Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis

doi:10.1016/j.eururo.2015.10.047

European Urology

Volume 69, Issue 4, April 2016, Pages 693-703

https://doi.org/10.1016/j.eururo.2015.10.047 Get rights and content

Abstract

Context

Exercise could be beneficial for prostate cancer survivors. However, no systematic review across cancer stages and treatment types addressing potential benefits and harms exists to date.

Objective

To assess the effects of exercise on cancer-specific quality of life and adverse events in prostate cancer trials.

Evidence acquisition

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, SPORTDiscus, and PEDro. We also searched grey literature databases, including trial registers. Searches were from database inception to March 2015. Standardised mean differences (SMDs) were calculated for meta-analysis.

Evidence synthesis

We included 16 randomised controlled trials (RCTs) involving 1574 men with prostate cancer. Follow-up varied from 8 wk to 12 mo. RCTs involved men with stage I–IV cancers. A high risk of bias was frequently due to problematic intervention adherence. Seven trials involving 912 men measured cancer-specific quality of life. Pooling of the data from these seven trials revealed no significant effect on this outcome (SMD 0.13, 95% confidence interval [CI] –0.08 to 0.34, median follow-up 12 wk). Sensitivity analysis of studies that were judged to be of high quality indicated a moderate positive effect estimate (SMD 0.33, 95% CI 0.08–0.58; median follow-up 12 wk). Similar beneficial effects were seen for cancer-specific fatigue, submaximal fitness, and lower body strength. We found no evidence of benefit for disease progression, cardiovascular health, or sexual function. There were no deaths attributable to exercise interventions. Other serious adverse events (eg, myocardial infarction) were equivalent to those seen in controls.

Conclusions

These results support the hypothesis that exercise interventions improve cancer-specific quality of life, cancer-specific fatigue, submaximal fitness, and lower body strength.

Patient summary

This review shows that exercise/physical activity interventions can improve quality of life, fatigue, fitness, and function for men with prostate cancer.

Introduction

Prostate cancer is the primary cause of years lived with cancer disability in the Americas, Northwest Europe, Australia, New Zealand, and much of sub-Saharan Africa [1]. Management of prostate cancer ranges from no intervention (active surveillance or watchful waiting) to radical local treatment (prostatectomy and radiation therapy) with or without combined androgen deprivation therapy (ADT), ADT alone, to taxane-based chemotherapy for progressive castration-resistant disease [2] and second-line hormone agents [3], [4]. First-line radical treatment for prostate cancer can negatively impact quality of life (eg, erectile dysfunction, incontinence, radiation proctitis), as can ADT (eg, loss of muscle mass, fatigue, psychological morbidity, higher risk of cardiovascular disease and bone fracture) [5], [6]. Direct symptoms for advanced or metastatic cancer (eg, pain, hypercalcaemia, spinal cord compression, pathological fractures) can also adversely affect health [7], [8].

Several recent systematic reviews have examined the effects of exercise in cancer survivors in terms of quality of life [9], [10], exercise behaviour [11], and fatigue [12]. These reviews cover an amalgamation of heterogeneous primary cancers. Most evidence comes from trials in breast cancer and thus cannot be generalised to men with prostate cancer. Furthermore, exercise therapy appears to be beneficial in the short term, but little is known about dose, duration, and longer-term effects of such therapy, including adverse effects over extended follow-up. Finally, despite the potential health benefits for men with prostate cancer, few clinicians are aware of the role of exercise, and in many cases it goes unprescribed. The aim of this review was primarily to evaluate the effect of exercise interventions on cancer-specific quality of life after prostate cancer diagnosis and to assess adverse effects.

Section snippets

Evidence acquisition

Methods for this systematic review have been described in detail elsewhere [13]. In brief, the primary review outcomes were quality of life and adverse events. Secondary outcomes include effects on fatigue, disease progression, cardiovascular health, physical fitness and function, and sexual function.

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, SPORTDiscus, and PEDro databases from inception to March 31, 2015. We expanded the database

Search results

Figure 1 shows the results for the literature searches and screening process for the review. We identified 4356 unique records from database searches and 22 manuscripts through grey literature and hand checking of references for studies included and related systematic reviews [16], [17]. After reviewing by title and abstract, we evaluated the full text for 91 records, after which 67 studies were excluded from the review. All full-text manuscripts were available in English. We sent 31 emails

Conclusions

There is level 1 evidence that exercise interventions are efficacious in improving cancer-specific quality of life, fatigue, and exercise capacity in men with prostate cancer. The high-quality evidence comes mainly from men with advanced disease on ADT. Adverse events such as minor soft-tissue injuries (sprains and strains) can be expected in a minority of men but can also be mitigated by properly tailored exercise prescription and progression around individual capabilities and existing

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Cited by (203)

Control4Life: A randomized controlled trial protocol examining the feasibility and efficacy of a combined pelvic health rehabilitation and exercise fitness program for individuals undergoing prostatectomy.
2024, Contemporary Clinical Trials
Urinary incontinence (UI), erectile dysfunction and cardiometabolic conditions are common after prostatectomy for prostate cancer (PCa). Although physical activity could improve overall survival and quality of survivorship, fear of UI can restrict participation in exercise. Individuals with PCa could benefit from therapeutic exercise programming to support continence recovery and cardiometabolic health.
The main objective of this study is to determine the feasibility and the effects of a combined pelvic health rehabilitation and exercise fitness program on UI after prostatectomy. The combined exercise program will be delivered both in-person and virtually.
This study follows a modified Zelen, two-arm parallel randomized controlled trial design. A total of 106 individuals with PCa will be recruited before prostatectomy surgery. Participants will be randomized between two groups: one receiving usual care and one receiving a combined exercise fitness and intensive pelvic floor muscle training program. Exercise programming will begin 6–8 weeks after prostatectomy and will last 12 weeks. Outcomes include: the 24-h pad test (primary outcome for UI); physical fitness, metabolic indicators, and patient-reported outcomes on erectile function, self-efficacy, severity of cancer symptoms and quality of life. Important timepoints for assessments include before surgery (T0), after surgery (T1), after intervention (T3) and at one-year after surgery (T4).
This study will inform the feasibility of offering comprehensive exercise programming that has the potential to positively impact urinary continence, erectile function and cardiometabolic health of individuals undergoing prostatectomy for prostate cancer.
ClinicalTrials Registration Number: NCT06072911.
A comparison of aerobic- and resistance-emphasised exercise on cardiometabolic health and quality of life in men receiving androgen deprivation therapy for prostate cancer: Protocol for a feasibility trial
2024, Contemporary Clinical Trials
Those with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes.
This is a 6-month randomised two-armed feasibility trial. Prostate cancer patients undergoing ADT and radiotherapy will be recruited (n = 24) and randomised to either a resistance- or aerobic-emphasised group. Participants will attend twice-weekly supervised individual or small group sessions, with 75% of exercise time in the primary exercise modality. The primary outcome will be feasibility, determined via assessment of recruitment, retention, adherence, safety, and acceptability. Secondary outcomes will include quality of life, body composition, vascular indices, aerobic and muscular fitness and cardiometabolic health blood biomarkers.
It is envisaged that the trial will provide valuable information and preliminary difference data that will aid in the design of an efficacious larger trial that will adopt a major and minor emphasis approach to the scheduling of resistance and aerobic exercise.
What more comprehensive physiotherapy techniques than pelvic floor muscles training should be investigated in the context of post-prostatectomy? A narrative review
2023, Progres en Urologie
In a previous article, we have underlined the emerging level of evidence for the effectiveness of a more comprehensive functional physical therapy than solely pelvic floor muscles training (PFMT) for men after radical prostatectomy (RP). More and more authors suggest that physiotherapy programs should not focus only on the side effect of continence, but more generally on the interaction of continence disorders with all other side effects related to patient's physical and emotional functioning.
The aims of this narrative review are to highlight rehabilitation approaches unrelated to analytical PFMT that would seem relevant to consider in the future for post-RP men.
Our narrative review sought to map the body of literature relevant to the primary objective (non-PFMT), supplementing the data from our previous review with additional recent articles that were not eligible due to not meeting the inclusion criteria for a systematic review.
After full text screening, 13 interventional studies have been selected. Intervention strategies were based on five major type of exercises: flexibility, synergism & co-activation, coordination & movement control, strength & endurance, aerobic & games therapy. Most of the studies of this narrative review focused on synergies, co-activations and movement control techniques that emphasized the deep abdominal muscles and PFMs reflexive activation. The wide variety of countries represented in the 13 studies with consistent results point to the potential effectiveness and replicability across various socio-cultural, ethnical, or religious contexts.
We found 13 studies from 9 different countries that provide a more complete rehabilitation approach than PFMT alone in men post-RP. Intervention strategies were built around five main types of exercises, with the majority of them emphasizing synergies, co-activations, and movement control techniques. In light of these data, we hope that future research will enable us to offer the most relevant and patient-centered physiotherapy treatment.
Dans un article précédent, nous avons souligné l’émergence d’un niveau de preuve de l’efficacité d’une physiothérapie fonctionnelle plus complète que le seul entraînement des muscles du plancher pelvien l’homme après une prostatectomie radicale. De plus en plus d’auteurs suggèrent que les programmes de physiothérapie ne devraient pas se concentrer uniquement sur l’effet secondaire de la continence, mais plus globalement sur l’interaction des troubles de la continence avec l’ensemble des autres effets secondaires liés au fonctionnement physique et émotionnel du patient.
Les objectifs de cette revue narrative sont de mettre en évidence les approches rééducatives différentes de l’entraînement des muscles du plancher pelvien (EMPP) de manière analytique, qu’il semblerait pertinent de considérer à l’avenir pour les hommes post-prostatectomie.
Notre revue narrative a cherché à cartographier l’ensemble de la littérature répondant à l’objectif principal (techniques rééducatives non-EMPP), en complétant les données de notre revue précédente avec d’autres articles récents qui n’étaient pas éligibles, car ils ne remplissaient pas les critères d’inclusion d’une revue systématique.
Après lecture du texte intégral, 13 études interventionnelles ont été sélectionnées. Les stratégies d’intervention étaient basées sur cinq grands types d’exercices. La plupart des études de cette revue narrative se sont concentrées sur les synergies, les co-activations et les techniques de contrôle des mouvements qui mettaient l’accent sur l’activation réflexe des muscles abdominaux profonds et des muscles du plancher pelvien. La grande variété de pays représentés dans les 13 études avec des résultats cohérents suggère une efficacité possible et reproductible dans divers contextes socio-culturels, ethniques ou religieux.
Nous avons retrouvé 13 études de 9 pays différents qui apportent une approche rééducative fonctionnelle plus complète que le seul EMPP analytique chez les hommes post-prostatectomie. Les stratégies d’intervention ont été construites autour de cinq principaux types d’exercices, la majorité d’entre eux mettant l’accent sur les synergies, les co-activations et les techniques de contrôle des mouvements. À la lumière de ces données, nous espérons que les recherches futures nous permettront d’offrir un traitement de physiothérapie le plus pertinent et centré sur le patient.
Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial
2023, Journal of Sport and Health Science
Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period.
Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes.
At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups.
The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.
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Prostate cancer is among most malignant tumors around the world and this urological tumor can be developed as result of genomic mutations and their accumulation during progression towards advanced stage. Due to lack of specific symptoms in early stages of prostate cancer, most cancer patients are diagnosed in advanced stages that tumor cells display low response to chemotherapy. Furthermore, genomic mutations in prostate cancer enhance the aggressiveness of tumor cells. Docetaxel and paclitaxel are suggested as well-known compounds for chemotherapy of prostate tumor and they possess a similar function in cancer therapy that is based on inhibiting depolymerization of microtubules, impairing balance of microtubules and subsequent delay in cell cycle progression. The aim of current review is to highlight mechanisms of paclitaxel and docetaxel resistance in prostate cancer. When oncogenic factors such as CD133 display upregulation and PTEN as tumor-suppressor shows decrease in expression, malignancy of prostate tumor cells enhances and they can induce drug resistance. Furthermore, phytochemicals as anti-tumor compounds have been utilized in suppressing chemoresistance in prostate cancer. Naringenin and lovastatin are among the anti-tumor compounds that have been used for impairing progression of prostate tumor and enhancing drug sensitivity. Moreover, nanostructures such as polymeric micelles and nanobubbles have been utilized in delivery of anti-tumor compounds and decreasing risk of chemoresistance development. These subjects are highlighted in current review to provide new insight for reversing drug resistance in prostate cancer.

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Collaborative Review – Prostatic DiseaseExercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Context

Objective

Evidence acquisition

Evidence synthesis

Conclusions

Patient summary

Introduction

Section snippets

Evidence acquisition

Search results

Conclusions

Lancet

Eur Urol

Eur Urol

Eur Urol

J Urol

Eur Urol

Eur Urol

Cancer Epidemiol

Eur Urol

Arch Phys Med Rehab

J Urol

J Clin Epidemiol

Arch Phys Med Rehab

Abiraterone and increased survival in metastatic prostate cancer

N Engl J Med

Increased survival with enzalutamide in prostate cancer after chemotherapy

N Engl J Med

The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma

Cancer

Exercise interventions on health-related quality of life for cancer survivors

Cochrane Database Syst Rev

Exercise interventions on health-related quality of life for people with cancer during active treatment

Cochrane Database Syst Rev.

Interventions for promoting habitual exercise in people living with and beyond cancer

Cochrane Database Syst Rev

Exercise for the management of cancer-related fatigue in adults

Cochrane Database Syst Rev

Exercise interventions for men with prostate cancer

Cochrane Database Syst Rev

Collaborative Review – Prostatic Disease
Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis