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Ipos 2010

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Ipos 2010

  1. 1. AEROBIC VERSUS RESISTANCE EXERCISE TRAINING FOR PROSTATE CANCER PATIENTS ON ADT Daniel Santa Mina1,2 PhD (Cand), Shabbir M.H. Alibhai3 MD , Meysam Pirbaglou1 BSc, Andrew Matthew2 PhD, John Trachtenberg2 MD, Neil Fleshner2 MD, Mike Connor1 PhD, George Tomlinson3 PhD, And Paul Ritvo1,4,5 PhD 1.York University; 2.Princess Margaret Hospital; 3.Toronto General Hospital; 4.Cancer Care Ontario, 5.Ontario Cancer Institute BACKGROUND PARTICIPATION Aerobic Exercise Program Prostate cancer (PCa) is the most common cancer in N=161 participants were approached, of whom, n=56 were randomized Canadian men1. Androgen Deprivation Therapy (ADT) is (35% participation rate). N=6 participants have dropped out before 12 Booster Sessions • 3-5x per week indicated in more than 50% of all PCa patients with locally weeks, with no additional dropouts after 12 weeks(3 dropped out at ELLICSR • 50-85% MHR • (RPE = 4-7/10) advanced or metastatic disease2. ADT increases 5 and 10 because they were assigned to their non-preferred exercise modality). • 30-60 minutes year survival but is associated with numerous side- Retention at 12 weeks is 50/56(89%.) • Intensity is monitored effects, including: increased fatigue and fat mass, and w/ HR monitors reduced muscle mass and physical strength3. These side- effects collectively contribute to a reduced health-related RESULTS Preferred modality: 1. Walking (Road) quality of life (HRQOL). Supervised and home-based Preliminary data are presented 2. Walking (Treadmill) physical activity (PA) and exercise programs have Table 1: Baseline Characteristics (Both Groups; n=50) 3. Cycling (Road) demonstrated benefits for these patients4, but studies Variable` n (%) Variable Mean (SD) 4. Cycling (Stationary) have not yet compared specific exercise modalities or 5. Swimming Caucasian 34 (68%) Age (years) 71 (8.9) 6. Elliptical Machine assessed long-term adherence (beyond 3-6 months). Retired 31 (62%) BMI (kg/m2) 28.9 (3.9) 7. Stepping Machine Married (inc. common-law) 35 (70%) Waist Circumference (cm) 104.3 (9.9) OBJECTIVES Education (Undergrad/Grad) 24(48%) Chest Skinfold (mm) 36.0 (11.0) DISCUSSION Resistance Exercise Program Not Smoking 47(94%) Grip Strength (comb.; kg) 50.2 (12.5) •At 12 wks, AET is superior to RET in improvements LHRH +/- Bicalutamide 41(82%) VO2 Max (mlO2/kg/min) 27.6 (8.6) in weight and BMI (p<0.05), and trends towards • 3-5x per week 1) To compare the benefits of aerobic exercise training (AET) • ~50-85% of 1RM and resistance exercise training (RET) Gleason (7+) 30(60%) PA Volume (met-hrs/wk) 18.5 (14.4) greater improvements in waist circumference, chest • (RPE = 4-7/10) 2) To assess adherence (and correlates of adherence) to skinfold thickness, VO2 max, and PA volume (p<0.10) • 8-12 reps, 1-2 sets home-base exercise in both exercise modalities Table 2: Baseline to 12 wks •At 24 wks, there is no difference in outcomes • 10 exercises using 3) To assess the feasibility of recruitment and retention within Outcome AET (n=21) RET (n=23) AET v RET between AET and RET resistance bands, (p=) a pilot randomized trial •At 24 wks, both groups (in aggregate) significant stability balls, and Weight (kg) -1.5 (2.2); p=0.007 0.2(2.4); p=0.968 0.046 improvements were observed in waist exercise mats BMI (kg/m2) -0.5(0.7); p= 0.006 -0.001 (0.8); p=0.99 0.049 circumference, chest skinfold thickness, and VO2 max (provided to patient -2.0 (3.3); p=0.009 0.12(3.7); p=0.881 0.052 measurements(p<0.05) Waist Circumference (cm) Exercises: •Participation is 35%, similar to other exercise METHODS Chest Skinfold (mm) -4.4 (7.9); p=0.019 -2.2(6.6); p=0.154 0.339 interventions in PCa 1. Ball squats 2. Hip Extensions -1.19(7.7); p=0.488 -0.9 (6.9); p=0.564 0.899 •Strong retention (~90%) demonstrates acceptable 3. Hamstring Curls 50 patients undergoing continuous ADT were recruited from the Grip Strength (comb.; kg) and tolerable exercise interventions 4. Push-Ups Prostate Centre at Princess Margaret Hospital. Participants 2.7 (4.9); p= 0.032 0.26(5.1); p=0.818 0.142 VO2 Max (mlO2/kg/min) 5. Bicep Curls were randomized to a home-based AET (n=30) or a home-based 6. Triceps Extension RET (n=30) for 24 weeks (see sidebar for intervention details). Outcome measures were assessed at: baseline, 12 weeks, and PA Volume (met-hrs/wk) Fatigue (FACT-F) 16.5 (34.2); p=0.05 -1.7 (5.0); p=0.154 0.34(18.5); p=0.930 1.6(9.8); p=0.473 0.080 0.192 CONCLUSIONS12 weeks of AET Preliminary findings indicate that 7. Lateral Raise 8. Seated Row 24 weeks (final endpoint is at 48 weeks and is not yet available). -0.04 (7.3); p=0.980 0.25 (8.0); p=0.904 0.912 9. Upright Row HRQOL (PORPUS) can improve several fitness outcomes, and is Group-based “Booster Sessions” were held for all exercising 10.Abdominal Crunch subjects on a bi-weekly basis to facilitate adherence as well as HRQOL (FACT-P) -2.0 (11.5); p=0.503 4.2 (13.4); p=0.218 0.169 superior to RET for improvements in weight, BMI, competent and confident home-based exercise (see sidebar for waist circumference, and PA volume (p<0.1). At 24 Booster Sessions weeks, RET participants significantly improved chest Booster Session details). Table 3: AET +RET (n=25) Baseline to24 wks •Every other week Fitness Outcomes (measures) skinfold thickness and VO2 max (p<0.05). At 24 wks, Outcome (SD) Sig. •Resistance and Aerobic • Aerobic Fitness (est. VO2 max; mod.Bruce Protocol) no between-group differences were apparent. The Exercise Instruction Weight (kg) -0.22(2.7) p=0.69 • Grip Strength high retention rate and improvements in weekly PA •60 minutes of exercise + 30 BMI (kg/m2) -0.056(0.95) p=0.77 volume indicate a highly adherent population minutes of class discussion • Anthropometry (Waist circumference, BMI, Chest Skinfold, Waist Circumference (cm) -1.76(3.7) p=0.025 supporting the feasibility of future large-scale •12 Rotating Behaviour- Weight) studies comparing AET and RET. Change topics (class • Adherence (Godin Leisure-Time Exercise Quest.) Chest Skinfold (mm) -4.15(6.31) p=0.003 discussion) Psychosocial Outcomes (measures) 0.083(8.03) p=0.960 Booster Session Topics Grip Strength (combined; kg) • Fatigue (FACT-F) 1. Introduction to Exercise VO2 Max (mlO2/kg/min) 3.3 3(5.1) p=0.004 • HRQOL (FACT-P; PORPUS) PA Volume (met-hrs/wk) 11.0 (29.0) p=0.076 FUTURE DIRECTIONS 2. Goal Setting 3. Behaviour Change 0.9(7.9) p=0.587 4. Planning for Barriers Fatigue (FACT-F) • Complete data collection (n=60 at 24 and 48 wks) 5. Social Support HRQOL (PORPUS) 1.5(6.7) p=0.319 • Analyze stored serum (IGF-1, leptin & adiponectin) 6. Monitoring Behaviour 1.8 (14.7) p=0.596 • Analysis of adherence (PA log) and related variables 7. Maintaining Motivation HRQOL (FACT-P) (self-efficacy, social support, and exercise-feelings) 8. Adapting Your Program *increases in psychosocial values indicate improvement 9. Personal Control 10.Self-Reward/Discipline 11.Home-Based Exercise 12.Keeping Active References 1 . Canadian Cancer Society/National Cancer Institute of Canada, Canadian Cancer Statistics, 2008, 1-72 Survivorship 2. Cooperberg, M.R. et al, National practice patterns and time trends in androgen ablation for localized prostate cancer. J Nat Can Inst, 2003, 95: 981-989 3. Alibhai, SMH, S. Gogov, and Z. Allibhai. Long-term side effects of androgen deprivation therapy in men with non- Exercise metastatic prostate cancer: A systematic literature review. Crit Rev Onc/Haem, 2006 (6): 201-215 4. Thorsen, L., Courneya, K.S., Stevinson, C. and S.D. Fossa. A systematic review of physical activity in prostate cancer Princess Margaret Hospital Program survivors: Outcomes, prevalence, and determinants. Supp Care Cancer, 2008, 987-997 Exercise Space Provided by: E L L I C S R

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