Lifestyle Intervention for Promoting Physical Activity in Prostate Cancer Patients with Androgen Deprivation Therapy

Main Article Content

Jung Jun Lim
Yeon Soo Kim
Hong Yong Choi
Kyu Shik Kim
Hong Sang Moon
Hyung Joon Park
Jae Hang Shim


prostate cancer, lifestyle intervention, androgen deprivation therapy, side effects


Background and objective
Despite the awareness of the important roles of physical activity (PA), the majority of cancer survivors fail to meet PA guidelines due to a lack of access to facilities or motivation. The purpose of this study is to examine the effectiveness of lifestyle intervention in prostate cancer (PC) patients receiving androgen deprivation therapy (ADT).

Material and methods
A total of 23 PC patients (aged 75.26 ± 6.9 years) receiving ADT at least 3 months were randomized into an intervention group (n=12) and a control group (n=11). The intervention group received lifestyle intervention in the form of education program. Levels of PA, body composition, physical function, disease-specific quality of life (QoL), and fatigue were assessed before and after the 12-week intervention.

The intervention group showed improvements in the level of PA (step count: p=0.028, moderate to vig-orous PA: p=0.013) compared with the control group. Thigh circumference (p=0.002), physical function (grip strength: p=0.034; knee extensor: p=0.004, up and go: p=0.001; 2-min step: p=0.001), QoL (p<0.001), and fatigue (p=0.001) were also improved compared with the control group. There were no adverse events during the lifestyle intervention period.

The 12-week lifestyle intervention program appears to be a promising strategy to increase the PA and mitigate the side effects of ADT for PC patients.


Download data is not yet available.
Abstract 66 | PDF Downloads 37 XML Downloads 0 HTML Downloads 5


1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394– 424.
2. Rebbeck TR. Prostate cancer genetics: Variation by race, ethnicity, and geography. Semin Radiat Oncol 2017;27(1):3–10. semradonc.2016.08.002
3. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359–86. https://doi. org/10.1002/ijc.29210
4. Ito K. Prostate cancer in Asian men. Nat Rev Urol 2014;11(4):197–212. nrurol.2014.42
5. Zhou CK, Check DP, Lortet-Tieulent J, et al. Prostate cancer incidence in 43 populations world-wide: An analysis of time trends overall and by age group. Int J Cancer 2016;138(6):1388–400. https://
6. Park SK, Sakoda LC, Kang D, et al. Rising prostate cancer rates in South Korea. Prostate 2006;66(12): 1285–91.
7. Han HH, Park JW, Na JC, et al. Epidemiology of prostate cancer in South Korea. Prostate Int 2015;3(3):99–102. prnil.2015.06.003
8. Hoang DT, Iczkowski KA, Kilari D, et al. Androgen receptor-dependent and—Independent mechanisms driving prostate cancer progression: Opportunities for therapeutic targeting from multiple angles. Oncotarget 2017;8(2):3724–45. https://
9. Nam JK, Lee KS, Kim TN. Use of testosterone replacement therapy after radical prostatectomy might kill two birds with one stone from the per-spective of men’s health and disease control. J Mens Health 2020;16(SP1):e52–6. https://doi. org/10.15586/jomh.v16iSP1.271
10. Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA 2005;294(2):238–44. 294.2.238
11. Bell MA, Campbell JD, Joice G, et al. Shifting the paradigm of testosterone replacement therapy in prostate cancer. World J Mens Health 2018;36(2):103– 9.
12. Kadomoto S, Shigehara K, Iwamoto H, et al. Testosterone replacement therapy for patients with hypogonadism after high dose-rate brachytherapy for high-risk prostate cancer: A report of six cases and literature review. World J Mens Health 2020;38(1): 132–6.
13. Loblaw DA, Virgo KS, Nam R, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2007;25(12):1596–605. JCO.2006.10.1949
14. Alibhai SM, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol 2006; 60(3):201–15. 2006.06.006
15. Galvao DA, Spry NA, Taaffe DR, et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008;102(1):44–7. https://doi. org/10.1111/j.1464-410X.2008.07539.x
16. Nam YS, Lee G, Yun JM, et al. Testosterone replacement, muscle strength, and physical function. World J Mens Health 2018;36(2):110–22.
17. Smith MR, Saad F, Egerdie B, et al. Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol 2012;30(26):3271–6. https://
18. Braga-Basaria M, Dobs AS, Muller DC, et al. Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation ther-apy. J Clin Oncol 2006;24(24):3979–83. https://doi. org/10.1200/JCO.2006.05.9741
19. Shin MJ, Jeon YK, Kim IJ. Testosterone and sar-copenia. World J Mens Health 2018;36(3):192–8.
20. Bonn SE, Sjolander A, Lagerros YT, et al. Physical activity and survival among men diagnosed with prostate cancer. Cancer Epidemiol Biomarkers Prev 2015;24(1):57–64.
21. Kenfield SA, Stampfer MJ, Giovannucci E, et al. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol 2011;29(6):726–32. https://doi. org/10.1200/JCO.2010.31.5226
22. Bourke L, Smith D, Steed L, et al. Exercise for men with prostate cancer: A systematic review and meta-analysis. Eur Urol 2016;69(4):693–703. https://
23. Smith L, Croker H, Fisher A, et al. Cancer survivors’ attitudes towards and knowledge of physical activity, sources of information, and barriers and facilitators of engagement: A qualitative study. Eur J Cancer Care (Engl) 2017;26(4):12641. https://doi. org/10.1111/ecc.12641
24. Hardcastle SJ, Maxwell-Smith C, Kamarova S, et al. Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors. Support Care Cancer 2018;26(4):1289–95. s00520-017-3952-9
25. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010;42(7):1409–26. https://doi. org/10.1249/MSS.0b013e3181e0c112
26. Malavolti M, Mussi C, Poli M, et al. Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21–82 years. Ann Hum Biol 2003;30(4):380–91. https://doi. org/10.1080/0301446031000095211
27. Loprinzi PD, Lee H, Cardinal BJ. Objectively measured physical activity among US cancer survivors: Considerations by weight status. J Cancer Surviv 2013;7(3):493–9. s11764-013-0293-7
28. Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008;40(1):181–8.
29. Cadenas-Sanchez C, Sanchez-Delgado G, Martinez-Tellez B, et al. Reliability and validity of different models of TKK hand dynamometers. Am J Occup Ther 2016;70(4):7004300010. https://doi. org/10.5014/ajot.2016.019117
30. Mentiplay BF, Perraton LG, Bower KJ, et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: A reliability and validity study. PLoS One 2015;10(10):e0140822.
31. Langhammer B, Stanghelle JK. The senior fitness test. J Physiother 2015;61(3):163. https://doi. org/10.1016/j.jphys.2015.04.001
32. Hong JH, Jeon SS, Lee HM, et al. The Functional Assessment of Cancer Therapy-Prostate (FACT-P) scales in men with prostate cancer: Reliability and validity of the Korean version. J Korean Med Sci 2006;21(2):295–9. jkms.2006.21.2.295
33. Yellen SB, Cella DF, Webster K, et al. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 1997;13(2):63–74. S0885-3924(96)00274-6
34. Lee IM, Wolin KY, Freeman SE, et al. Physical activity and survival after cancer diagnosis in men. J Phys Act Health 2014;11(1):85–90. https://doi. org/10.1123/jpah.2011-0257
35. Cormie P, Newton RU, Spry N, et al. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis 2013;16(4):328–35. https://doi. org/10.1038/pcan.2013.22
36. Lee DH, Kim JY, Lee MK, et al. Effects of a 12-week home-based exercise program on the level of physical activity, insulin, and cytokines in colorectal cancer survivors: A pilot study. Support Care Cancer 2013;21(9):2537–45. s00520-013-1822-7
37. van Londen GJ, Levy ME, Perera S, et al. Body composition changes during androgen deprivation therapy for prostate cancer: A 2-year prospective study. Crit Rev Oncol Hematol 2008;68(2):172–7.
38. Hanson ED, Sheaff AK, Sood S, et al. Strength training induces muscle hypertrophy and functional gains in black prostate cancer patients despite androgen deprivation therapy. J Gerontol A Biol Sci Med Sci 2013;68(4):490–8. gerona/gls206
39. Alberga AS, Segal RJ, Reid RD, et al. Age and androgen-deprivation therapy on exercise outcomes in men with prostate cancer. Support Care Cancer 2012;20(5):971–81. s00520-011-1169-x
40. Keogh JW, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: A systematic review. J Pain Symptom Manage 2012;43(1):96–110. jpainsymman.2011.03.006
41. Chen BB, Shih TT, Hsu CY, et al. Thigh muscle volume predicted by anthropometric measurements and correlated with physical function in the older adults. J Nutr Health Aging 2011;15(6):433–8.
42. Hansen PA, Dechet CB, Porucznik CA, et al. Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: A pilot study. PM R 2009;1(11):1019–24. https://doi. org/10.1016/j.pmrj.2009.09.016
43. Galvao DA, Taaffe DR, Spry N, et al. Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: A comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis 2009;12(2):198–203.
44. Cormie P, Galvao DA, Spry N, et al. Can super-vised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: A randomised controlled trial. BJU Int 2015;115(2):256–66. bju.12646
45. Segal RJ, Reid RD, Courneya KS, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003;21(9):1653–9. JCO.2003.09.534
46. Cherrier MM, Aubin S, Higano CS. Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non-metastatic prostate cancer. Psychooncology 2009;18(3):237–47.
47. Galvao DA, Taaffe DR, Spry N, et al. Acute versus chronic exposure to androgen suppression for prostate cancer: Impact on the exercise response. J Urol 2011;186(4):1291–7. juro.2011.05.055
48. Cella D, Nichol MB, Eton D, et al. Estimating clinically meaningful changes for the Functional Assessment of Cancer Therapy—Prostate: Results from a clinical trial of patients with met-astatic hormone-refractory prostate cancer. Value Health 2009;12(1):124–9. 1111/j.1524-4733.2008.00409.x
49. Cella D, Eton DT, Lai JS, et al. Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage 2002;24(6):547–61. S0885-3924(02)00529-8
50. Craike MJ, Livingston PM, Botti M. An exploratory study of the factors that influence physical activity for prostate cancer survivors. Support Care Cancer 2011;19(7):1019–28. s00520-010-0929-3
51. Min J, Yoo S, Kim MJ, et al. Exercise participation, barriers, and preferences in Korean prostate cancer survivors. Ethn Health 2019:1–13. 1080/13557858.2019.1634184