Abstract
Background
High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) have been increasingly adopted for localized prostate cancer (PCa) under active surveillance (AS). However, it is unclear which training modality is the most favorable in terms of cardiorespiratory fitness and biochemical progression.
Methods
We searched PubMed, Cochrane and Embase for relevant RCTs. PRISMA guideline was adopted to ensure optimal conduct of this study. Serum prostate specific antigen (PSA) and peak VO2 were selected as primary outcomes and PSA doubling time (PSADT) and testosterone were selected as secondary outcomes. Only articles written in English were included. Cochrane risk-of-bias tool was used for risk of bias evaluation.
Results
A total of 501 studies were selected. Six RCTs with 222 patients were included for data extraction and analysis. High-intensity interval training (HIIT) group demonstrated significantly lower PSA compared with usual care (UC) (MD = −1.4; 95%CI = −2.77 to −0.03) and moderate-intensity continuous training (MICT) group (MD = −1.67; 95%CI = −3.30 to −0.05). Both HIIT and MICT showed significantly improved peak VO2 compared with UC. No significant difference was observed in PSADT and testosterone among different training modalities and UC. Regarding peak VO2, MICT had the highest surface under cumulative ranking curve (SUCRA) scores (98.1%). For serum PSA, HIIT had the highest probability (97.8%) to be the training with the highest efficacy. The potential source of bias mainly came from poorly performed allocation concealment and blinding strategies.
Conclusions
The present study indicated that HIIT and MICT showed considerable cardiorespiratory benefits for localized PCa. HIIT was preferred over MICT in biochemical progression control in terms of decreasing serum PSA levels. However, MICT was favored over HIIT regarding cardiorespiratory benefits. The findings of this study may facilitate future lifestyle intervention, particularly in the form of physical training, for individuals diagnosed with localized PCa under AS.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
American Cancer Society. Global cancer facts & figures. 3rd edition. American Cancer Society; 2015.
Wang L, Lu B, He M, Wang Y, Wang Z, Du L. Prostate cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019. Front Public Health. 2022;10:811044.
Buyyounouski MK, Choyke PL, McKenney JK, Sartor O, Sandler HM, Amin MB, et al. Prostate cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67:245–53.
Butler S, Muralidhar V, Chavez J, Fullerton Z, Mahal A, Nezolosky M, et al. Active surveillance for low-risk prostate cancer in black patients. N Engl J Med. 2019;380:2070–2.
Tosoian JJ, Carter HB. Patients with intermediate risk prostate cancer may be good candidates for active surveillance: Con. J Urol. 2017;198:997–9.
Lao C, Edlin R, Rouse P, Brown C, Holmes M, Gilling P, et al. The cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low-risk localised prostate cancer. BMC Cancer. 2017;17:529.
Drost F, Rannikko A, Valdagni R, Pickles T, Kakehi Y, Remmers S, et al. Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real-life clinical practice in the PRIAS study. Transl Androl Urol. 2018;7:98–105.
Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N. Engl J Med. 2016;375:1415–24.
Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol. 2016;13:205–15.
Kang D, Fairey A, Boulé N, Field C, Wharton S, Courneya K. A randomized trial of the effects of exercise on anxiety, fear of cancer progression and quality of life in prostate cancer patients on active surveillance. J Urol. 2022;207:814–22.
Billinger S, Boyne P, Coughenour E, Dunning K, Mattlage A. Does aerobic exercise and the FITT principle fit into stroke recovery? Curr Neurol Neurosci Rep. 2015;15:519.
Piraux E, Caty G, Renard L, Vancraeynest D, Tombal B, Geets X, et al. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Prostate Cancer Prostatic Dis. 2021;24:156–65.
Bourke L, Stevenson R, Turner R, Hooper R, Sasieni P, Greasley R, et al. Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study. Sci Rep. 2018;8:8374.
Kang DW, Fairey AS, Boulé NG, Field CJ, Wharton SA, Courneya KS. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the ERASE randomized clinical trial. JAMA Oncol. 2021;7:1487–95.
Androulakis-Korakakis P, Langdown L, Lewis A, Fisher J, Gentil P, Paoli A, et al. Effects of exercise modality during additional “high-intensity interval training” on aerobic fitness and strength in powerlifting and strongman athletes. J Strength Condition Res. 2018;32:450–7.
Pereira-Rodríguez JE, et al. Cambios hemodinámicos y calidad de vida en pacientes con cáncer de próstata luego de un entrenamiento HIIT Y MICT: ensayo clínico aleatorizado (ONCO-EXE TRIAL). Anal Facult Med. 2019;80:275–82.
Hwang C, Lim J, Yoo J, Kim H, Hwang M, Handberg E, et al. Effect of all-extremity high-intensity interval training vs. moderate-intensity continuous training on aerobic fitness in middle-aged and older adults with type 2 diabetes: a randomized controlled trial. Exp Gerontol. 2019;116:46–53.
Lopez P, Taaffe DR, Newton RU, Galvão DA. Resistance exercise dosage in men with prostate cancer: systematic review, meta-analysis, and meta-regression. Med Sci Sports Exerc. 2021;53:459–69.
Ornish D, Magbanua M, Weidner G, Weinberg V, Kemp C, Green C, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci USA. 2008;105:8369–74.
Lunacek A, Tischler M, Mrstik C, Hebenstreit D, Oeser R, Bektic J, et al. Effects of cycling and rowing on serum concentrations of prostate-specific antigen: a randomized study of 101 male subjects. Prostate. 2022;82:804–8.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clin Res ed). 2009;339:b2535.
Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Cochrane, 2022. 2022.
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.
Su L, Fu J, Sun S, Zhao G, Cheng W, Dou C, et al. Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: a meta-analysis. PLoS One. 2019;14:e0210644.
Wewege M, van den Berg R, Ward RE, Keech A. The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes Rev. 2017;18:635–46.
Mueller S, Winzer EB, Duvinage A, Gevaert AB, Edelmann F, Haller B, et al. Effect of high-intensity interval training, moderate continuous training, or guideline-based physical activity advice on peak oxygen consumption in patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2021;325:542–51.
Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C, Cornelissen V, et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid-based Healthc. 2015;13:9–18.
Hvid T, Lindegaard B, Winding K, Iversen P, Brasso K, Solomon TP, et al. Effect of a 2-year home-based endurance training intervention on physiological function and PSA doubling time in prostate cancer patients. Cancer Causes Control. 2016;27:165–74.
Van Blarigan EL, Kenfield SA, Olshen A, Panchal N, Encabo K, Tenggara I, et al. Effect of a home-based walking intervention on cardiopulmonary fitness and quality of life among men with prostate cancer on active surveillance: the active surveillance exercise randomized controlled trial. Eur Urol Oncol. 2023. https://doi.org/10.1016/j.euo.2023.10.012.
Eriksen AK, Hansen RD, Borre M, Larsen RG, Jensen JM, Overgaard K, et al. A lifestyle intervention among elderly men on active surveillance for non-aggressive prostate cancer: a randomised feasibility study with whole-grain rye and exercise. Trials. 2017;18:20.
Papadopoulos E, Gillen J, Moore D, Au D, Kurgan N, Klentrou P, et al. High-intensity interval training or resistance training versus usual care in men with prostate cancer on active surveillance: a 3-arm feasibility randomized controlled trial. Appl Physiol Nutr Metab. 2021;46:1535–44.
Crump C, Stattin P, Brooks JD, Stocks T, Sundquist J, Sieh W, et al. Early-life cardiorespiratory fitness and long-term risk of prostate cancer. Cancer Epidemiol Biomark Prev. 2020;29:2187–94.
Reiter-Brennan C, Dzaye O, Al-Mallah MH, Dardari Z, Brawner CA, Lamerato LE, et al. Fitness and prostate cancer screening, incidence, and mortality: results from the Henry Ford Exercise Testing (FIT) Project. Cancer. 2021;127:1864–70.
Lakoski SG, Willis BL, Barlow CE, Leonard D, Gao A, Radford NB, et al. Midlife cardiorespiratory fitness, incident cancer, and survival after cancer in men: the cooper center longitudinal study. JAMA Oncol. 2015;1:231–7.
Herrero F, Balmer J, San Juan AF, Foster C, Fleck SJ, Pérez M, et al. Is cardiorespiratory fitness related to quality of life in survivors of breast cancer? J Strength Cond Res. 2006;20:535–40.
Kindred MM, Pinto BM, Dunsiger SI. Association of body esteem with fitness and body fat among colorectal cancer survivors: secondary analyses from a randomized trial. Int J Behav Med. 2019;26:619–28.
Baldelli G, De Santi M, Gervasi M, Annibalini G, Sisti D, Højman P, et al. The effects of human sera conditioned by high-intensity exercise sessions and training on the tumorigenic potential of cancer cells. Clin Transl Oncol. 2021;23:22–34.
Ndjavera W, Orange ST, O’Doherty AF, Leicht AS, Rochester M, Mills R, et al. Exercise-induced attenuation of treatment side-effects in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy: a randomised controlled trial. BJU Int. 2020;125:28–37.
Herranz-Gómez A, Cuenca-Martínez F, Suso-Martí L, Varangot-Reille C, Calatayud J, Blanco-Díaz M, et al. Effectiveness of HIIT in patients with cancer or cancer survivors: an umbrella and mapping review with meta-meta-analysis. Scand J Med Sci Sports. 2022;32:1522–49.
Hooshmand Moghadam B, Golestani F, Bagheri R, Cheraghloo N, Eskandari M, Wong A, et al. The effects of high-intensity interval training vs. moderate-intensity continuous training on inflammatory markers, body composition, and physical fitness in overweight/obese survivors of breast cancer: a randomized controlled clinical trial. Cancers. 2021;13:4386.
Esfarjani F, Laursen PB. Manipulating high-intensity interval training: effects on VO2max, the lactate threshold and 3000 m running performance in moderately trained males. J Sci Med Sport. 2007;10:27–35.
Cocks M, Shaw CS, Shepherd SO, Fisher JP, Ranasinghe AM, Barker TA, et al. Sprint interval and endurance training are equally effective in increasing muscle microvascular density and eNOS content in sedentary males. J Physiol. 2013;591:641–56.
Milanović Z, Sporiš G, Weston M. Effectiveness of High-Intensity Interval Training (HIT) and continuous endurance training for VO2max improvements: a systematic review and meta-analysis of controlled trials. Sports Med. 2015;45:1469–81.
MacInnis MJ, Gibala MJ. Physiological adaptations to interval training and the role of exercise intensity. J Physiol. 2017;595:2915–30.
Arboleda-Serna VH, Feito Y, Patiño-Villada FA, Vargas-Romero AV, Arango-Vélez EF. Effects of high-intensity interval training compared to moderate-intensity continuous training on maximal oxygen consumption and blood pressure in healthy men: a randomized controlled trial. Biomedica. 2019;39:524–36.
Carlsson SV, Vickers AJ. Screening for prostate cancer. Med Clin North Am. 2020;104:1051–62.
Mulders PF, Schalken JA. Measuring therapeutic efficacy in the changing paradigm of castrate-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2009;12:241–6.
Schmidt JD. Clinical diagnosis of prostate cancer. Cancer. 1992;70:221–4.
Fang J, Metter EJ, Landis P, Chan DW, Morrell CH, Carter HB. Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. Urology. 2001;58:411–6.
Loeb S, Catalona WJ. Prostate-specific antigen screening: pro. Curr Opin Urol. 2010;20:185–8.
Baumann FT, Zopf EM, Bloch W. Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials. Support Care Cancer. 2012;20:221–33.
Galvao DA, Nosaka K, Taaffe DR, Spry N, Kristjansons LJ, McGuigan MR, et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc. 2006;38:2045–52.
Chang M, Wang J, Hashim HA, Xie S, Malik AA. Effect of high-intensity interval training on aerobic capacity and fatigue among patients with prostate cancer: a meta-analysis. World J Surg Oncol. 2022;20:348.
Idorn M, Hojman P. Exercise-dependent regulation of NK cells in cancer protection. Trends Mol Med. 2016;22:565–77.
Hojman P, Gehl J, Christensen JF, Pedersen BK. Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metab. 2018;27:10–21.
Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol. 2014;65:115–23.
Hyun JS. Prostate cancer and sexual function. World J Mens Health. 2012;30:99–107.
Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montorsi F. Testosterone therapy in men with prostate cancer. Eur Urol. 2016;69:894–903.
Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014;17:132–43.
Boyle P, Koechlin A, Bota M, d’Onofrio A, Zaridze DG, Perrin P, et al. Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU Int. 2016;118:731–41.
Yassin A, AlRumaihi K, Alzubaidi R, Alkadhi S, Al Ansari A. Testosterone, testosterone therapy and prostate cancer. Aging Male. 2019;22:219–27.
Taaffe DR, Buffart LM, Newton RU, Spry N, Denham J, Joseph D, et al. Time on androgen deprivation therapy and adaptations to exercise: secondary analysis from a 12-month randomized controlled trial in men with prostate cancer. BJU Int. 2018;121:194–202.
Ambroży T, Rydzik Ł, Obmiński Z, Błach W, Serafin N, Błach B, et al. The effect of high-intensity interval training periods on morning serum testosterone and cortisol levels and physical fitness in men aged 35-40 years. J Clin Med. 2021;10:2143.
Lane AR, Hackney AC. Relationship between salivary and serum testosterone levels in response to different exercise intensities. Hormones. 2015;14:258–64.
Vingren JL, Kraemer WJ, Ratamess NA, Anderson JM, Volek JS, Maresh CM. Testosterone physiology in resistance exercise and training: the up-stream regulatory elements. Sports Med. 2010;40:1037–53.
Barone B, Napolitano L, Abate M, Cirillo L, Reccia P, Passaro F, et al. The role of testosterone in the elderly: what do we know? Int J Mol Sci. 2022;23:3535.
Lopez P, Newton RU, Taaffe DR, Singh F, Lyons-Wall P, Buffart LM, et al. Interventions for improving body composition in men with prostate cancer: a systematic review and network meta-analysis. Med Sci Sports Exerc. 2022;54:728–40.
Lin YC, Shao IH, Juan YH, Yeh KY, Hou CP, Chen CL, et al. The impact of exercise on improving body composition and PSA in high-risk prostate cancer patients on androgen-deprivation therapy. Nutrients. 2022;14:5088.
Abate-Shen C, Nunes de Almeida F. Establishment of the LNCaP cell line - the dawn of an era for prostate cancer research. Cancer Res. 2022;82:1689–91.
Zhang Y, Kim JS, Wang TZ, Newton RU, Galvao DA, Gardiner RA, et al. Potential role of exercise-induced extracellular vesicles in prostate cancer suppression. Front Oncol. 2021;11:746040.
Schauer T, Djurhuus SS, Simonsen C, Brasso K, Christensen JF. The effects of acute exercise and inflammation on immune function in early-stage prostate cancer. Brain Behav Immun—Health. 2022;25:100508.
Kim JS, Taaffe DR, Galvão DA, Hart NH, Gray E, Ryan CJ, et al. Exercise in advanced prostate cancer elevates myokine levels and suppresses in-vitro cell growth. Prostate Cancer Prostatic Dis. 2022;25:86–92.
Singh B, Hayes SC, Spence RR, Steele ML, Millet GY, Gergele L. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. Int J Behav Nutr Phys Act. 2020;17:122.
Author information
Authors and Affiliations
Contributions
QYZ and XYX performed data extraction and analysis. XYX and QYZ were responsible for design of this study and the first draft of this manuscript. QYZ, QZ, QD and YH interpreted the results and wrote the final version of this manuscript. JMZ, DBL and GYZ helped formatting the final manuscript. LY and JKL provided methodology consultation and critical revision of this manuscript. LY and JKL are the co-corresponding authors of this manuscript. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zhu, Q., Xiong, X., Zheng, Q. et al. High-intensity interval training versus moderate-intensity continuous training for localized prostate cancer under active surveillance: a systematic review and network meta-analysis. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00801-7
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41391-024-00801-7