Enhancing quality of life in patients with prostate cancer through a remote exercise programme

Prostate cancer (PCa) remains one of the most prevalent malignancies among men worldwide [1]. Although systemic treatments such as androgen deprivation therapy (ADT), chemotherapy, and next-generation androgen receptor inhibitors (e.g. abiraterone and enzalutamide) have improved survival, these therapies are frequently associated with declines in health-related quality of life (HRQOL) and increased symptom burden [1-3]. Common adverse effects include fatigue, reduced physical function, mood changes, and musculoskeletal issues [1, 2, 4]. Exercise is increasingly recognised as a key supportive care strategy in PCa, helping maintain physical function and body composition, and potentially influencing treatment outcomes and survival [5, 6]. Resistance training can counteract the ADT-related declines in muscle mass, strength, and aerobic capacity [6, 7]. However, adherence is often challenging, particularly in remote or home-based interventions. Digital platforms such as WhatsApp® and video-based tools offer scalable solutions to deliver exercise guidance. This study evaluated the impact of adherence to a remote, home-based exercise programme on HRQOL and symptom burden among men with advanced PCa. We hypothesised that higher adherence to this programme would be associated with greater improvements in HRQOL and lower symptom burden compared with lower adherence. Instructional materials, including video demonstrations and written guidance, were delivered through the Vedius platform, ensuring participants performed exercises using the proper technique. Exercise volume and intensity were progressively adjusted based on participant tolerance and perceived exertion. Adherence was assessed pragmatically using weekly participant self-reports via WhatsApp, exercise logs within the Vedius platform, and video submissions when available, reflecting sustained real-world engagement rather than session-level compliance. Adherence was categorised as moderate to high (≥6 weeks of consistent exercise) or low (≤5 weeks of exercise participation). The ≥6-week threshold was selected a priori and is comparable to higher or superior adherence definitions used in prior exercise oncology studies. The primary outcomes were changes in HRQOL and symptom burden from T1 to T2, stratified by adherence level. Descriptive statistics summarised clinical characteristics, and linear mixed models evaluated changes over time and between groups. Statistical significance was set at P < 0.05; analyses used SPSS 29.0. A total of 35 men were recruited. Their median (range) age was 74 (58–91) years. Most were white (65.7%), married (82.9%), highly educated (88.6%), and retired (85.7%). Twenty patients (57.1%) had metastatic castration-resistant PCa and 15 (42.9%) had metastatic hormone-sensitive PCa. Treatments included abiraterone (34.3%), docetaxel (25.7%), enzalutamide (22.8%), or a combination of chemotherapy and abiraterone (17.2%). Based on adherence, 27 patients were classified as moderate-to-high and 8 as low. Participant feedback indicated high acceptability, with 91.4% reporting satisfaction with the remote programme. At 12 weeks (Fig. 1), patients with moderate to high adherence had higher overall mean HRQOL scores compared to those with low adherence (94.9 vs 88.7; P = 0.01). Improvements were observed in mean scores for physical (25.1 vs 23.6; P = 0.03), functional (22.8 vs 20.7; P = 0.03) and emotional (22.2 vs 20.3; P = 0.03) well-being. Mean symptom burden was also lower in the moderate to high adherence group (9.1 vs 14.7; P = 0.01). This study adds support to the growing literature on the benefits of exercise for patients with PCa. Prior research has demonstrated that structured exercise interventions, particularly those involving both aerobic and resistance components, can mitigate the adverse effects of cancer treatment on physical health, including muscle mass, strength, and cardiovascular function [1]. In our study, the implementation of a remote, WhatsApp-delivered programme allowed patients to engage in guided exercise with minimal logistical barriers. Notably, those who adhered to the regimen experienced significant improvements in HRQOL domains related to physical, emotional and functional well-being, along with a reduction in symptom burden. These results are consistent with prior findings showing that moderate to high intensity resistance training can counteract the loss of muscle mass and strength commonly associated with ADT, independent of exercise volume [1, 7]. Moreover, there is emerging evidence that exercise may exert immunomodulatory effects on the tumour microenvironment [8]. Vigorous exercise has been associated with altered immune gene expression and reduced tumour-infiltrating lymphocytes in certain molecular subtypes of PCa [8]. Although our study was not designed to explore biological endpoints, these data reinforce the potential for exercise to influence cancer progression beyond symptomatic management. Despite these benefits, exercise adherence remains a critical bottleneck in realising these outcomes. Our study demonstrates the feasibility of using simple digital tools, such as WhatsApp messaging and online instructional platforms, to improve adherence and deliver structured interventions in real-world settings. This approach may be particularly valuable in resource-constrained environments or in populations with limited access to in-person rehabilitation services. Although this study lacked a control group, stratification by adherence provided meaningful comparisons. Limitations include the small sample size, a potential selection bias toward digitally literate patients, and unmeasured confounders such as baseline physical activity and nutrition. Improvements in HRQOL may also reflect anticancer treatment response, which was not formally assessed. Additional limitations include the absence of oncological and safety outcomes (e.g. falls or skeletal-related events) and lack of long-term HRQOL follow-up. Observed improvements in FACT-G exceeded published minimally important difference thresholds, supporting clinical relevance. Future research should explore long-term adherence, biological correlates, and integration into routine care, especially in older and comorbid populations where functional preservation is critical. Adherence to a remote, home-based exercise programme significantly improved HRQOL and reduced symptom burden in men undergoing treatment for advanced PCa. Digital platforms can deliver effective, scalable exercise interventions, even in low-resource settings. Oncology teams should prioritise early integration of exercise, with guidance and digital support, as a cost-effective strategy to enhance patient-centred outcomes. These results are hypothesis-generating and require confirmation in larger, randomised studies with diverse populations and broader outcome assessment. Nothing to declare. None. The data supporting the findings of this study are available from the corresponding author upon reasonable request.