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The effect of exercise training on cardiometabolic health in men with prostate cancer receiving androgen deprivation therapy: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases volume 24, pages 35–48 (2021)Cite this article

Subjects

Abstract

Background

Growing evidence suggests that men exposed to androgen deprivation therapy (ADT) have an increased risk of cardiovascular disease. While exercise has shown to attenuate some adverse effects of ADT, the effects on cardiometabolic health have not been systematically evaluated.

Objective

To evaluate the effect of exercise on cardiometabolic health in men with prostate cancer (PCa) receiving ADT.

Methods

A systematic literature search of MEDLINE, EMBASE, CINHAL, SCOPUS, WEB OF SCIENCE and SPORTSDICUS from database inception to April 2020 was performed. A quantitative synthesis using Cohens d effect size and a meta-analysis using random-effects models were conducted.

Results

Overall, fourteen randomised controlled trials (RCTs) and four non-randomised studies were included. Eleven RCTs (n = 939 patients) were included in the meta-analysis. Exercise training improved the 400-m-walk test (MD −10.11 s, 95% CI [−14.34, −5.88]; p < 0·00001), diastolic blood pressure (−2.22 mmHg, [−3.82, −0.61]; p = 0.007), fasting blood glucose (−0.38 mmol/L, [−0.65, −0.11]; p = 0.006), C-reactive protein (−1.16 mg/L, [−2.11, −0.20]; p = 0.02), whole-body lean mass (0.70 kg, [0.39, 1.01]; p < 0.0001), appendicular lean mass (0.59 kg, [0.43, 0.76]; p < 0.00001), whole-body fat mass (−0.67 kg, [−1.08, −0.27]; p = 0.001), whole-body fat percentage (−0.79%, [−1.16, −0.42]; p < 0.0001), and trunk fat mass (−0.49 kg, [−0.87, −0.12]; p = 0.01), compared to usual care. No significant effects on systolic blood pressure or blood lipid metabolism were detected.

Conclusions

In a small subset of evaluated studies, exercise may favourably improve some but not all markers of cardiometabolic health. Future exercise intervention trials with cardiometabolic outcomes as primary endpoints are needed to confirm these initial findings.

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References

  1. Australian Institute of Health and Welfare. Australian Institute of Health and Welfare (AIHW) 2018 Cancer Data in Australia. Canberra: Australian Institute of Health and Welfare; 2018.

  2. Keating NL, O’Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006;24:4448–56.

    CAS  PubMed  Google Scholar 

  3. Bosco C, Crawley D, Adolfsson J, Rudman S, Van Hemelrijck M. Quantifying the evidence for the risk of metabolic syndrome and its components following androgen deprivation therapy for prostate cancer: a meta-analysis. PLoS One. 2015;10:e0117344.

    PubMed  PubMed Central  Google Scholar 

  4. Levine GN, D’Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, et al. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation. 2010;121:833–40.

    PubMed  PubMed Central  Google Scholar 

  5. Morote J, Gomez-Caamano A, Alvarez-Ossorio JL, Pesqueira D, Tabernero A, Gomez Veiga F, et al. The metabolic syndrome and its components in patients with prostate cancer on androgen deprivation therapy. J Urol. 2015;193:1963–9.

    CAS  PubMed  Google Scholar 

  6. Smith MR, Lee H, McGovern F, Fallon MA, Goode M, Zietman AL, et al. Metabolic changes during gonadotropin-releasing hormone agonist therapy for prostate cancer: differences from the classic metabolic syndrome. Cancer. 2008;112:2188–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Spry NA, Taaffe DR, England PJ, Judge JS, Stephens DA, Peddle-McIntyre C, et al. Long-term effects of intermittent androgen suppression therapy on lean and fat mass: a 33-month prospective study. Prostate Cancer Prostatic Dis. 2013;16:67–72.

    CAS  PubMed  Google Scholar 

  8. Nanda A, Chen MH, Moran BJ, Braccioforte MH, Dosoretz D, Salenius S, et al. Neoadjuvant hormonal therapy use and the risk of death in men with prostate cancer treated with brachytherapy who have no or at least a single risk factor for coronary artery disease. Eur Urol. 2014;65:177–85.

    CAS  PubMed  Google Scholar 

  9. Weston KS, Wisloff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48:1227–34.

    PubMed  Google Scholar 

  10. Wall BA, DA GA, Fatehee N, Taaffe DR, Spry N, Joseph D, et al. Exercise improves V O2max and body composition in androgen deprivation therapy-treated prostate cancer patients. Med Sci Sports Exerc. 2017;49:1503–10.

    PubMed  Google Scholar 

  11. Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28:340–7.

    CAS  PubMed  Google Scholar 

  12. Cormie P, Galvao DA, Spry N, Joseph D, Chee R, Taaffe DR, et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int. 2015;115:256–66.

    PubMed  Google Scholar 

  13. Galvao DA, Nosaka K, Taaffe DR, Spry N, Kristjanson 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.

    PubMed  Google Scholar 

  14. Nilsen TS, Raastad T, Skovlund E, Courneya KS, Langberg CW, Lilleby W, et al. Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy. Acta Oncol 2015;54:1805–13.

    CAS  PubMed  Google Scholar 

  15. Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for men with prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;69:693–703.

    PubMed  Google Scholar 

  16. Ostergren PB, Kistorp C, Bennedbaek FN, Faber J, Sonksen J, Fode M. The use of exercise interventions to overcome adverse effects of androgen deprivation therapy. Nat Rev Urol. 2016;13:353–64.

    PubMed  Google Scholar 

  17. Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 2014;32:335–46.

    PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    PubMed  PubMed Central  Google Scholar 

  19. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.

    PubMed  Google Scholar 

  20. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    PubMed  PubMed Central  Google Scholar 

  21. Morris SB. Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods. 2008;11:364–86.

    Google Scholar 

  22. Cohen J. Statisical Power Analysis for Behavioural Sciences. 2nd ed. New York: Routledge; 1988.

  23. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]: The Cochrane Collaboration 2011. Available from: www.handbook.cochrane.org.

  24. Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, Catto JW, et al. Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Eur Urol. 2014;65:865–72.

    PubMed  Google Scholar 

  25. Gilbert SE, Tew GA, Fairhurst C, Bourke L, Saxton JM, Winter EM, et al. Effects of a lifestyle intervention on endothelial function in men on long-term androgen deprivation therapy for prostate cancer. Br J Cancer. 2016;114:401–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Hojan K, Kwiatkowska-Borowczyk E, Leporowska E, Milecki P. Inflammation, cardiometabolic markers, and functional changes in men with prostate cancer. A randomized controlled trial of a 12month exercise program. Pol Arch Intern Med. 2017;127:25–35.

    PubMed  Google Scholar 

  27. Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, et al. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Supportive Care Cancer Off J Multinatl Assoc Supportive Care Cancer. 2010;18:591–9.

    Google Scholar 

  28. Alibhai SMH, Santa Mina D, Ritvo P, Tomlinson G, Sabiston C, Krahn M, et al. A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy. BMC Cancer. 2019;19:2.

    PubMed  PubMed Central  Google Scholar 

  29. Newton RU, Galvao DA, Spry N, Joseph D, Chambers SK, Gardiner RA, et al. Exercise mode specificity for preserving spine and hip bone mineral density in prostate cancer patients. Med Sci Sports Exerc. 2019;51:607–14.

    CAS  PubMed  Google Scholar 

  30. Taaffe DR, Newton RU, Spry N, Joseph D, Chambers SK, Gardiner RA, et al. Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: a year-long randomised controlled trial. Eur Urol. 2017;72:293–9.

    PubMed  Google Scholar 

  31. 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.

    CAS  PubMed  Google Scholar 

  32. Papadopoulos E, Mina DS, Culos-Reed N, Durbano S, Ritvo P, Sabiston CM, et al. Effects of six months of aerobic and resistance training on metabolic markers and bone mineral density in older men on androgen deprivation therapy for prostate cancer. J Geriatr Oncol. 2020;S1879-4068:30378–9.

  33. Zabegalina NS, Henderickx MMEL, Lamotte V, Segers B, Stassijns G, De Wachter S, et al. Effects of a six-month supervised physical exercise program on physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy: a pilot and feasibility study. Cent Eur J Urol. 2018;71:234–41.

    CAS  Google Scholar 

  34. Hvid T, Winding K, Rinnov A, Dejgaard T, Thomsen C, Iversen P, et al. Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy. Endocr Relat Cancer. 2013;20:621–32.

    CAS  PubMed  Google Scholar 

  35. Culos-Reed SN, Robinson JL, Lau H, O’Connor K, Keats MR. Benefits of a physical activity intervention for men with prostate cancer. J Sport Exerc Psychol. 2007;29:118–27.

    PubMed  Google Scholar 

  36. Santa Mina D, Alibhai SM, Matthew AG, Guglietti CL, Pirbaglou M, Trachtenberg J, et al. A randomized trial of aerobic versus resistance exercise in prostate cancer survivors. J Aging Phys Act. 2013;21:455–78.

    PubMed  Google Scholar 

  37. Galvão DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, et al. Resistance training and reduction of treatment side effects in prostate cancer. Med Sci Sports Exerc. 2006;38:2045–52.

    PubMed  Google Scholar 

  38. Galvao DA, Spry NA, Taaffe DR, Newton RU, Stanley J, Shannon T, et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int. 2008;102:44–7.

    PubMed  Google Scholar 

  39. American College of Sports M, Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510–30.

    Google Scholar 

  40. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.

    PubMed  Google Scholar 

  41. Laukkanen JA, Zaccardi F, Khan H, Kurl S, Jae SY, Rauramaa R. Long-term change in cardiorespiratory fitness and all-cause mortality: a population-based follow-up study. Mayo Clin Proc. 2016;91:1183–8.

    PubMed  Google Scholar 

  42. Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295:2018–26.

    CAS  PubMed  Google Scholar 

  43. Wall BA, Galvao DA, Fatehee N, Taaffe DR, Spry N, Joseph D, et al. Reduced cardiovascular capacity and resting metabolic rate in men with prostate cancer undergoing androgen deprivation: a comprehensive cross-sectional investigation. Adv Urol. 2015;2015:976235.

    PubMed  PubMed Central  Google Scholar 

  44. Howden EJ, Bigaran A, Beaudry R, Fraser S, Selig S, Foulkes S, et al. Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients. Eur J Prev Cardiol. 2019;26:305–15.

    PubMed  Google Scholar 

  45. Koelwyn GJ, Jones LW, Moslehi J. Unravelling the causes of reduced peak oxygen consumption in patients with cancer: complex, timely, and necessary. J Am Coll Cardiol. 2014;64:1320–2.

    PubMed  Google Scholar 

  46. Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007;116:151–7.

    CAS  PubMed  Google Scholar 

  47. Cavalot F, Pagliarino A, Valle M, Di Martino L, Bonomo K, Massucco P, et al. Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up. Lessons San Luigi Gonzaga Diabetes Study. 2011;34:2237–43.

    Google Scholar 

  48. Little JP, Gillen JB, Percival ME, Safdar A, Tarnopolsky MA, Punthakee Z, et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol. 2011;111:1554–60.

    CAS  PubMed  Google Scholar 

  49. Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ. Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab. 2012;14:575–7.

    CAS  PubMed  Google Scholar 

  50. Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012;590:1077–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473.

    PubMed  PubMed Central  Google Scholar 

  52. Molmen-Hansen HE, Stolen T, Tjonna AE, Aamot IL, Ekeberg IS, Tyldum GA, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol. 2012;19:151–60.

    PubMed  Google Scholar 

  53. Cornelissen VA, Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2005;23:251–9.

    CAS  PubMed  Google Scholar 

  54. Hambrecht R, Adams V, Erbs S, Linke A, Krankel N, Shu Y, et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation. 2003;107:3152–8.

    CAS  PubMed  Google Scholar 

  55. Costa EC, Hay JL, Kehler DS, Boreskie KF, Arora RC, Umpierre D, et al. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in adults with pre- to established hypertension: a systematic review and meta-analysis of randomized trials. Sports Med. 2018;48:2127–42.

    PubMed  Google Scholar 

  56. Herrmann J. From trends to transformation: where cardio-oncology is to make a difference. Eur Heart J. 2019;40:3898–900.

  57. Sturgeon KM, Deng L, Bluethmann SM, Zhou S, Trifiletti DM, Jiang C, et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J. 2019;40:3889–97.

    PubMed  PubMed Central  Google Scholar 

  58. Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS. Physical activity and survival after prostate cancer. Eur Urol. 2016;70:576–85.

    PubMed  Google Scholar 

  59. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol. 2011;29:726–32.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia

    Ashley Bigaran, Eva Zopf & Prue Cormie

  2. Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

    Ashley Bigaran, Andre La Gerche & Erin J. Howden

  3. School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia

    Jason Gardner

  4. Cardiology Department, St Vincent’s Hospital, Melbourne, Victoria, Australia

    Andre La Gerche

  5. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Declan G. Murphy

  6. The Sir Peter MacCallum Department of Urology, University of Melbourne, Melbourne, Victoria, Australia

    Declan G. Murphy

  7. School of Behavioural and Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia

    Michael K. Baker

  8. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Prue Cormie

  9. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

    Prue Cormie

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  1. Ashley Bigaran
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Bigaran, A., Zopf, E., Gardner, J. et al. The effect of exercise training on cardiometabolic health in men with prostate cancer receiving androgen deprivation therapy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 24, 35–48 (2021). https://doi.org/10.1038/s41391-020-00273-5

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