Clinical Practice Guidelines for the management of locally advanced ...

Berglund 33 showed no difference in quality of life outcomes in a low-quality randomised trial of a
seven-week physical activity (movement and fitness training) program compared with standard care,
an information-only or combined physical exercise–information program. The study involved 211
men newly diagnosed with prostate cancer at various stages. The investigators found that stage
(presence or absence of metastases) was a stronger predictor of quality-of-life status than intervention
group.
Segal 34 undertook a low-quality randomised controlled trial comparing the effects of a resistance
exercise program (training three times per week for 12 weeks) on muscular fitness, body composition,
fatigue and quality of life (FACT-P) in 155 men receiving androgen therapy for at least three months.
While body composition did not change, muscular fitness did increase, accompanied by a 2.2-point
reduction in fatigue score (p=0.002 for difference between groups). The FACT-P quality-of-life score
also increased by 2.0 points (p=0.001 for difference between groups). The intervention was effective
in men receiving androgen deprivation therapy (ADT) for both curative and palliative intents, and
receiving ADT for less than or more than one year.
The effectiveness of resistance training in improving muscle strength, endurance and other fitness
parameters was also shown by Galvao 35 ; however this case series of ten men did not include qualityof-life
or symptom outcomes. These authors suggested that for men receiving androgen ablation,
resistance training improves muscle endurance and functional capacity that then enhances their ability
to carry out activities of daily living with less fatigue.
Windsor et al 36 undertook a high-quality randomised controlled trial with 66 men of the effect of a
home-based moderate-intensity (30 minutes, three times per week) walking program on fatigue and
walking fitness amongst men undergoing radiotherapy for mixed-stage (majority T1, T2) prostate
cancer. Fatigue increased in the control group (p=0.01), but not in the intervention group (p=0.20).
However the difference between groups was not statistically significant. The shuttle-test distance
(walking fitness) increased in the intervention group by 67 meters (p=0.0003), but not in the control
group (p=0.49), with a statistically significant difference between groups at four weeks (difference in
means = 111.5 95% CI: 40.5 to 182.5, p=0.003). Generic quality-of-life measures were not included.
In summary, physical activity interventions, both cardiovascular and strength-based, which increase
fitness have been shown to reduce fatigue after radiotherapy and fatigue associated with androgen
ablation. Generic quality of life has also been shown to improve for men receiving androgen ablation.
The effect of physical activity programs on symptoms other than fatigue, and on fatigue in other
treatment contexts such as chemotherapy, has not yet been demonstrated.
Evidence summary Level References
There is good evidence that resistance exercise and moderate to
strenuous physical activity improves quality of life and muscular
fitness and reduces fatigue and the impact of fatigue on daily living
for men with prostate cancer.
There are few studies in the area and further research is needed
where stages of disease and treatment approaches are controlled
and acceptability and compliance with exercise protocols are
assessed in order to develop guidelines on optimal exercise levels
and patient suitability.
II 31,34,36
Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer
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