Androgen-Deprivation Therapy and Cardiovascular Disease Risk - The Role of Exercise in prostate Cancer Treatment

Reduced levels of physical activity and increased levels of fatigue are commonly reported in prostate cancer patients treated with androgen-deprivation therapy (ADT) (1) that in turn reduces functional capacity. Reductions are seen in cardiorespiratory endurance, upper and lower body strength and endurance, and physical components of quality of life (1-3), which lead to inhibiting activities of daily living. In addition to these well-established side effects, cardiovascular disease (CVD) risk is now being increasingly associated with ADT (4, 5). Keating et al. (6) report ADT use is associated with higher risks of incident diabetes, coronary heart disease, acute myocardial infarction, and sudden cardiac death. The increasing body of literature supports an earlier report indicating that CVD is the most common form of mortality in men with prostate cancer, and not the actual cancer itself (7). Exercise has been shown to be effective for improving surgical outcomes, reducing symptom experience, managing side effects, improving psychological health, maintaining physical function, and reducing fat gain and muscle and bone loss in cancer patients (8) and hence has the potential to reduce CVD risk factors. Studies in the past have used aerobic exercise (9), resistance exercise (9, 10), or a combination of aerobic and resistance exercise (11). Exercise programs have also differed in method of delivery with some home based (12) while others are group based in a clinic setting (11, 13) making comparisons as to the best treatment mode of exercise difficult.