Exercise and Quality of Life During Androgen Deprivation Therapy
Maneno muhimu
Kikemikali
Maelezo
Androgen deprivation therapy (ADT) is commonly used in management of advanced or recurrent prostate cancer. It also frequently used adjuvant to curative-intent radiation therapy for localized prostate cancer. Low testosterone levels during androgen deprivation commonly cause adverse effects reducing quality of life. Most common adverse effects include fatigue, weight gain, loss of lean muscle mass, hyperglycemia and hypercholesterolemia.
Regular exercise, especially programs involving combination of both aerobic exercise and resistance training has been shown to reduce to reduce adverse effects of ADT on physical functioning and quality of life. It may also improve disease prognosis.
The study compares effects of supervised and unsupervised exercise on plasma lipid parameters (total cholesterol, LDL, HDL and triglycerides) and glucose levels (fasting plasma glucose, glycated hemoglobin), overall quality of life and on average daily exercise activity in men with prostate cancer and under ADT. As secondary outcome we will study effect on continued exercise activity after the intervention, changes in body composition, blood pressure and risk of fractures, castration resistance as well as death due to prostate cancer and due to any cause.
Study hypothesis is that supervised exercise will improve quality of life, lipid and glucose parameters and increase daily exercise activity more that non-supervised exercise. We also expect higher continued exercise activity, greater changes in body composition and blood pressure and lowered risk of fractures and death in the supervised exercise group.
This is a randomized, controlled clinical trial. The study aims to recruit 40 men on ADT for prostate cancer. This will be a pilot study to estimate effect sizes in Finnish population to inform further larger trial.
All participants attend introductory lecture, where a urologist informs them about adverse effects of ADT and positive effects of exercise during ADT, exercise instructor gives advice for training both at home and in the gym and nutritional therapeutist tells about nutrition to overcome adverse effects of ADT and support training.
After the introductory lecture the participants are randomized 1:1 to either the supervised or non-supervised exercise group (Figure). Men in the supervised group participate in progressive group exercise sessions twice a week for total of 12 weeks at the Varala sports academy in Tampere, Finland. Each exercise session includes both aerobic and resistance training targeting all major muscle groups (Additional document I, exercise program). The non-supervised group will exercise independently for 12 weeks according to the instructions given at the introductory lecture. The first control visit will be after this first period of 12 weeks of exercise.
After the first follow-up visit both group will continue non-supervised exercise for 12 weeks, after which the second control visit will be arranged. Special focus on the second control visit is to see how many in each group has been able to carry on active exercising, i.e. has the intervention promoted long-term change in exercise activity.
Both study group will be given Polar wrist activity monitors to be used 24 h/day for the entire course of the study.
All participants are asked to fill validated quality of life surveys EORTC QLQC-30 (overall quality of life) and EORTC QLQC-PR25 (prostate cancer-specific quality of life) at baseline and again at 1st and 2nd control visits. Additionally, qualitative evaluation of quality of life as well as perceived possibilities and obstacles for exercise are evaluated in individual- and group interviews during the study visits. Plasma lipid and glucose parameters, blood pressure and body composition will be measured at each of these visits.
At each visit a separate blood sample is taken and stored for future measurement of biomarkers associated with prostate cancer progression, glucose and lipid metabolism and effects of exercise.
Tarehe
| Imethibitishwa Mwisho: | 08/31/2019 |
| Iliyowasilishwa Kwanza: | 06/26/2018 |
| Uandikishaji uliokadiriwa Uliwasilishwa: | 08/06/2019 |
| Iliyotumwa Kwanza: | 08/07/2019 |
| Sasisho la Mwisho Liliwasilishwa: | 09/09/2019 |
| Sasisho la Mwisho Lilichapishwa: | 09/10/2019 |
| Tarehe halisi ya kuanza kwa masomo: | 08/14/2019 |
| Tarehe ya Kukamilisha Msingi iliyokadiriwa: | 08/14/2020 |
| Tarehe ya Kukamilisha Utafiti: | 08/14/2021 |
Hali au ugonjwa
Uingiliaji / matibabu
Other: Supervised exercise arm
Other: Lecture
Awamu
Vikundi vya Arm
| Mkono | Uingiliaji / matibabu |
|---|---|
| Experimental: Supervised exercise arm Informational initiation lecture and supervised exercise twice a week for 12 weeks followed by 12 weeks of non-supervised exercise. | Other: Supervised exercise arm 12 weeks of progressive weight training twice a week supervised by a qualified physiotherapist. |
| Active Comparator: Non-supervised exercise arm Informational initiation lecture and only non-supervised exercise |
Vigezo vya Kustahiki
| Zama zinazostahiki Kujifunza | 18 Years Kwa 18 Years |
| Jinsia Inastahiki Kujifunza | Male |
| Hupokea Wajitolea wa Afya | Ndio |
| Vigezo | Inclusion Criteria: - Undergoing castration treatment for prostate cancer - Informed consent for the study Exclusion Criteria: - Unable to participate in exercise (ECOG 2 or greater) - High bone fracture risk (as judged by the primary physician) - Unable to understand spoken and written instructions in Finnish |
Matokeo
Hatua za Matokeo ya Msingi
1. Daily total activity [At randomization and twice more at 12 week intervals]
2. Fasting plasma total cholesterol [At randomization and twice more at 12 week intervals]
3. Fasting plasma LDL cholesterol [At randomization and twice more at 12 week intervals]
4. Fasting plasma HDL cholesterol [At randomization and twice more at 12 week intervals]
5. Fasting plasma triglycerides [At randomization and twice more at 12 week intervals]
6. Fasting plasma glucose level [At randomization and twice more at 12 week intervals]
7. Blood glycated hemoglobin (HbA1C) level [At randomization and twice more at 12 week intervals]
8. Overall quality of life [At randomization and twice more at 12 week intervals]
9. Prostate cancer-specific quality of life [At randomization and twice more at 12 week intervals]
Hatua za Matokeo ya Sekondari
1. Change in daily activity after the intervention [Measured daily for 12 weeks' time after the intervention]
2. Subjective adverse effects of castration treatment [At randomization and twice more at 12 week intervals]
3. Lean body mass [At randomization and twice more at 12 week intervals]
4. Muscle mass [At randomization and twice more at 12 week intervals]
5. Skeletal mass [At randomization and twice more at 12 week intervals]
6. Fat mass [At randomization and twice more at 12 week intervals]
7. Metabolic age [At randomization and twice more at 12 week intervals]
8. Systolic blood pressure [At randomization and twice more at 12 week intervals]
9. Diastolic blood pressure [At randomization and twice more at 12 week intervals]
Hatua Nyingine za Matokeo
1. Time to castration resistance [Followed yearly for up to 15 years from randomization]
2. Time to death [Followed yearly for up to 15 years from randomization]
3. Time to prostate cancer death [Followed yearly for up to 15 years from randomization]
4. Bone fractures [Followed yearly for up to 15 years from randomization]
