EURURO Vol. 72 No. 2

in vitality (

trend

0.001) with exercise

( Fig. 2

). Sensitivity

analysis was conducted using complete cases

[22]

with no

change in the results for vitality and although for fatigue

there was a significant main effect for time (

= 0.003) with

the magnitude of difference within groups over time

similar, with the reduction in sample size and hence

statistical power the only significant difference was for ART

(

= 0.032).

3.3.

Other measures and adverse events

For cardiorespiratory fitness, there was no significant

interaction (

= 0.216) but a significant effect for time

(

0.001) with fitness improved (

= 0.008) in ILRT at

12 mo by 14 s and in ART (

0.001) by 13 s at 12 mo,

with the change in DEL of 11 s at 12 mo approaching

significance (

= 0.063;

Table 4

). Notably, there was no

change in cardiorespiratory fitness during the nonexercise

period for DEL. For muscle strength, there was a significant

interaction (

0.001) with strength progressively increas-

ing at 6 mo and 12 mo (

0.001) in ILRT, increasing during

the initial 6-mo supervised phase in ART (

0.001) with no

change thereafter, and no change between baseline and

6 mo in DEL but a difference by 12 mo following exercise

(

0.001). No adverse effects from exercise resulted in any

participants having to withdraw from the study. Two men

in ILRT withdrew within the 1st 6 mo due to compressed

spinal discs and shoulder issues, although the person

developed shoulder issues prior to commencing exercise

training. Two men in ART had cardiovascular problems, one

in the 1st 6 mo and one in the 2nd 6 mo, with one requiring

heart bypass surgery while another participant in ART

developed back pain. Two men withdrew from DEL in the

1st 6 mo due to difficulty walking and the other required

back surgery.

Discussion

To our knowledge, this is the first year-long RCT to evaluate

the effects of different exercise modalities on fatigue in

prostate cancer patients undergoing ADT. There were two

important findings: (1) all exercise modalities (resistan-

ce + impact loading, aerobic + resistance, aerobic only) had

a beneficial effect on fatigue and vitality, and (2) those with

the highest levels of fatigue and lowest vitality improved

the most with exercise.

A substantial proportion of PCa patients will receive ADT

as part of their treatment. Prevalence of clinically-relevant

fatigue in these patients has been reported as 40%

[2,23]

. The fatigue scores from the EORTC QLQ-C30 in our

cohort are similar to the reference values for men with PCa

aged 60–69 y (25.2 26.6)

[24] .

Vitality has also been shown

to decline during ADT. In a population-based sample of men

with PCa followed for 1 y, Alibhai et al

[25]

reported vitality

was substantially lower in ADT-treated compared with non-

ADT patients. A more recent prospective study also showed

changes in vitality following 12 mo of ADT with rapid declines

during the initial 3 mo

[26] .

Short-term exercise trials have shown the efficacy of

combined resistance and aerobic exercise, or as sole training

modes, to improve fatigue in men undergoing radiation

therapy/ADT for PCa

[5,7,8]

. We have also shown improve-

ments in vitality following a 12-wk exercise intervention

[5]

. Here we extend these findings by providing data on the

largest exercise trial undertaken with men undergoing ADT

[(Fig._2)TD$FIG]

–20

–15

–10

–5

FaƟgue

–2

Vitality

Q1 Q2 Q3 Q4

< 0.001

Fig. 2 – Change in fatigue (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 36) and vitality (Short

Form-36) with 6–12 mo exercise according to baseline status. Quartile 1 (Q1) least fatigued and highest vitality to quartile 4 (Q4) most fatigued and

least vitality. Fatigue cut-points were 22 for Q2, 33 for Q3, and 44 for Q4. For vitality, cut-points were 58 for Q2, 51 for Q3, and 44 for Q4. The

value

is for trend analysis.

Table 4 – Cardiovascular fitness and muscle strength at baseline,

6 mo, and 12 mo

Baseline

6 mo

12 mo

value

Cardiovascular fitness (s)

ILRT 274.6 56.1 264.3 47.7 260.8 48.7 0.008 B

ART 269.6 50.9 254.8 41.7 256.8 47.7

0.001 B

DEL 278.8 52.5 276.3 53.8 268.3 47.1 0.063

Muscle strength (kg)

ILRT 161.2 57.6 188.9 63.5 199.4 65.5

0.001 B

ART 163.8 61.3 193.5 66.0 191.8 64.8 0.001 B

6, 12

DEL 168.8 73.7 177.1 70.0 187.5 76.8

0.001 B

ART = aerobic + resistance training; B = baseline; DEL = usual care/delayed

exercise; ILRT = impact-loading + resistance training.

Cardiovascular fitness determined by the 400-m walk; muscle strength

equals the sum for the chest press and leg press exercises.

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 2 9 3 – 2 9 9

297