Supervised exercises can tackle anxiety in men with prostate cancer

Working out under supervision helps ease psychological distress in prostate cancer patients undergoing androgen deprivation therapy (ADT), as shown in a study.

“Psychological distress is common in men with prostate cancer across treatment modalities and stages of disease. The prevalence of depression and anxiety in men with prostate cancer across treatment trajectories has been estimated to be between 15 percent and 27 percent,” they said. [BMJ Open 2014;4:e003901]

In the present population of 135 prostate cancer patients aged 43–90 years receiving ADT, the prevalence of clinical distress at baseline ranged between 4 percent and 38 percent, as this variation was dependent on the case rule employed (standard, Zabora, or Recklitis).

All patients were then assigned to undergo physical activity—which has been proposed to have a significant antidepressant effect. They were randomized to one of the three interventions: (1) supervised impact loading and resistance exercise (ImpRes, n=49) for 12 months, (2) supervised aerobic and resistance exercise for the initial 6 months, followed by another 6 months of a home-based maintenance programme (AerRes, n=50), or (3) provided with a printed booklet with information about exercise for the initial 6 months, followed by 6 months of supervised aerobic exercise (usual care/delayed supervised aerobic exercise [DelAer], n=36).

The Brief Symptom Inventory-18 (BSI-18) was used to evaluate anxiety, depression, and somatization, as well as the global severity index (GSI). The 12-month data showed no change in somatization from baseline. However, there were significant differences seen for depression, anxiety, and the GSI.

Specifically, ImpRes produced meaningful improvements in depression (from 1.88 to 1.48 at 6 months and 0.78 at 12 months; p<0.001), GSI (from 5.94 to 4.64 at 6 months and 3.67 at 12 months; p<0.001), and anxiety (from 1.98 to 1.08 at 12 months). [Prostate Cancer Prostatic Dis 2021;24:758-766]

With AerRes, depression and the GSI decreased at 6 months (p<0.05) but increased again by 12 months. Meanwhile, DelAer led to a substantial reduction in the GSI, from 5.25 at 6 months to 3.78 at 12 months (p=0.031).

Exercise, regardless of the mode, yielded the greatest benefit to men with the highest level of anxiety, depression, somatization, and the GSI (p<0.001). Also, there were parallel improvements in objectively measured physical function seen across the three intervention groups.

Hopping and skipping under supervision

It should be noted that the positive improvements in the elements of psychological distress in this study were largely a result of the supervised portion of the exercise programme in each group, according to the investigators. “These results are consistent with those of a meta-analysis demonstrating that the effects of exercise on depressive symptoms were larger with programmes supervised or partially supervised.” [Cancer Epidemiol Biomark Prev 2012;21:3-19]

In the AerRes group, for example, patients continued to perform resistance training from 6–12 months, but at home with elastic bands. During this period, the intensity and volume of resistance exercise might have declined and contributed to the initial benefits of clinic-based exercise being diluted, the investigators explained.

“Thus, [the] elements of a supervised exercise programme, such as social interaction with peers and professionals, learning new skills and receiving positive feedback, may contribute to improvements in symptoms of distress,” they said. [Cancer Epidemiol Biomark Prev 2012;21:3-19; Cancer Treat Rev 2017;52:91-104]

To improve the long-term efficacy of and adherence to exercise interventions in nonclinical settings, the investigators recommended employing digital health technology such as wearable sensors, as well asdigital exercise platforms for prescription, delivery, and instruction. Finally, they advised setting up video chat sessions with a qualified exercise professional to monitor and support the patient. [Eur Urol Open Sci 2020;21:47-50]