EURURO Vol. 72 No. 2

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for PCa by examining the long-term effects of exercise and
potential impact of different exercise modalities. We found
that all exercise modalities had a similar effect on fatigue
and vitality following the intervention. In a recent
systematic review on fatigue instruments, the MID reported
for the EORTC QLQ-C30 ranged from 3.0–19.7 points
The mean differences for our exercise regimens was
5 points with those in quartiles 3 and 4 at baseline having
a change of 10 or more points. Similarly, it has been
recommended that the MID in vitality using the SF-36 is
5 points The mean change for each of the three exercise
regimens was 4 points, with quartiles 3 and 4 gaining a
mean of 5 points or more. This result is important as it
provides practical information to guide the prescription of
exercise in men with PCa to mitigate cancer-related fatigue.
We have recently reported that only 12% of Australian
PCa survivors are meeting sufficient exercise levels . It
appears that supervised exercise undertaken at moderate- to
high-intensity, irrespective of modality (eg, aerobic, resis-
tance, or impact) has a beneficial effect on fatigue. Moreover,
those with higher levels of fatigue/lower levels of vitality
responded the best to exercise such that there was a
progressive decrease in fatigue and increase in vitality with
exercise. As a result, fatigued patients are likely to benefit
most from any form of structured supervised exercise when
undertaken at appropriate intensity and dose. From this we
propose that screening patients on ADT for fatigue and
directing tailored and prescribed exercise interventions to
these men should be part of the prostate cancer care pathway.
During the nonexercise period for the delay group there
was no change in fatigue or vitality and no change in
cardiorespiratory fitness or muscle strength. Conversely,
with exercise improvements were observed in physical
functioning as they were in ILRT and ART, and these were
accompanied by changes in fatigue and vitality. Cardiore-
spiratory fitness changes as determined by the 400-m walk
, although not substantial , would at least provide a
greater safety margin before thresholds for disability are
encountered, hence may potentially be clinically meaning-
ful (especially for men in poorer condition than those in the
present study).
Our study has several features that are worthy of
comment. This is the largest and longest exercise trial in
PCa patients undergoing ADT examining different exercise
modalities including resistance, impact loading and aerobic
training. Fatigue was assessed using the EORTC QLQ-C30
fatigue subscale which is a validated measure, widely used,
and recommended for use in trials to measure cancer-
related fatigue . However, the generalisability of the
data may be limited given that participants volunteered to
participate in an exercise trial, were generally quite healthy,
and predominantly were married and nonsmokers. In
addition, a potential confounding factor was the group
nature of the supervised sessions resulting in the sharing of
common experiences and the camaraderie which may have
developed, impacting on the outcomes of the study. Finally,
men in this study were primarily in the initial year of ADT,
therefore results may not be generalisable to men receiving
ADT for a longer duration.
5. Conclusions
In conclusion, in the largest year-long exercise interven-
tion study in men with PCa undergoing ADT, all exercise
programs had comparable effects on reducing fatigue and
enhancing vitality. However, the benefits were small to
nonexistent for those least fatigued at baseline and as
such an involved intervention should primarily be
considered for those who are most fatigued. Encouraging
fatigued patients to undertake exercise at adequate
intensity, regardless of mode, will likely aid in reducing
or attenuating the adverse effects of ADT on fatigue and
vitality. Screening all men on ADT for fatigue and
providing an exercise intervention is warranted.
Author contributions: Dennis R. Taaffe had full access to all the data in
the study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Taaffe, Newton, Spry, Joseph, Galva˜o.
Acquisition of data: Taaffe, Newton, Wall, Bolam, Galva˜o.
Analysis and interpretation of data: Taaffe, Newton, Spry, Galva˜o.
Drafting of the manuscript: Taaffe, Newton, Spry, Galva˜o.
Critical revision of the manuscript for important intellectual content: Taaffe,
Newton, Spry, Joseph, Gardiner, Chambers, Bolam, Wall, Cormie, Galva˜o.
Statistical analysis: Taaffe, Newton, Galva˜o.
Obtaining funding: Taaffe, Newton, Spry, Joseph, Gardiner, Galva˜o.
Administrative, technical, or material support: None.
Supervision: None.
Other: None.
Financial disclosures: Dennis R. Taaffe certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consul-
tancies, honoraria, stock ownership or options, expert testimony,
royalties, or patents filed, received, or pending), are the following:
None.
Funding/Support and role of the sponsor: This study was funded by the
National Health and Medical Research Council 534409, Prostate
Cancer Foundation of Australia, 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. Galva˜o is funded by a Cancer
Council Western Australia Research Fellowship. Suzanne Chambers is
supported by an Australian Research Council Professorial Future
Fellowship.
A phase 3 clinical trial of exercise modalities on treatment side-effects in
men receiving therapy for prostate cancer; ACTRN12609000200280
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