Radiotherapy for prostate cancer (PCa) may cause unfavorable changes in fatigue, quality of life (QOL), and physical fitness. We report results from the Prostate Cancer Radiotherapy and Exercise Versus Normal Treatment study examining the effects of 24 weeks of resistance or aerobic training versus usual care on fatigue, QOL, physical fitness, body composition, prostate-specific antigen, testosterone, hemoglobin, and lipid levels in men with PCa receiving radiotherapy.

Between 2003 and 2006, we conducted a randomized controlled trial in Ottawa, Canada, where 121 PCa patients initiating radiotherapy with or without androgen deprivation therapy were randomly assigned to usual care (n = 41), resistance (n = 40), or aerobic exercise (n = 40) for 24 weeks. Our primary end point was fatigue assessed by the Functional Assessment of Cancer Therapy–Fatigue scale.

The follow-up assessment rate for our primary end point of fatigue was 92.6%. Median adherence to prescribed exercise was 85.5%. Mixed-model repeated measures analyses indicated both resistance (P =.010) and aerobic exercise (P = .004) mitigated fatigue over the short term. Resistance exercise also produced longer-term improvements (P = .002). Compared with usual care, resistance training improved QOL (P = .015), aerobic fitness (P = .041), upper- (P < .001) and lower-body (P < .001) strength, and triglycerides (P = .036), while preventing an increase in body fat (P = .049). Aerobic training also improved fitness (P = .052). One serious adverse event occurred in the group that performed aerobic exercise.

In the short term, both resistance and aerobic exercise mitigated fatigue in men with PCa receiving radiotherapy. Resistance exercise generated longer-term improvements and additional benefits for QOL, strength, triglycerides, and body fat.

Prostate cancer (PCa) is the most common malignancy in men in North America and the second most common cause of cancer death in men older than 70 years.1,2 Radiotherapy is an important modality for curative treatment in early-stage disease, and improves disease-free and overall survival in locally advanced or higher-risk disease.3-6 The most common complaint of patients receiving radiotherapy is fatigue (60% to 80%), which tends to be cumulative and persistent even after treatment is completed.7-12 Increased fatigue is associated with psychological distress, as well as reduced quality of life (QOL) and functional capacity. Interventions to reduce fatigue would be an important element of supportive care.

Previously, we showed that a 12-week program of resistance exercise training reduced fatigue and improved QOL and fitness in men with PCa receiving androgen deprivation therapy (ADT).13 Here we report results from the Prostate Cancer Radiotherapy and Exercise Versus Normal Treatment study examining the effects of 24 weeks of resistance or aerobic training versus usual care on fatigue, cancer-specific QOL, physical fitness, body composition, and prostate-specific antigen (PSA), testosterone, and serum lipid levels in men with PCa receiving radiotherapy.

We hypothesized that both resistance and aerobic training would be superior to usual care for patient-rated fatigue and disease-specific QOL; resistance training would improve strength and body fat percentage, whereas aerobic training would improve aerobic fitness and body fat; and both exercise interventions would improve serum lipid levels and have no adverse effects on PSA, testosterone, or hemoglobin.

Setting and Participants

The trial was conducted at the Ottawa Hospital Regional Cancer Centre, Ottawa, Canada. The protocol was approved by the institutional research ethics committee and all participants provided written informed consent. Men were eligible to participate if they had histologically documented PCa, were scheduled to receive radiotherapy with or without ADT, and if the treating oncologist approved. Men were excluded if they had severe cardiac disease (New York Heart Association functional class III or IV), uncontrolled hypertension, pain, psychiatric illness, or lived more than 1 hour away.

Design and Procedures

The study was a prospective, three-armed, randomized, controlled trial (Fig 1). Eligible participants were identified by their oncologist. Consenting participants completed a questionnaire, anthropometric measures, physical fitness tests, blood tests, and a dual energy x-ray absorptiometry scan (DEXA; added after 20 participants underwent random assignment).

Randomization

Participants were stratified by intended duration of ADT (≤ 16 weeks/none v ADT > 16 weeks) and randomly assigned to one of three groups: resistance training, aerobic training, or usual care using computer-generated numbers. Central random assignment was used, with allocation concealment before assignment. To ensure blinding of the research coordinator, an exercise specialist handled the random assignments.

Exercise Training Interventions

Participants in the exercise groups exercised for a total of 24 weeks. All exercise sessions were supervised by exercise specialists at the Cancer Rehabilitation Center. Warm-up and cool-down periods were 5 minutes of light aerobic activity and stretching. Resistance training participants exercised three times per week performing two sets of eight to12 repetitions of 10 different exercises (leg extension, leg curl, seated chest fly, latissimus pulldown, overhead press, triceps extension, biceps curls, calf raises, low back extension, and modified curl-ups) at 60% to 70% of their estimated one-repetition maximum (1 RM).14 Resistance was increased by 5 lb when participants completed more than 12 repetitions. Aerobic training participants exercised three times per week on a cycle ergometer, treadmill, or elliptical trainer beginning at 50% to 60% of their predetermined peak oxygen consumption (VO2peak) for weeks 1 to 4 and progressing to 70% to 75% for weeks 5 to 24. Exercise duration began at 15 minutes and increased by 5 minutes every 3 weeks until it reached 45 minutes. Exercise intensity was standardized using heart rate monitors. Usual-care participants were asked not to initiate exercise and were offered a program, postintervention assessments.

Assessment of Primary and Secondary End Points

Patient-rated outcomes were assessed at baseline before commencement of radiotherapy, in the middle (12 weeks), and at the end of intervention (24 weeks). Fatigue, PCa-specific, and cancer-specific QOL were assessed by the Functional Assessment of Cancer Therapy–Fatigue (FACT-Fatigue), Prostate (FACT-P), and General (FACT-G) scales,15 respectively.

Some objectively measured outcomes (aerobic fitness, strength, body weight, body fat percentage, serum lipids) were assessed at baseline and 24 weeks, whereas others (PSA, testosterone, and hemoglobin) were measured at all three time points. Aerobic fitness was evaluated using a maximal incremental exercise protocol on a treadmill. Whole-body oxygen uptake (V̇o2) was measured using expired gas samples. VO2peak was determined by taking the highest values during a 15-second period. Muscular strength was assessed as the maximum weight that could be lifted eight times while maintaining proper form (8 RM) on the horizontal bench and leg press. This was used to estimate 1 RM.14 Body weight to the nearest 0.1 kg and standing height to the nearest 0.5 cm were assessed without shoes using a balance beam scale. A DEXA scan (LUNAR EXPERT; General Electric, Princeton, NJ) assessed percent body fat. A blood sample to measure PSA, serum free testosterone, hemoglobin, and serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol, and triglycerides) was obtained and processed by a centralized laboratory.

Assessment of Covariates, Exercise Adherence, and Adverse Events

Demographic and behavioral data were collected by self-report and medical data were abstracted from clinical records. Exercise specialists monitored adherence and adverse events. Nonprotocol exercise was assessed by self-report at 24 weeks.

Statistical Analyses and Sample Size Calculation

A priori, we calculated that with 37 participants per group, our trial had 80% power to detect a difference in change scores of 3.5 points (standard deviation = 5.8) on the FACT-Fatigue16 with a loss to follow-up of 10%, a two-tailed level of significance of .05, and no adjustment for multiple testing.17 Baseline comparisons were performed using univariate analysis of variance for continuous variables and χ2 analyses for categoric variables. Mixed-model repeated measures analysis was used to compare the differences between groups over time. For the patient-rated outcomes assessed at baseline, midpoint, and postintervention, we used contrasts defined a priori to examine changes between baseline and midpoint (12 weeks) and baseline and post-test (24 weeks) for each outcome and to compare group differences in mean change (resistance v usual care and aerobic v usual care). Our primary analysis was unadjusted, but we also tested a model that adjusted for age, cancer stage, ADT (yes/no), and Gleason score. For all analyses, an intention-to-treat approach was followed. All analyses were done using SPSS Version 16.0 (SPSS Inc, Chicago, IL).

Patient Flow and Follow-Up

Recruitment ran from February 2003 to April 2006 (Fig 1). We recruited 121 (37%) of 325 eligible participants. Common reasons for refusal were already active (n = 50), no time (n = 19), lacked transportation (n = 11), unavailable for more than 2 weeks during the intervention (n = 11), and no reason (n = 109). We obtained follow-up data from 112 (92.6%) of 121 participants. Loss to follow-up was similar between groups.

Baseline Characteristics

Groups were balanced at baseline (Table 1, online only). Resistance and aerobic participants completed a median of 88% (63 of 72 sessions) and 83% (60 of 72 sessions) of scheduled sessions, respectively (P = .845). Overall, 18 (15%) of 121 participants reported regular exercise outside treatment group assignment: eight resistance participants reported aerobic exercise ≥ three times/wk; five aerobic participants reported resistance exercise ≥ two times/wk; six usual-care participants reported aerobic exercise ≥ three times/wk (including one participant who also reported resistance exercise ≥ two times/wk).

Changes in Patient-Rated Outcomes

Table 2, online only, lists the patient-rated outcomes. The analysis for fatigue showed no main effect for group (F = 0.62; P = .540), but a significant main effect of time (F = 10.02; P < .001) and significant interaction between group and time (F = 3.84; P = .005). Planned contrasts showed fatigue was improved with resistance and aerobic training compared with usual care from baseline to 12 weeks. From baseline to 24 weeks, only resistance exercise was superior to usual care. PCa-specific QOL (FACT-P) declined over time (F = 19.17; P < .001) but there were no significant effects of group assignment. For cancer-specific QOL (FACT-G), there was no main effect for group (F = 0.16; P = .854), but there was a significant main effect of time (F = 5.11; P = .007) and a borderline significant interaction between group and time (F = 2.16; P = .076). Planned contrasts showed resistance exercise was superior to usual care for group differences in mean change between baseline and follow-up. All results were unchanged after covariate adjustment.

Changes in Objectively Measured Outcomes

Table 3, online only, lists physical fitness and body composition end points. VO2peak was superior with resistance (P = .041) and aerobic training (P = .052) compared with usual care. After adjustment for covariates, resistance training remained superior in VO2peak (P = .038), whereas aerobic training was borderline superior (P = .063). Lower- and upper-body strength were superior with resistance training (P < .001 for both). Results were unchanged after covariate adjustment. Resistance training attenuated increases in body fat percentage compared with usual care (P = .049). After covariate adjustment, the difference between resistance training and usual care was borderline significant (P = .055).

Table 4, online only, lists hemoglobin, PSA, and testosterone data. The analysis for hemoglobin showed no main effect for group (F = 0.51; P = .606), but a significant main effect of time (F = 54.28; P < .001). The interaction between group and time (F = 0.99; P = .414) was not significant. Hemoglobin levels declined over time in all groups and results were unchanged after adjustment. For testosterone, there was no main effect for group (F = 0.49; P = .611), but there was a significant main effect of time (F = 5.11; P < .001) and a significant interaction between group and time (F = 2.64; P < .035). Planned contrasts showed a trend (P = .090) for less reduction in testosterone with resistance training in the analysis of group differences in mean change from baseline to 12 weeks. The between-group difference was reduced (to 1.17 pmol; P = .267) after covariate adjustment. For PSA, there was no main effect of group (F = 1.13; P = .326); however, there was a significant main effect for time (F = 26.88; P < .001). The interaction between group and time was not significant (F = 1.21; P = .309). Planned contrasts showed less reduction in PSA with resistance training in the analysis of group differences in mean changes from baseline to 12 weeks. The between-group difference was increased (to 1.59 ng/mL; P = .031) after covariate adjustment.

At baseline, mean levels (and standard deviations) of total cholesterol, low- and high-density lipoprotein cholesterol, and triglyceride levels were 5.4 ± 1.0, 3.3 ± 0.8, 1.4 ± 0.3, and 1.6 ± 0.9 mmol/L, respectively. There were no significant between-group differences. During the intervention, total and low-density lipoprotein cholesterol levels trended lower in all groups (0.1 ± 0.8 and 0.2 ± 0.6 mmol/L, respectively); however, there were no significant between-group differences. High-density lipoprotein values remained unchanged in all groups. Triglyceride levels increased by 0.3 ± 0.7 mmol/L in both the aerobic and usual-care groups, and decreased by 0.1 ± 0.6 mmol/L with resistance training. The change in triglycerides between the resistance training and usual care was significant (P = .036).

Adverse Events

Three participants experienced adverse events related to exercise; only one was deemed serious (ie, resulting in hospitalization or disability). In the resistance group, one man experienced chest pain during exercise. Subsequent cardiologic investigations were negative. In the aerobic group, one man had syncope before his treadmill exercise test. No underlying cause was identified. He later completed testing without incident. The lone serious adverse event occurred in the aerobic group, where a man suffered an acute myocardial infarction. The patient was on the third day of the training protocol. Fifteen minutes after completion of the session he collapsed and was found to be in ventricular fibrillation. He was resuscitated and made a full recovery, although he did not complete the intervention. His ECG at hospital admission showed ST-segment elevation consistent with acute anterior wall myocardial infarction. No previous cardiac history had been reported.

In the short term, both resistance and aerobic exercise mitigated fatigue in men with PCa receiving radiotherapy, but resistance training also produced longer-term improvements; our main hypothesis was partially supported. Resistance training provided additional benefits for QOL, muscular strength, triglycerides, and body fat percentage. Aerobic training preserved aerobic fitness, but unexpectedly, so did resistance training. There was less reduction in PSA with resistance training compared with usual care. Other than for triglyceride levels, no training effects on serum lipid levels were observed.

Between-group differences were the result of a worsening of fatigue in the usual-care group, whereas symptoms remained stable or improved in the exercise groups. The observed 4.1- to 4.8-point improvements in fatigue with exercise intervention are clinically important16 and are of greater magnitude than the 3.0-point improvement reported previously by our group.13 They are also similar to the 4.2-point change in FACT-Fatigue associated with a ≥ 2 g/dL increase in hemoglobin after treatment with erythropoietic agents.18 Given that erythropoietin agents have been associated with thromboembolic complications in anemic patients19 and are contraindicated in nonanemic patients, it is encouraging that exercise is an effective alternative for managing cancer-related fatigue. Improvements in fatigue were associated with improvements in upper-body strength (r = .21; P = .03), but not hemoglobin (r = .14; P = .13). This suggests that exercise training may improve fatigue by improving neuromuscular efficiency and reducing muscular fatigue.9 Other mechanisms by which exercise might improve fatigue include reduced depression, improved sleep, and increased socialization. It is also possible that the observed effects of training were placebo effects.

To our knowledge, only one other published study20 has examined the effects of exercise training on fatigue in men receiving similar treatment. Windsor et al20 randomly assigned 66 men before radiotherapy for PCa either to exercise or control. Moderate-intensity, home-based walking was performed 3 days/wk during radiotherapy. There was a trend toward less fatigue in the exercise group. Another published study has examined the effects of exercise on fatigue in men receiving ADT, but not radiotherapy: Culos-Reed et al21 found fatigue was significantly reduced after 12 weeks of home-based exercise in an uncontrolled study of 31 men with PCa on ADT. The present study provides strong evidence of the benefits of both resistance and aerobic exercise for mitigating fatigue over the short term during radiotherapy in men with PCa; resistance training also produced longer-term improvements.

Our data showed resistance training improved cancer-specific QOL; however, neither exercise intervention improved PCa-specific concerns related to radiotherapy. Previously, we found resistance training improved PCa-specific QOL measured by the combined FACT-G and FACT-P.13 In the present study, we divided the FACT-P into its prostate cancer–specific symptom component and the general cancer–specific QOL component, and found that the benefits of resistance training were related to improvement in general cancer–specific QOL. The 4.3- to 4.8-point difference between resistance training and usual care exceeds the minimal clinically important difference of 4.0 points observed in FACT-G.16

Resistance and aerobic training mitigated a reduction in VO2peak compared with usual care. Between-group differences indicated an approximate 5% advantage to either resistance or aerobic training compared with usual care. The relatively modest effect of aerobic training on aerobic fitness may be partially explained by the fact that six usual-care participants “dropped in” to aerobic training, possibly reducing between-group changes in VO2peak. The benefit of resistance training on VO2peak was unexpected. Again, one reason may be the fact that eight resistance training participants reported vigorous aerobic exercise in addition to their assigned training. Resistance training is not generally considered a primary means for developing VO2peak; however, studies evaluating circuit weight training show an average improvement in VO2peak of 6%.22 With resistance training, upper- and lower-body muscular strength were also improved by 22% and 24%, respectively, compared with usual care. These improvements are somewhat smaller than reported in a previous uncontrolled pilot study of 10 men with PCa on ADT.23 In our previous 12-week study of resistance training in men with PCa receiving ADT, we found changes in upper- and lower-body muscular fitness averaging 42% and 32%, respectively.13

Neither exercise intervention prevented weight gain, but resistance training helped avoid an increase in body fat, a common side effect of ADT.24 To our knowledge, only one previous study23 has reported body fat percentage changes on the basis of DEXA analysis during exercise intervention in PCa patients, with no observed change after 20 weeks of resistance training. Using a randomized design and a larger sample size, our study confirms the benefits of resistance training for preserving body composition.

The smaller reduction over time in PSA levels in the resistance training group is probably not clinically important, but caution is warranted. One reason may be that PSA levels in the usual-care group were higher at baseline and had farther to decline during the intervention period. Previous studies of men with PCa participating in resistance training13,23 have not reported adverse effects on PSA levels. To our knowledge, the present study is the first to provide information on changes in PSA, testosterone, and hemoglobin during aerobic training in men with PCa.

A serious exercise-related adverse cardiovascular event occurred during aerobic exercise. The American College of Sports Medicine25 recommends symptom-limited exercise stress testing to screen for ischemic heart disease in previously sedentary men age 45 years or older who wish to begin a vigorous exercise program, in men with symptoms of coronary artery disease, or with known cardiac, pulmonary, or metabolic disease. Screening for the presence and severity of cardiovascular disease in men with PCa before embarking on the types of vigorous exercise programs used in this study should be considered.

The strengths of our trial include the comparison of aerobic or resistance exercise training to usual care; the large sample size; the well-defined population; supervised exercise; and a comprehensive assessment of important end points with validated measures, intention-to-treat analysis, and limited loss to follow-up. Limitations include the well-educated, ethnically homogenous sample and the lack of long-term follow-up.

In summary, our trial demonstrates that both resistance and aerobic exercise mitigated fatigue in men with PCa receiving radiotherapy over the short term. Resistance exercise also produced longer-term improvements in fatigue and additional benefits for QOL, muscular strength, triglycerides, and body fat percentage. Resistance and aerobic exercise training use should be considered as supportive care therapies to preserve QOL and vigor in men undergoing radiotherapy for PCa.

The author(s) indicated no potential conflicts of interest.

Conception and design: Roanne J. Segal, Robert D. Reid, Kerry S. Courneya, Ronald J. Sigal, Glen P. Kenny, Denis G. Prud'homme, Shawn C. Malone, George A. Wells, Chris G. Scott

Financial support: Denis G. Prud'homme

Administrative support: Roanne J. Segal, Chris G. Scott

Provision of study materials or patients: Roanne J. Segal, Shawn C. Malone

Collection and assembly of data: Roanne J. Segal, Robert D. Reid, Chris G. Scott, Monika E. Slovinec D'Angelo

Data analysis and interpretation: Roanne J. Segal, Robert D. Reid, Kerry S. Courneya, Ronald J. Sigal, Glen P. Kenny, Denis G. Prud'homme, Shawn C. Malone, George A. Wells, Chris G. Scott, Monika E. Slovinec D'Angelo

Manuscript writing: Roanne J. Segal, Robert D. Reid, Kerry S. Courneya, Ronald J. Sigal, Glen P. Kenny, Denis G. Prud'homme, Shawn C. Malone, George A. Wells, Chris G. Scott, Monika E. Slovinec D'Angelo

Final approval of manuscript: Roanne J. Segal, Robert D. Reid, Kerry S. Courneya, Ronald J. Sigal, Glen P. Kenny, Denis G. Prud'homme, Shawn C. Malone, George A. Wells, Chris G. Scott, Monika E. Slovinec D'Angelo

Stratified Analysis of Results for Men Not Receiving Androgen Deprivation Therapy and Men Receiving Androgen Deprivation Therapy

For the 47 men not receiving androgen deprivation therapy (ADT), between-group differences for the mean change from baseline to 6 months for resistance versus usual care were as follows: fatigue (7.3 points; 95% CI, 2.5 to 12.2; P = .004); cancer-specific quality of life (QOL) as measured by FACT-G (8.6 points; 95% CI, 3.2 to 13.9; P = .002); prostate cancer (PCa)-specific QOL as measured by FACT-P (3.1 points; 95% CI, 0.5 to 5.8; P = .020); VO2peak (2.6 mL/kg/min; 95% CI, 0.16 to 5.0 mL/kg/min; P = .037); upper-body strength (12.3 kg; 95% CI, 8.4 to 16.1 kg; P < .001); lower-body strength (29.0 kg; 95% CI, 15.7 to 42.3 kg; P = < .001); dual energy X-ray absorptiometry (DEXA) body fat (−0.02%; 95% CI, −2.28 to 2.24%; P = .988); and hemoglobin (2.0 g/dL; 95% CI, −2.1 to 6.0 g/dL; P = .330). Between-group differences for the mean change from baseline to 6 months for aerobic versus usual care were as follows: fatigue (1.7 points; 95% CI, −3.2 to 6.5; P = .482); cancer-specific QOL as measured by FACT-G (6.3 points; 95% CI, 0.9 to 11.6; P = .023); PCa -specific QOL as measured by FACT-P (0.9 points; 95% CI, −1.8 to 3.5; P = .508); VO2peak (1.3 mL/kg/min; 95% CI, −1.1 to 3.8 mL/kg/min; P = .276); upper-body strength (2.4 kg; 95% CI, −1-4 to 6.2 kg; P = .218); lower-body strength (8.8 kg; 95% CI, −5.0 to 22.7 kg; P = .204); DEXA body fat (1.25%; 95% CI, −1.08 to 3.59%; P = .283); and hemoglobin (−2.1 g/dL; 95% CI, −6.2 to 2.0 g/dL; P = .313).

For the 74 men receiving ADT, between-group differences for the mean change from baseline to 6 months for resistance versus usual care were as follows: fatigue (2.8 points; 95% CI, −1.0 to 6.7; P = .148); cancer-specific QOL as measured by FACT-G (1.6 points; 95% CI, −3.0 to 6.2; P = .489); PCa-specific QOL as measured by FACT-P (0.2 points; 95% CI, −3.3 to 3.7; P = .914); VO2peak (0.70 mL/kg/min; 95% CI, −1.16 to 2.56 mL/kg/min; P = .822); upper-body strength (14.1 kg; 95% CI, 9.9 to 18.2 kg; P < .001); lower-body strength (23.2 kg; 95% CI, 9.5 to 37.1 kg; P = .001); DEXA body fat (−2.79%; 95% CI, −4.71 to −0.87%; P = .005); and hemoglobin (−1.7 g/dL; 95% CI, −7.0 to 3.6 g/dL; P = .525). Between-group differences for the mean change from baseline to 6 months for aerobic versus usual care were as follows: fatigue (3.3 points; 95% CI, −0.4 to 7.0; P = .082); cancer-specific QOL as measured by FACT-G (0.3 points; 95% CI, −4.1 to 4.6; P = .906); PCa-specific QOL as measured by FACT-P (2.0 points; 95% CI, −1.4 to 4.2; P = .247); VO2peak (1.43 mL/kg/min; 95% CI, −0.37 to 3.23 mL/kg/min; P = .422); upper-body strength (4.7 kg; 95% CI, 0.8 to 8.7 kg; P = .020); lower-body strength (1.9 kg; 95% CI, −11.4to 15.2 kg; P = .777); DEXA body fat (−0.4%; 95% CI, −2.6 to 1.8%; P = .726); and hemoglobin (−0.9 g/dL; 95% CI, −6.0 to 4.1 g/dL; P = .711).

Table

Table 1. Baseline Characteristics of Volunteers Participating in Exercise Study

Table 1. Baseline Characteristics of Volunteers Participating in Exercise Study

CharacteristicOverall Sample (N = 121)
Usual Care Group (n = 41)
Resistance Exercise Training Group (n = 40)
Aerobic Exercise Training Group (n = 40)
No.%No.%No.%No.%
Demographic profile
    Age
        Mean66.365.366.466.2
        SD7.07.67.66.8
    Married10082.63278.03280.03690.0
    Completed university or college6251.22151.21947.52255.0
    Employed full-time2923.91434.1615.0922.5
Medical profile
    Weight, kg
        Mean86.386.584.388.1
        SD12.215.29.910.9
    BMI, kg/m2
        Mean28.629.028.128.9
        SD12.24.23.53.4
    Testosterone, pmol
        Mean7.87.86.49.3
        SD7.37.16.28.5
    PSA, ng/mL
        Mean3.13.93.02.5
        SD4.35.53.33.8
    On androgen deprivation therapy7461.22663.42357.52562.5
    Cancer stage grouping
        Stage I10.800.000.012.5
        Stage II9578.53585.43177.52972.5
        Stage III2117.349.8820.0922.5
        Stage IV10.812.400.000.0
        Unassignable group32.412.412.512.5
    Gleason score
        Mean6.76.76.76.9
        SD0.90.91.10.8
Behavioral profile
Current aerobic exerciser4436.41639.01435.01435.0
Current weight trainer1310.737.3410.0615.0
Current smoker54.124.900.037.5

Note: Data are presented as the mean and SD for continuous variables and the number and percentage for categorical variables.

Abbreviations: SD, standard deviation; BMI, body mass index; PSA, prostate-specific antigen.

Table

Table 2. Effects of Aerobic and Resistance Exercise on Patient-Rated Outcomes in Prostate Cancer Patients Receiving Radiation Therapy

Table 2. Effects of Aerobic and Resistance Exercise on Patient-Rated Outcomes in Prostate Cancer Patients Receiving Radiation Therapy

CharacteristicBaseline
Midpoint
Post-Test
Change From Baseline to Midpoint (12 weeks)
Change From Baseline to Post-Test (24 weeks)
Unadjusted Group Difference in Mean Change From Baseline to Midpoint (12 weeks)
Unadjusted Group Difference in Mean Change From Baseline to Post-Test (24 weeks)
MSDMSDMSDM95% CIPM95% CIPM95% CIPM95% CIP
FACT–Fatigue Subscale
    UC44.68.739.08.942.18.8−5.57−7.80 to −3.34< .001−2.45−4.50 to −0.40.020
    RET42.88.741.39.145.19.1−1.46−3.81 to 0.89.2202.330.13 to 4.53.040RET v UCRET v UC
4.110.87 to 7.35.0104.781.77 to 7.78.002
    AET44.18.743.18.844.28.9−0.93−3.17 to 1.31.4100.20−1.90 to 2.29.850AET v UCAET v UC
4.641.47 to 7.80.0042.65−0.29 to 5.58.080
FACT–Prostate Symptom Subscale
    UC37.16.432.96.536.06.4−4.17−5.97 to −2.38< .001−1.13−2.70 to 0.43.154
    RET37.46.435.56.737.76.7−1.91−3.79 to −0.02.0470.27−1.41 to 1.95.750RET v UCRET v UC
2.26−0.34 to 4.87.0881.40−0.89 to 3.70.228
    AET37.56.434.36.537.86.5−3.17−4.98. to 1.37< .0010.31−1.29 to 1.90.703AET v UCAET v UC
1.00−1.55 to 3.54.4401.44−0.80 to 3.68.205
FACT–General Scale
    UC90.013.087.513.289.813.1−2.48−5.16 to 0.21.070−0.17−2.53 to 2.19.886
    RET88.213.090.513.492.413.42.27−0.55 to 5.11.1134.171.62 to 6.70.002RET v UCRET v UC
4.760.86 to 8.65.0174.340.88 to 7.80.015
    AET89.513.090.213.191.813.10.75−1.95 to 3.44.5852.35−0.06 to 4.77.055AET v UCAET v UC
3.22−0.58 to 7.02.0962.52−0.85 to 5.90.141

Abbreviations: M, mean; SD, standard deviation; FACT, Functional Assessment of Cancer Therapy; UC, usual care; RET, resistance exercise training; AET, aerobic exercise training.

Table

Table 3. Effects of Aerobic and Resistance Exercise on Physical Fitness and Body Composition in Prostate Cancer Patients Receiving Radiation Therapy

Table 3. Effects of Aerobic and Resistance Exercise on Physical Fitness and Body Composition in Prostate Cancer Patients Receiving Radiation Therapy

CharacteristicBaseline
Post-Test
Mean Change
Unadjusted Group Difference in Mean Change From Faseline to Post-Test (24 weeks)
Adjusted Group Difference in Mean Change From Baseline to Post-Test (24 weeks)
MSDMSDM95% CIPM95% CIPM95% CIP
VO2peak, ml/kg/min
    UC28.85.127.65.1−1.4−2.4 to −0.4.008
    RET28.26.929.16.6+0.14−0.9 to 1.2.785RET v UCRET v UC
+1.50.06 to 3.0.041+1.61.0 to 3.1.037
    AET29.46.529.66.4+0.04−.98 to 1.1.941AET v UCAET v UC
+1.4−.01 to 2.8.052+1.4.08 to 2.8.063
8-RM leg, kg
    UC117.353.5119.255.9+0.41−6.3 to 7.1.905
    RET104.637.7134.141.6+25.618.7 to 32.6< .001RET v UCRET v UC
+25.215.6 to 34.9< .001+25.115.3 to 34.9< .001
    AET125.655.8128.060.9+4.4−2.4 to 11.2.205AET v UCAET v UC
+4.0−5.6 to 13.6.412+3.7−6.0 to 13.4.45
8-RM chest, kg
    UC55.213.352.914.6−2.5−4.5 to −.60.011
    RET49.511.160.814.0+10.98.8 to 13.0< .001RET v UCRET v UC
+13.510.6 to 16.3< .001+13.710.7 to 16.6< .001
    AET53.412.154.913.0+1.3−.68 to 3.3.193AET v UCAET v UC
+3.91.1 to 6.6.007+4.01.2 to 6.9.006
Weight, kg
    UC86.515.287.715.9+1.250.43 to 2.1.003
    RET84.39.985.210.5+.860.03 to 1.7.042RET v UCRET v UC
−.39−1.6 to 0.78.514−.52−1.7 to 0.67.390
    AET88.110.988.611.6+.46−.38 to 1.3.281AET v UCAET v UC
−.79−2.0 to 0.39.186−.88−2.1 to 0.32.148
Body fat, %
    UC31.78.433.38.1+1.60.56 to 2.6.003
    RET31.75.631.37.1−.04−1.2 to 1.1.947RET v UCRET v UC
−1.5−3.1 to −.01.049−1.5−3.1 to 0.03.055
    AET31.05.932.37.1+1.40.27 to 2.6.016AET v UCAET v UC
−.19−1.7 to 1.3.808−.15−1.7 to 1.4.847

NOTE. Adjusted for age, cancer stage, androgen deprivation therapy (yes/no), and Gleason score. P values presented only for hypothesized comparisons.

Abbreviations: M, mean; SD, standard deviation; FACT, Functional Assessment of Cancer Therapy; UC, usual care; RET, resistance exercise training; AET, aerobic exercise training; VO2peak, peak volume of oxygen consumed; RM, repetition maximum.

Table

Table 4. Effects of Aerobic and Resistance Exercise on Serology Outcome Indicators in Prostate Cancer Patients Receiving Radiation Therapy

Table 4. Effects of Aerobic and Resistance Exercise on Serology Outcome Indicators in Prostate Cancer Patients Receiving Radiation Therapy

CharacteristicBaseline
Midpoint
Post-Test
Change From Baseline to 3 Months
Change From Baseline to 6 Months
Unadjusted Group Difference in Mean Change From Baseline to Midpoint (12 weeks)
Unadjusted Group Difference in Mean Change From Baseline to Post-Test (24 weeks)
MSDMSDMSDM95% CIPM95% CIPM95% CIPM95% CIP
Hemoglobin
    UC147.112.1140.612.2141.812.2−6.46−8.70 to −4.21< .001−5.25−7.72 to −2.79< .001
    RET145.112.1139.312.4139.912.5−5.35−7.72 to −2.98< .001−5.16−7.81 to −2.52< .001RET v UCRET v UC
1.10−2.15 to 4.37.5030.09−3.52 to 3.70.960
    AET145.712.1137.212.2139.112.3−8.53−10.78 to −6.27< .001−6.64−9.18 to −4.11< .001AET v UCAET v UC
−2.07−5.25 to 1.11.201−1.39−4.93 to 2.14.437
Testosterone, pmol
    UC7.687.285.997.305.507.30−1.70−3.14 to −0.25.021−2.18−4.02 to −0.34.020
    RET6.437.256.527.436.087.610.10−1.40 to 1.61.892−0.34−2.31 to 1.63.734RET v UCRET v UC
1.80−0.29 to 3.89.0901.84−0.85 to 4.54.177
    AET9.627.296.367.316.977.38−3.26−4.73 to −1.80< .001−2.65−4.54 to −0.76.006AET v UCAET v UC
−1.57−3.62 to 0.49.134−0.46−3.10 to 2.17.728
Prostate-specific antigen, ng/dL
    UC3.863.041.313.090.573.07−2.54−3.52 to −1.57< .001−3.29−4.46 to −2.11< .001
    RET2.943.031.843.201.193.31−1.11−2.13 to −0.09.033−1.76−3.01 to −0.51.006RET v UCRET v UC
1.430.02 to 2.86.0461.53−0.18 to 3.25.090
    AET2.543.030.863.070.403.10−1.69−2.67 to −0.71< .001−2.14−3.34 to −0.94< .001AET v UCAET v UC
0.86−0.52 to 2.24.2231.14−0.53 to 2.82.181

Abbreviations: M, mean; SD, standard deviation; FACT, Functional Assessment of Cancer Therapy; UC, usual care; RET, resistance exercise training; AET, aerobic exercise training.

© 2009 by American Society of Clinical Oncology

published online ahead of print at www.jco.org on December 8, 2008.

Supported by Grant No. 013232 from the Canadian Prostate Cancer Research Fund.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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DOI: 10.1200/JCO.2007.15.4963 Journal of Clinical Oncology 27, no. 3 (January 20, 2009) 344-351.

Published online September 22, 2016.

PMID: 19064985

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