Men with localized prostate cancer (PC) frequently receive months of hormone ablation (HA+) therapy plus radiation therapy (RT). These patients experience significant bone loss; those receiving HA+ therapy experience even greater bone loss of 4–13% yearly which can affect functional status and symptoms. Despite strong evidence demonstrating exercise benefits during treatment for breast cancer, there has been little investigation of exercise to reduce losses in bone mineral density (BMD) and functional status among PC patients.
Purpose/Objective(s)
This RCCT was conducted to determine the effects of a nurse-led, home-based walking program in maintaining physical function and managing cancer- and treatment-related symptoms during RT for PC.
Materials/Methods
Eighty men with AJCC Stage I-III PC scheduled for RT were randomized to usual care (UC) or exercise (EX) during treatment; of these, more than half (n = 37) received HA+ therapy. The EX intervention was a brisk, incremental 20–30 minute walk, 5–6 times/week. Data were collected prior to and at the end of RT and included measures of physical function (treadmill tests), BMD (DEXA scans), HRQOL, physical activity, and symptom distress.
Results
Sample age range was 41–80 (mean = 66) years; 27% were ethnic minorities. The majority were partnered, college-educated and had stage II cancer. Overall, general symptom distress was low; bowel problems were the most prevalent symptom. Of patients randomized to EX, 87% were able to adhere to the program, walking an average of 32 minutes/session 5 days/week. Peak VO2 increased in the EX group and decreased in the UC group (F = 3.84) (p = .05), consistent with increased measures of physical activity in EX and decreases in UC. A 2–3 month EX intervention during RT appeared to reduce/reverse the rate of bone loss associated with HA+ therapy as demonstrated by an increase in BMD (0.48%) in the HA+ EX group, and a decrease (2.26%) in the HA+ UC group (p = 0.047). These differences are clinically significant given normal yearly BMD losses of 0.05–1.0% for males, beginning in middle age. Further, T-scores comparing changes in bone mineral density over 2 months approached significance among those who completed a post-test DEXA scan (p = 0.067; n = 34) [Table 1].
Conclusions
A low-cost, moderate-intensity, nurse-led EX program improves functional capacity and may reduce or actually reverse bone loss associated with HA+ therapy during RT for PC. Findings will guide implementation of EX interventions for PC patients during RT. Further investigation should also be conducted on the effects of HA+ therapy on BMD, bone loss, and functional capacity among PC patients, particularly those receiving HA+ therapy, using larger samples over a longer period.
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