Time on androgen deprivation therapy and adaptations to exercise: secondary analysis from a 12‐month randomized controlled trial in men with prostate cancer

Medientyp: E-Artikel
Titel: Time on androgen deprivation therapy and adaptations to exercise: secondary analysis from a 12‐month randomized controlled trial in men with prostate cancer
Beteiligte: Taaffe, Dennis R.; Buffart, Laurien M.; Newton, Robert U.; Spry, Nigel; Denham, James; Joseph, David; Lamb, David; Chambers, Suzanne K.; Galvão, Daniel A.
Erschienen: Wiley, 2018
Erschienen in: BJU International
Sprache: Englisch
DOI: 10.1111/bju.14008
ISSN: 1464-4096; 1464-410X
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Beschreibung: <jats:sec><jats:title>Objectives</jats:title><jats:p>To explore if duration of previous exposure to androgen deprivation therapy (<jats:styled-content style="fixed-case">ADT</jats:styled-content>) in men with prostate cancer (<jats:styled-content style="fixed-case">PC</jats:styled-content>a) undertaking a year‐long exercise programme moderates the exercise response with regard to body composition and muscle performance, and also to explore the moderator effects of baseline testosterone, time since <jats:styled-content style="fixed-case">ADT</jats:styled-content>, and baseline value of the outcome.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>In a multicentre randomized controlled trial, 100 men who had previously undergone either 6 months (short‐term) or 18 months (long‐term) of <jats:styled-content style="fixed-case">ADT</jats:styled-content> in combination with radiotherapy, as part of the <jats:styled-content style="fixed-case">TROG</jats:styled-content> 03.04 <jats:styled-content style="fixed-case">RADAR</jats:styled-content> trial, were randomized to 6 months supervised exercise, followed by a 6‐month home‐based maintenance programme, or to printed physical activity educational material for 12 months across 13 university‐affiliated exercise clinics in Australia and New Zealand. The participants were long‐term survivors of <jats:styled-content style="fixed-case">PC</jats:styled-content>a with a mean age of 71.7 ± 6.4 years, and were assessed for lower extremity performance (repeated chair rise), with a subset of men (<jats:italic>n</jats:italic> = 57) undergoing additional measures for upper and lower body muscle strength and body composition (lean mass, fat mass, appendicular skeletal muscle [<jats:styled-content style="fixed-case">ASM</jats:styled-content>]) by dual X‐ray absorptiometry. Data were analysed using generalized estimating equations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Time on <jats:styled-content style="fixed-case">ADT</jats:styled-content> significantly moderated the exercise effects on chair rise (β<jats:sub>interaction</jats:sub> = −1.3 s, 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] −2.6 to 0.0), whole‐body lean mass (β<jats:sub>interaction</jats:sub> = 1194 g, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 234 to 2153) and <jats:styled-content style="fixed-case">ASM</jats:styled-content> mass (β<jats:sub>interaction</jats:sub> = 562 g, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 49 to 1075), and approached significance for fat mass (β<jats:sub>interaction</jats:sub> = −1107 g, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> −2346 to 132), with greater benefits for men previously on long‐term <jats:styled-content style="fixed-case">ADT</jats:styled-content>. At 6 months, the intervention effects on chair rise time −1.5 s (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> −2.5 to −0.5), whole‐body lean mass 824 g (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 8 to 1640), <jats:styled-content style="fixed-case">ASM</jats:styled-content> mass 709 g (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 260 to 1158), and fat mass −1377 g (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> −2156 to −598) were significant for men previously on long‐term <jats:styled-content style="fixed-case">ADT</jats:styled-content>, but not for men on short‐term <jats:styled-content style="fixed-case">ADT</jats:styled-content>. At 12 months, the intervention effects for men on long‐term <jats:styled-content style="fixed-case">ADT</jats:styled-content> remained significant for the chair rise, with improved performance (−2.0 s, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> −3.0 to −1.0) and increased <jats:styled-content style="fixed-case">ASM</jats:styled-content> (537 g, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 153 to 921). Time on <jats:styled-content style="fixed-case">ADT</jats:styled-content> did not moderate the exercise effects on muscle strength, nor did time since <jats:styled-content style="fixed-case">ADT</jats:styled-content> cessation moderate any intervention effects. Similarly, testosterone and baseline values of the outcome had negligible moderator effects.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Men with <jats:styled-content style="fixed-case">PC</jats:styled-content>a previously treated long‐term with <jats:styled-content style="fixed-case">ADT</jats:styled-content> respond more favourably to exercise in terms of lower body muscle performance and body composition (lean and fat mass, and <jats:styled-content style="fixed-case">ASM</jats:styled-content>) than those with short‐term <jats:styled-content style="fixed-case">ADT</jats:styled-content> exposure. As a result, men who were formerly on long‐term androgen suppression regimens should be especially prescribed exercise medicine interventions to alleviate residual treatment‐related adverse effects.</jats:p></jats:sec>

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