Physical exercise for functional capacity, blood immune function, fatigue, and quality of life in high-risk prostate cancer patients during radiotherapy: a prospective, randomized clinical study

Abstract

Background: During radiotherapy (RT), prostate cancer (PCa) patients may report cancer related fatigue (CRF), which impairs functional capacity, psychological status, and quality of life (QoL). RT can induce cytokine responses that could play a role in mediating radiation toxicity by increasing inflammation. While it is known that physical exercise plays an important anti-inflammatory role in healthy adults, its specific anti-inflammatory effects in PCa patients with CRF have not yet been determined.

Aim: Previous studies have shown that physical exercise in cancer patients undergoing RT improves cardiac fitness, muscle strength, and QoL, however it is still unknown how physical exercise affects inflammation and its specific consequences in PCa patients. Therefore, the purpose of this trial was to examine the effect of supervised physical exercise on inflammatory blood markers, as well as the relationship of these parameters with functional capacity, fatigue, and QoL in high-risk PCa patients undergoing RT.

Design: This was a prospective, two-arm randomized controlled clinical trial.

Setting: The study was performed in our outpatients center.

Population: Fifty-four high-risk PCa men were randomly allocated to two groups prior to undergoing RT.

Methods: Twenty-seven patients performed supervised, moderate-intensity physical exercise (exercise group; EG) and the other 27 formed a control group that carried out normal daily physical activity (usual group; UG). The following parameters were assessed before and after RT: functional capacity, changes in blood count variables and production of pro-inflammatory cytokines (interleukin [IL]-1β, IL-6, tumor necrosis factor [TNF]-α), fatigue, and QoL (using FACT-F score and EORTC questionnaires).

Results: No significant differences existed between the study groups at baseline assessment. After RT, there was a significant improvement in functional capacity (P<0.05) and a decrease in pro-inflammatory cytokine levels (P>0.05) and fatigue (P<0.05) in the EG compared to the UG. Fatigue level was significantly higher in the UG (F[2.126]; P<0.05) after RT than before. Physical exercise had no effect on the correlation between inflammatory blood markers and functional capacity and fatigue scores provided by study participants.

Conclusions: Regular, moderate-intensity physical exercise improves functional capacity, decreases the production of inflammatory markers and fatigue, and has a positive influence on QoL in high-risk PCa patients during RT.

Clinical rehabilitation impact: This is one of the first studies to examine the effects of supervised exercise training on pro-inflammatory cytokine levels during RT in PCa patients by measuring functional capacity, fatigue, and QoL.