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