Advertisement

Resistance Training Reduces Disability in Prostate Cancer Survivors on Androgen Deprivation Therapy: Evidence From a Randomized Controlled Trial

Published:September 03, 2014DOI:https://doi.org/10.1016/j.apmr.2014.08.010

      Highlights

      • Resistance training increases muscle strength in prostate cancer survivors on androgen deprivation therapy.
      • Resistance training improved self-report physical function and lessened disability.
      • Increases in muscle strength likely contributed to reductions in disability.

      Abstract

      Objectives

      To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise.

      Design

      Randomized controlled trial.

      Setting

      Academic medical center.

      Participants

      PCS (N=51; mean age, 70.2y) on ADT.

      Intervention

      PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year.

      Main Outcome Measures

      Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates.

      Results

      Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05).

      Conclusions

      One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.

      Keywords

      List of abbreviations:

      ADT (androgen deprivation therapy), FLEX (placebo control program of seated stretching exercise), ITT (intention-to-treat), LLFDI (Late-Life Function and Disability Instrument), PCS (prostate cancer survivors), POWIR (Prevent Osteoporosis with Impact + Resistance), PPB (Physical Performance Battery)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Cancer Society
        Cancer facts & figures 2013.
        American Cancer Society, Atlanta2013
        • Freedland S.J.
        • Moul J.W.
        Prostate specific antigen recurrence after definitive therapy.
        J Urol. 2007; 177: 1985-1991
        • Abern M.R.
        • Aronson W.J.
        • Terris M.K.
        • et al.
        Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.
        Prostate. 2013; 73: 409-417
        • Freedland S.J.
        • Humphreys E.B.
        • Mangold L.A.
        • et al.
        Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.
        JAMA. 2005; 294: 433-439
        • Haseen F.
        • Murray L.J.
        • Cardwell C.R.
        • O'Sullivan J.M.
        • Cantwell M.M.
        The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis.
        J Cancer Surviv. 2010; 4: 128-139
        • Galvao D.A.
        • Taaffe D.R.
        • Spry N.
        • Joseph D.
        • Turner D.
        • Newton R.U.
        Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation.
        Prostate Cancer Prostatic Dis. 2009; 12: 198-203
        • Bennett J.A.
        • Winters-Stone K.
        • Nail L.
        Conceptualizing and measuring physical functioning in cancer survivorship studies.
        Oncol Nurs Forum. 2006; 33: 41-49
        • Fried L.P.
        • Young Y.
        • Rubin G.
        • Bandeen-Roche K.
        Self-reported preclinical disability identifies older women with early declines in performance and early disease.
        J Clin Epidemiol. 2001; 54: 889-901
        • Verbrugge L.M.
        • Jette A.M.
        The disablement process.
        Soc Sci Med. 1994; 38: 1-14
        • Smith M.R.
        • Saad F.
        • Egerdie B.
        • et al.
        Sarcopenia during androgen-deprivation therapy for prostate cancer.
        J Clin Oncol. 2012; 30: 3271-3276
        • Basaria S.
        • Lieb 2nd, J.
        • Tang A.M.
        • et al.
        Long-term effects of androgen deprivation therapy in prostate cancer patients.
        Clin Endocrinol. 2002; 56: 779-786
        • Hairi N.N.
        • Cumming R.G.
        • Naganathan V.
        • et al.
        Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project.
        J Am Geriatr Soc. 2010; 58: 2055-2062
        • Puthoff M.L.
        • Nielsen D.H.
        Relationships among impairments in lower-extremity strength and power, functional limitations, and disability in older adults.
        Phys Ther. 2007; 87: 1334-1347
        • Hicks G.E.
        • Shardell M.
        • Alley D.E.
        • et al.
        Absolute strength and loss of strength as predictors of mobility decline in older adults: the InCHIANTI Study.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 66-73
        • Giampaoli S.
        • Ferrucci L.
        • Cecchi F.
        • et al.
        Hand-grip strength predicts incident disability in non-disabled older men.
        Age Ageing. 1999; 28: 283-288
        • Guralnik J.M.
        • Fried L.P.
        • Salive M.E.
        Disability as a public health outcome in the aging population.
        Ann Rev Public Health. 1996; 17: 25-46
        • Ostir G.V.
        • Carlson J.E.
        • Black S.A.
        • Rudkin L.
        • Goodwin J.S.
        • Markides K.S.
        Disability in older adults. 1: Prevalence, causes, and consequences.
        Behav Med. 1999; 24: 147-156
        • Hauer K.
        • Rost B.
        • Rutschle K.
        • et al.
        Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls.
        J Am Geriatr Soc. 2001; 49: 10-20
        • Campbell A.J.
        • Robertson M.C.
        • Gardner M.
        • Norton R.N.
        • Buchner D.M.
        Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.
        Age Ageing. 1999; 28: 513-518
        • Latham N.K.
        • Bennett D.A.
        • Stretton C.M.
        • Anderson C.S.
        Systematic review of progressive resistance strength training in older adults.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 48-61
        • Winters-Stone K.
        • Dobek J.
        • Nail L.
        • Bennett J.A.
        • Naik A.
        • Schwartz A.
        Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized controlled trial.
        Breast Cancer Res Treat. 2011; 27: 447-456
        • Winters-Stone K.M.
        • Dobek J.
        • Bennett J.A.
        • Nail L.M.
        • Leo M.C.
        • Schwartz A.
        The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial.
        J Cancer Surviv. 2012; 6: 189-199
        • Winters-Stone K.M.
        • Dobek J.
        • Nail L.M.
        • et al.
        Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial.
        Osteoporos Int. 2013; 24: 1637-1646
        • Shaw J.M.
        • Snow C.M.
        Weighted vest exercise improves indices of fall risk in older women.
        J Gerontol A Biol Sci Med Sci. 1998; 53: M53-M58
        • Winters K.M.
        • Snow C.M.
        Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women.
        J Bone Miner Res. 2000; 15: 2495-2503
        • Winters-Stone K.M.
        • Dobek J.C.
        • Bennett J.A.
        • Maddalozzo G.F.
        • Ryan C.W.
        • Beer T.M.
        Skeletal response to resistance and impact training in prostate cancer survivors.
        Med Sci Sports Exerc. 2014; 46: 1482-1488
        • Winters-Stone K.
        • Snow C.
        Site-specific response of bone to exercise in premenopausal women.
        Bone. 2006; 39: 1203-1209
        • Snow C.M.
        • Shaw J.M.
        • Winters K.M.
        • Witzke K.A.
        Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M489-M491
        • American College of Sports Medicine
        • Chodzko-Zajko W.J.
        • Proctor D.N.
        • et al.
        American College of Sports Medicine Position Stand. Exercise and physical activity for older adults.
        Med Sci Sports Exerc. 2009; 41: 1510-1530
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Stewart A.
        • Mills K.
        • King A.
        • Haskell W.
        • Gillis D.
        • Ritter P.
        CHAMPS physical activity questionnaire for older adults: outcomes for interventions.
        Med Sci Sports Exerc. 2001; 33: 1126-1141
        • Schwartz A.L.
        The Schwartz Cancer Fatigue Scale: testing reliability and validity.
        Oncol Nurs Forum. 1998; 25: 711-717
        • American College of Sports Medicine
        ACSM's guidelines for exercise testing and prescription.
        9th ed. Lippincott Williams & Wilkins, Philadelphia2009
        • Galvao D.A.
        • Taaffe D.R.
        • Spry N.
        • Joseph D.
        • Newton R.U.
        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: 340-347
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-94
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Penninx B.W.
        • Ferrucci L.
        • Leveille S.G.
        • Rantanen T.
        • Pahor M.
        • Guralnik J.M.
        Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M691-M697
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Aaronson N.K.
        • Ahmedzai S.
        • Bergman B.
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993; 85: 365-376
        • Jette A.M.
        • Haley S.M.
        • Coster W.J.
        • et al.
        Late life function and disability instrument: I. Development and evaluation of the disability component.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M209-M216
        • Haley S.M.
        • Jette A.M.
        • Coster W.J.
        • et al.
        Late Life Function and Disability Instrument: II. Development and evaluation of the function component.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M217-M222
        • Lane P.
        Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches.
        Pharm Stat. 2008; 7: 93-106
        • Streiner D.L.
        The case of the missing data: methods of dealing with dropouts and other research vagaries.
        Can J Psychiatry. 2002; 47: 68-75
        • Schlomer G.L.
        • Bauman S.
        • Card N.
        Best practices for missing data management in counseling psychology.
        J Counsel Psych. 2010; 57: 1-10
        • Tofighi D.
        • MacKinnon D.P.
        RMediation: an R package for mediation analysis confidence intervals.
        Behav Res. 2011; 43: 692-700
        • Segal R.J.
        • Reid R.D.
        • Courneya K.S.
        • et al.
        Resistance exercise in men receiving androgen deprivation therapy for prostate cancer.
        J Clin Oncol. 2003; 21: 1653-1659
        • Cormie P.
        • Galvão D.A.
        • Spry N.
        • et al.
        Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial.
        BJU Int. 2014 Jan 27; ([Epub ahead of print])
        • Winters-Stone K.M.
        • Neil S.E.
        • Campbell K.L.
        Attention to principles of exercise training: a review of exercise studies for survivors of cancers other than breast.
        Br J Sports Med. 2014; 48: 987-995