Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

doi:10.1111/bju.14505

Randomized Controlled Trial

. 2019 Feb;123(2):261-269.

doi: 10.1111/bju.14505. Epub 2018 Sep 21.

Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

Dennis R Taaffe^{1

2

3}, Daniel A Galvão^{1

2}, Nigel Spry^{1

4

5}, David Joseph^{1

5

6}, Suzanne K Chambers^{1

7

8

9}, Robert A Gardiner^{1

10

11}, Dickon Hayne^{12

13}, Prue Cormie¹⁴, David H K Shum^{7

15}, Robert U Newton^{1

2

3

16}

Affiliations

¹ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
² School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
³ School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland,, Australia.
⁴ Genesis CancerCare, Joondalup, Western Australia,, Australia.
⁵ Faculty of Medicine, University of Western Australia, Nedlands, Western Australia,, Australia.
⁶ Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
⁷ Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland,, Australia.
⁸ Centre for Research in Cancer, Cancer Council, Queensland, Brisbane, Queensland, Australia.
⁹ Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia.
¹⁰ Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland,, Australia.
¹¹ University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.
¹² UWA Medical School, University of Western Australia, Crawley, Western Australia,, Australia.
¹³ Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹⁴ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
¹⁵ Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
¹⁶ Institute of Human Performance, The University of Hong Kong, Hong Kong, China.

PMID: 30239116
PMCID: PMC6635752
DOI: 10.1111/bju.14505

Randomized Controlled Trial

Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

Dennis R Taaffe et al. BJU Int. 2019 Feb.

. 2019 Feb;123(2):261-269.

doi: 10.1111/bju.14505. Epub 2018 Sep 21.

Authors

Affiliations

¹ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
² School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
³ School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland,, Australia.
⁴ Genesis CancerCare, Joondalup, Western Australia,, Australia.
⁵ Faculty of Medicine, University of Western Australia, Nedlands, Western Australia,, Australia.
⁶ Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
⁷ Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland,, Australia.
⁸ Centre for Research in Cancer, Cancer Council, Queensland, Brisbane, Queensland, Australia.
⁹ Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia.
¹⁰ Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland,, Australia.
¹¹ University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.
¹² UWA Medical School, University of Western Australia, Crawley, Western Australia,, Australia.
¹³ Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹⁴ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
¹⁵ Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
¹⁶ Institute of Human Performance, The University of Hong Kong, Hong Kong, China.

PMID: 30239116
PMCID: PMC6635752
DOI: 10.1111/bju.14505

Abstract

Objectives: To examine whether it is more efficacious to commence exercise medicine in men with prostate cancer at the onset of androgen-deprivation therapy (ADT) rather than later on during treatment to preserve bone and soft-tissue composition, as ADT results in adverse effects including: reduced bone mineral density (BMD), loss of muscle mass, and increased fat mass (FM).

Patients and methods: In all, 104 patients with prostate cancer, aged 48-84 years initiating ADT, were randomised to immediate exercise (IMEX, n = 54) or delayed exercise (DEL, n = 50) conditions. The former consisted of 6 months of supervised resistance/aerobic/impact exercise and the latter comprised 6 months of usual care followed by 6 months of the identical exercise programme. Regional and whole body BMD, lean mass (LM), whole body FM and trunk FM, and appendicular skeletal muscle (ASM) were assessed by dual X-ray absorptiometry, and muscle density by peripheral quantitative computed tomography at baseline, and at 6 and 12 months.

Results: There was a significant time effect (P < 0.001) for whole body, spine and hip BMD with a progressive loss in the IMEX and DEL groups, although lumbar spine BMD was largely preserved in the IMEX group at 6 months compared with the DEL group (-0.4% vs -1.6%). LM, ASM, and muscle density were preserved in the IMEX group at 6 months, declined in the DEL group at 6 months (-1.4% to -2.5%) and then recovered at 12 months after training. FM and trunk FM increased (P < 0.001) over the 12-month period in the IMEX (7.8% and 4.5%, respectively) and DEL groups (6.5% and 4.3%, respectively).

Conclusions: Commencing exercise at the onset of ADT preserves lumbar spine BMD, muscle mass, and muscle density. To avoid treatment-related adverse musculoskeletal effects, exercise medicine should be prescribed and commenced at the onset of ADT.

Keywords: #PCSM; #ProstateCancer; androgen-deprivation therapy; exercise.

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Conflict of interest statement

The authors have no conflict of interests to disclose.

Figures

**Figure 1**
Consolidated Standards of Reporting Trials (CONSORT) diagram. ITT, intention‐to‐treat.

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References

1. Nguyen PL, Alibhai SM, Basaria S et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2015; 67: 825–36 - PubMed
1. Spry NA, Kristjanson L, Hooton B et al. Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer. Eur J Cancer 2006; 42: 1083–92 - PubMed
1. Galvão DA, Spry NA, Taaffe DR et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008; 102: 44–7 - PubMed
1. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154–64 - PubMed
1. Smith MR, Saad F, Egerdie B et al. Sarcopenia during androgen‐deprivation therapy for prostate cancer. J Clin Oncol 2012; 30: 3271–6 - PMC - PubMed

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[1] Nguyen PL, Alibhai SM, Basaria S et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2015; 67: 825–36 - PubMed

[2] Nguyen PL, Alibhai SM, Basaria S et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2015; 67: 825–36 - PubMed

[3] Spry NA, Kristjanson L, Hooton B et al. Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer. Eur J Cancer 2006; 42: 1083–92 - PubMed

[4] Spry NA, Kristjanson L, Hooton B et al. Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer. Eur J Cancer 2006; 42: 1083–92 - PubMed

[5] Galvão DA, Spry NA, Taaffe DR et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008; 102: 44–7 - PubMed

[6] Galvão DA, Spry NA, Taaffe DR et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008; 102: 44–7 - PubMed

[7] Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154–64 - PubMed

[8] Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154–64 - PubMed

[9] Smith MR, Saad F, Egerdie B et al. Sarcopenia during androgen‐deprivation therapy for prostate cancer. J Clin Oncol 2012; 30: 3271–6 - PMC - PubMed

[10] Smith MR, Saad F, Egerdie B et al. Sarcopenia during androgen‐deprivation therapy for prostate cancer. J Clin Oncol 2012; 30: 3271–6 - PMC - PubMed

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Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

Affiliations

Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition

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