When to exercise to counter ADT-related declines in strength, physical function?

For prostate cancer patients initiating androgen deprivation therapy (ADT), exercising either immediately or after 6 months of treatment effectively preserves and enhances muscle strength and physical function, as shown in a study. However, to prevent the treatment-induced declines in both outcomes, it is best to exercise at the onset of ADT.

In total, 104 men with prostate cancer (mean age, 68.3 years) starting ADT were randomly assigned to undergo immediate exercise (IMX, n=54) or delayed exercise (DEL, n=50) for 12 months. IMX involved 6 months of supervised resistance/aerobic/impact exercise initiated at the onset of ADT with another 6 months of follow-up. On the other hand, DEL consisted of 6 months of usual care followed by 6 months of resistance/aerobic/impact exercise.

There were no between-group differences in any measures of muscle strength at baseline (p-values range, 0.379–0.825). At month 6, however, all strength measures were more favourable in the IMX group, with leg press, seated row, and chest press strength better by 19.9, 5.6, and 4.3 kg (2.7–5.8 kg) than in the DEL group (p<0.001).

During the first 6 months, participants in the DEL group showed modest strength declines: –7 percent for the chest press and –4 percent for the seated row. However, following exercise between 7 and 12 months, the group showed big gains in all strength measures (p<0.001), such that they were comparable to that in the IMX group by 12 months (p-values range, 0.160–0.971).

At month 12, upper and lower body strength was significantly greater than at baseline (p<0.01) in both IMX and DEL groups.

Likewise, physical function at 6 months was better in the IMX vs the DEL group (p<0.001), with differences of −0.2 seconds in the 6-m fast walk, −9.7 seconds in the 400-m walk, –0.4 seconds in stair climb, and −1.0 in chair rise. There were no between-group differences seen in all these measures by 12 months, except for the 6-m fast walk (p<0.001).

The findings suggest that exercise boosts muscle strength and physical function in patients initiating ADT despite their compromised hormonal status, researchers said. Nevertheless, initiating exercise therapy at the onset of ADT should not only prevent the development of any adverse effects but also enhance muscle strength and physical function, and potentially prevent progression of comorbidities.