Lifestyle changes boost QoL during long-term ADT

A study shows that a lifestyle intervention, involving an exercise program and dietary advice, improves disease-specific quality of life (QoL) in sedentary men with advanced prostate cancer who are receiving long-term androgen-deprivation therapy (ADT).

Derek Rosario (University of Sheffield, UK) and colleagues randomly assigned 100 men with advanced prostate cancer, including 20 with metastatic disease, to an intervention or usual care group in the 12-week trial.

In the intervention group, the men took part in two sessions of aerobic exercise and resistance training supervised by an exercise physiologist per week and were asked to undertake one additional 30-minute exercise session each week between weeks 1 and 6. This was tapered to one supervised session and two independent sessions per week in weeks 7 to 12. The men also received a dietary advice pack and took part in healthy eating seminars every 2 weeks over the course of the study.

The researchers found that the men adhered well to the intervention program over the first 12 weeks, with 94% adherence to the supervised exercise sessions and 82% to the independent sessions. And, at 6 months follow-up, men in the intervention group continued to have significantly better exercise behavior, as measured by the Godin questionnaire, than men in the usual care group.

At 12 weeks, men in the intervention group also had significant and clinically relevant improvements in disease-specific QoL, with an adjusted mean difference of 8.9 points versus controls. However, at 6 months, these benefits were not sustained, with the difference falling to a nonsignificant 3.3 points.

There were no significant changes in body weight, diastolic or systolic blood pressure, or prostate-specific antigen levels, and a decrease in fat intake in the intervention group seen at 12 weeks did not reach statistical significance. But the researchers did observe significant and clinically relevant improvements in fatigue and aerobic exercise tolerance at both time points.

Writing in European Urology, Rosario and colleagues say their findings highlight the importance of ongoing supervised support in maintaining the QoL benefits of such interventions.

But noting that 32% of their patients did not take part in the 6-month follow-up, they say that strategies to prolong participation must be prioritised in future.

“Such strategies may include extended supervision and tapering with addition of intermittent contact sessions,” they suggest.

“The cost effectiveness of such approaches should be studied to determine the place of such exercise and dietary interventions in routine care.”

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