratory fitness, and other markers of cardiometabolic health in men undergoing ADT. METHODS: 31 men with PCa commencing ADT were randomly assigned to exercise training (EX; 66.6 ± 9.2 yrs, n = 16) or usual care (UC; 66.3 ± 10.2 yrs, n = 15). The EX-group were prescribed moderate to vigorous aerobic exercise training, including high-intensity interval training (HIIT) and resistance training three times a week for three months. At baseline and three months, left ventricular mass to volume ratio (LVM: V), LV mass index (LVMi), LV end-diastolic volume index (LVEDVi), LV stroke volume index (LVSVi), and LV cardiac output index (LVCOi) were measured by cardiac magnetic resonance imaging and LV ejection fraction and global longitudinal strain were quantified by echocardiogram. Cardiorespiratory fitness (peak oxygen uptake [VO2peak], peak power output) was assessed by cardiopulmonary exercise testing. RESULTS: Mean EX attendance was 85% (range, 58-100%). Compared with UC, significant between-group differences were observed for LVM:V (net difference, -0.13 ml/g, 95% CI -0.2, -0.03, group x time P = 0.01), LVEDVi (13 ml/m2, CI 7, 18, P < 0.001), LVSVi (11 ml/m2, CI 5, 17, P < 0.001) and LVCOi (0.7 ml/m2, CI 0.3, 1.0, P < 0.001) in favour of the EX-group. In addition, EX significantly improved VO2peak (3.5 ml/kg/min, CI 1.9, 5.0, P < 0.001), absolute VO2peak (0.2 L/min, CI -0.1, 0.4, P < 0.001) and peak power output (32 Watts, CI 13, 51, P = 0.001), compared with UC. No other differences were detected for any other outcomes between groups (all, P > 0.05). CONCLUSIONS: This is the first trial to assess the impact of moderate to vigorous aerobic and resistance exercise training, including HIIT, on cardiac remodelling in men with PCa treated with ADT. EX prevented adverse cardiac remodelling and improved VO2peak in men undergoing ADT compared with UC.