Androgen Depravation Therapy and Exercise
Hormone therapy, also known as androgen deprivation therapy (ADT), is a commonly used treatment for men with prostate cancer. ADT may serve as adjuvant therapy (administered after prostate removal or radiation therapy) or it may serve as primary therapy, as in the case of recurrent or metastatic prostate cancer to slow the advancement of the disease.
ADT works by reducing the body’s natural production of the hormone testosterone, slowing the progression of prostate cancer cells that are dependent on testosterone for growth. While ADT improves cancer-related symptoms and survival, testosterone deprivation has numerous side effects that may have negative consequences for overall health and quality of life. Exercise has been proposed as a strategy to counter the adverse effects of ADT and is already considered to be an effective treat- ment for chronic diseases such as type II diabetes and cardiovascular disease. Many men treated with ADT recognize the importance of doing exercise to stay healthy; however, the exact exercise prescription may be less clear.
Fatigue
A universal side effect reported by patients on ADT is fatigue, which may be attributed to any number of ADT-related complications including loss of muscle, low red blood cells, distressed emotional state, or disruption of sleep. Several studies have observed significant reduc- tions in fatigue as a result of exercise training, be it resistance or aerobic. In particular, performing either aerobic or resistance exercise at least twice per week reduced fatigue compared to not exercising at all.
Quality of Life
The impact of ADT on emotional state is substantial, with depressed mood and increased anxiety documented across several studies in men receiving ADT. Long-term use of ADT and the presence of other disease was associated with poorer quality of life, while men who remained physically active had greater psychosocial well-being. In- deed, many studies have demonstrated that men on ADT have a more positive outlook after participating in an exercise program compared to those who did not exercise.. This greater well-being may be due to improvements in muscle strength and body composi-
New Research - November 2018
Researchers in Australia have demonstrated that exercise has therapeutic benefit for the management of ADT-related side effects. Significant positive effects following exercise were observed for aerobic fitness, muscular strength, physical function, body composition, fatigue, sexual wellbeing, mental wellbeing, social function, comorbid disease risk factors, and quality of life. Emerging evidence suggests exercise may also play a role in managing bone loss, cognitive decline, and urinary problems, and may be delivered without exacerbating bone pain. Exercise did not negatively influence ADT treatment efficacy and led to few adverse events of minor severity, rendering it a safe intervention for men receiving ADT. To maximize the therapeutic effect of exercise, men with prostate cancer should participate in moderate-to-high intensity aerobic, resistance and impact exercise which is prescribed and supervised by a qualified exercise physiologist and delivered at a convenient location in a prostate cancer specific group-based environment. The level of evidence now available supports the view that the prescription of exercise medicine should be part of routine prostate cancer care.