FOR PROSTATE CANCER PATIENTS ON ADT

Prostate cancer (PCa) is the most common cancer inCanadian men1. Androgen Deprivation Therapy (ADT) isindicated in more than 50% of all PCa patients with locallyadvanced or metastatic disease2. ADT increases 5 and 10year survival but is associated with numerous side-effects, including: increased fatigue and fat mass, andreduced muscle mass and physical strength3. These side-effects collectively contribute to a reduced health-relatedquality of life (HRQOL). Supervised and home-basedphysical activity (PA) and exercise programs havedemonstrated benefits for these patients4, but studieshave not yet compared specific exercise modalities orassessed long-term adherence (beyond 3-6 months).

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

1) To compare the benefits of aerobic exercise training (AET)and resistance exercise training (RET)

2) To assess adherence (and correlates of adherence) tohome-base exercise in both exercise modalities

3) To assess the feasibility of recruitment and retention withina pilot randomized trial

OBJECTIVES

50 patients undergoing continuous ADT were recruited from theProstate Centre at Princess Margaret Hospital. Participantswere randomized to a home-based AET (n=30) or a home-basedRET (n=30) for 24 weeks (see sidebar for intervention details).Outcome measures were assessed at: baseline, 12 weeks, and24 weeks (final endpoint is at 48 weeks and is not yet available).Group-based “Booster Sessions” were held for all exercisingsubjects on a bi-weekly basis to facilitate adherence as well ascompetent and confident home-based exercise (see sidebar forBooster Session details).Fitness Outcomes (measures)• Aerobic Fitness (est. VO2 max; mod.Bruce Protocol)• Grip Strength• Anthropometry (Waist circumference, BMI, Chest Skinfold, Weight)• Adherence (Godin Leisure-Time Exercise Quest.)Psychosocial Outcomes (measures)• Fatigue (FACT-F)• HRQOL (FACT-P; PORPUS)

METHODS

Preliminary findings indicate that 12 weeks of AETcan improve several fitness outcomes, and issuperior to RET for improvements in weight, BMI,waist circumference, and PA volume (p<0.1). At 24weeks, RET participants significantly improved chestskinfold thickness and VO2 max (p<0.05). At 24 wks,no between-group differences were apparent. Thehigh retention rate and improvements in weekly PAvolume indicate a highly adherent populationsupporting the feasibility of future large-scalestudies comparing AET and RET.

CONCLUSIONS

•At 12 wks, AET is superior to RET in improvementsin weight and BMI (p<0.05), and trends towardsgreater improvements in waist circumference, chestskinfold thickness, VO2 max, and PA volume (p<0.10)•At 24 wks, there is no difference in outcomesbetween AET and RET•At 24 wks, both groups (in aggregate) significantimprovements were observed in waistcircumference, chest skinfold thickness, and VO2 maxmeasurements(p<0.05)•Participation is 35%, similar to other exerciseinterventions in PCa•Strong retention (~90%) demonstrates acceptableand tolerable exercise interventions

Princess Margaret Hospital

Survivorship

Exercise

Program

1 . Canadian Cancer Society/National Cancer Institute of Canada, Canadian Cancer Statistics, 2008, 1-72 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-metastatic prostate cancer: A systematic literature review. Crit Rev Onc/Haem, 2006 (6): 201-2154. Thorsen, L., Courneya, K.S., Stevinson, C. and S.D. Fossa. A systematic review of physical activity in prostate cancer survivors: Outcomes, prevalence, and determinants. Supp Care Cancer, 2008, 987-997

References

Outcome AET (n=21) RET (n=23) AET v RET(p=)

Weight (kg) -1.5 (2.2); p=0.007 0.2(2.4); p=0.968 0.046

BMI (kg/m2) -0.5(0.7); p= 0.006 -0.001 (0.8); p=0.99 0.049

Waist Circumference (cm) -2.0 (3.3); p=0.009 0.12(3.7); p=0.881 0.052

Chest Skinfold (mm) -4.4 (7.9); p=0.019 -2.2(6.6); p=0.154 0.339

Grip Strength (comb.; kg) -1.19(7.7); p=0.488 -0.9 (6.9); p=0.564 0.899

VO2 Max (mlO2/kg/min) 2.7 (4.9); p= 0.032 0.26(5.1); p=0.818 0.142

PA Volume (met-hrs/wk) 16.5 (34.2); p=0.05 0.34(18.5); p=0.930 0.080

Fatigue (FACT-F) -1.7 (5.0); p=0.154 1.6(9.8); p=0.473 0.192

HRQOL (PORPUS) -0.04 (7.3); p=0.980 0.25 (8.0); p=0.904 0.912

HRQOL (FACT-P) -2.0 (11.5); p=0.503 4.2 (13.4); p=0.218 0.169

Table 2: Baseline to 12 wks

•Every other week•Resistance and Aerobic Exercise Instruction•60 minutes of exercise + 30 minutes of class discussion•12 Rotating Behaviour-Change topics (class discussion)Booster Session Topics1. Introduction to Exercise2. Goal Setting3. Behaviour Change4. Planning for Barriers5. Social Support6. Monitoring Behaviour7. Maintaining Motivation8. Adapting Your Program9. Personal Control10.Self-Reward/Discipline11.Home-Based Exercise12.Keeping Active

• 3-5x per week• 50-85% MHR • (RPE = 4-7/10)• 30-60 minutes• Intensity is monitored

w/ HR monitors

Preferred modality:1. Walking (Road)2. Walking (Treadmill)3. Cycling (Road)4. Cycling (Stationary)5. Swimming6. Elliptical Machine7. Stepping Machine

• 3-5x per week• ~50-85% of 1RM • (RPE = 4-7/10)• 8-12 reps, 1-2 sets• 10 exercises using

resistance bands, stability balls, and exercise mats (provided to patient

Exercises:1. Ball squats2. Hip Extensions3. Hamstring Curls4. Push-Ups5. Bicep Curls6. Triceps Extension7. Lateral Raise8. Seated Row9. Upright Row10.Abdominal Crunch

Aerobic Exercise Program

Booster Sessions

Resistance Exercise Program

N=161 participants were approached, of whom, n=56 were randomized(35% participation rate). N=6 participants have dropped out before 12weeks, with no additional dropouts after 12 weeks(3 dropped outbecause they were assigned to their non-preferred exercise modality).Retention at 12 weeks is 50/56(89%.)

PARTICIPATION

Table 1: Baseline Characteristics (Both Groups; n=50)Variable` n (%) Variable Mean (SD)

Caucasian 34 (68%) Age (years) 71 (8.9)

Retired 31 (62%) BMI (kg/m2) 28.9 (3.9)

Married (inc. common-law) 35 (70%) Waist Circumference (cm) 104.3 (9.9)

Education (Undergrad/Grad) 24(48%) Chest Skinfold (mm) 36.0 (11.0)

Not Smoking 47(94%) Grip Strength (comb.; kg) 50.2 (12.5)

LHRH +/- Bicalutamide 41(82%) VO2 Max (mlO2/kg/min) 27.6 (8.6)

Gleason (7+) 30(60%) PA Volume (met-hrs/wk) 18.5 (14.4)

• Complete data collection (n=60 at 24 and 48 wks)• Analyze stored serum (IGF-1, leptin & adiponectin)• Analysis of adherence (PA log) and related variables (self-efficacy, social support, and exercise-feelings)

FUTURE DIRECTIONS

Exercise Space Provided by: E L L I C S R

*increases in psychosocial values indicate improvement

Booster Sessions at ELLICSR

Outcome (SD) Sig.

Weight (kg) -0.22(2.7) p=0.69

BMI (kg/m2) -0.056(0.95) p=0.77

Waist Circumference (cm) -1.76(3.7) p=0.025

Chest Skinfold (mm) -4.15(6.31) p=0.003

Grip Strength (combined; kg) 0.083(8.03) p=0.960

VO2 Max (mlO2/kg/min) 3.3 3(5.1) p=0.004

PA Volume (met-hrs/wk) 11.0 (29.0) p=0.076

Fatigue (FACT-F) 0.9(7.9) p=0.587

HRQOL (PORPUS) 1.5(6.7) p=0.319

HRQOL (FACT-P) 1.8 (14.7) p=0.596

Table 3: AET +RET (n=25) Baseline to24 wks

Preliminary data are presentedRESULTS

DISCUSSION

AEROBIC VERSUS RESISTANCE EXERCISE TRAINING