Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
Prostate Cancer Prostatic Dis. 2013 Dec;16(4):328-35. doi: 10.1038/pcan.2013.22. Epub 2013 Aug 6.
Due to concerns of fragility fracture, exercise is a perceived contraindication for prostate cancer patients with bone metastases. These patients experience significant functional impairment and muscle atrophy, which may lead to an increased likelihood of skeletal complicaTIOns (i.e., pathological fracture, bone pain) and/or falls. Safe resistance exercise prescription may counteract this effect. The aim of this feasibility trial was to determine the safety and efficacy of resistance exercise by prostate cancer survivors with bone metastatic disease.
Twenty men with established bone metastases secondary to prostate cancer were randomly assigned to a 12-week resistance exercise program in which exercise prescription was based on the location of bone lesions (n=10) or usual care (n=10). Outcomes included safety and tolerance of the exercise program, physical function, physical activity level, body composition, fatigue, quality of life and psychological distress. Outcomes were compared between groups using analysis of covariance adjusted for baseline values.
Participants had significant disease load with 65% of participants presenting with two or more regions affected by bone metastases and an average Gleason score of 8.2±0.9. Five participants (exercise=2; usual care=3) did not complete the intervention, three of which were due to advancing disease (exercise=2; usual care=1). No adverse events or skeletal complications occurred during the supervised exercise sessions. The exercise program was well tolerated as evidenced by high attendance (83%) and compliance rates (93%), and the ability of the participants to exercise at an intensity within the target range for cancer survivors (rating of perceived exertion =13.8±1.5). The change in physical function (muscle strength ∼11%; submaximal aerobic exercise capacity ∼5% and ambulation ∼12%), physical activity level (∼24%) and lean mass (∼3%) differed significantly between groups following the intervention, with favorable changes in the exercise group compared with the usual care group. No significant between-group differences were observed for fatigue, quality of life or psychological distress.
This initial evidence involving a small sample size suggests that appropriately designed and supervised resistance exercise may be safe and well tolerated by prostate cancer patients with bone metastatic disease and can lead to improvements in physical function, physical activity levels and lean mass. Future trials involving larger sample sizes are required to expand these preliminary findings.
由于担心脆性骨折，患有骨转移的前列腺癌患者被认为不宜进行运动。这些患者会出现明显的功能障碍和肌肉萎缩，这可能会增加发生骨骼并发症（即病理性骨折、骨痛）和/或跌倒的可能性。安全的抗阻运动处方可能会抵消这种影响。本可行性试验旨在确定患有骨转移的前列腺癌幸存者进行抗阻运动的安全性和疗效。
20 名患有前列腺癌骨转移的男性患者被随机分配到 12 周的抗阻运动计划中，根据骨病变的位置（n=10）或常规护理（n=10）进行运动处方。主要结局包括运动计划的安全性和耐受性、身体功能、身体活动水平、身体成分、疲劳、生活质量和心理困扰。使用协方差分析对基线值进行调整，比较两组之间的结果。
参与者的疾病负担很重，65%的参与者有两个或两个以上部位的骨转移，平均 Gleason 评分为 8.2±0.9。有 5 名参与者（运动组 2 名，常规护理组 3 名）未完成干预，其中 3 名是由于疾病进展（运动组 2 名，常规护理组 1 名）。在监督运动期间没有发生不良事件或骨骼并发症。该运动计划耐受性良好，出勤率高（83%），依从性好（93%），且参与者能够在适合癌症幸存者的目标强度范围内进行运动（感知用力等级=13.8±1.5）。运动组与常规护理组相比，身体功能（肌肉力量增加约 11%，亚最大有氧运动能力增加约 5%，步行能力增加约 12%）、身体活动水平（增加约 24%）和瘦体重（增加约 3%）均有显著改善。两组之间的疲劳、生活质量或心理困扰没有显著差异。
本研究样本量较小，但初步结果表明，设计合理、监督得当的抗阻运动对患有骨转移的前列腺癌患者可能是安全且耐受良好的，并且可以改善身体功能、身体活动水平和瘦体重。需要更大样本量的试验来扩大这些初步发现。
