Exercise Mode Specificity for Preserving Spine and Hip BMD in Prostate Cancer Patients

Purpose Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine effects of targeted exercise modes on BMD in men with PCa undergoing ADT. Methods Between 2009 and 2012, 154 PCa patients aged 43-90 years on ADT were randomised to exercise targeting the musculoskeletal system (impact loading+resistance training; ImpRes; n=57) supervised for 12 months, cardiovascular and muscular systems (aerobic+resistance training; AerRes; n=50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n=47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). Endpoints were lumbar spine, hip and whole-body BMD measured by DXA with secondary endpoints of lean and fat mass, appendicular skeletal muscle mass (ASM) and neuromuscular strength. Analysis of covariance was used to compare the exercise groups to DelAer at 6 and 12 months. Results There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months, p=0.039; 12 months, p=0.035) and femoral neck (6 months, p=0.050), with decline attenuated in ImpRes (~ -1.0% vs. ~ -2.0%). Compared to DelAer, ImpRes increased ASM at 6 months (0.3 kg, p=0.045) and improved muscle strength at 6 and 12 months (p≤0.012) by 9-34%. A limitation was inclusion of well-functioning patients. Conclusion Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT. Address for correspondence and reprint requests to: Robert U. Newton, PhD, Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia. P: 61 8 6304 3443. Email: r.newton@ecu.edu.au This study was funded by the National Health and Medical Research Council (NHMRC) 534409, Prostate Cancer Foundation of Australia (PCFA), Cancer Council of Western Australia and Cancer Council of Queensland. The sponsors did not participate in the design or conduct of the study; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Daniel A. Galvão is funded by a Cancer Council Western Australia Research Fellowship. Suzanne Chambers is supported by an Australian Research Council Professorial Future Fellowship. CONFLICT OF INTEREST: Robert U Newton, Daniel A. Galvão and Dennis R. Taaffe had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors had no conflict of interest, including relevant financial interests, activities, relationships, and affiliations to declare relating to this manuscript. The results of the study are presented clearly, honestly, without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Submitted for publication February 2018. Accepted for publication October 2018. © 2018 American College of Sports Medicine

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