Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ipos 2010


Published on

Published in: Education
  • Be the first to comment

  • Be the first to like this

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