Cardiovascular and metabolic complications during androgen deprivation: exercise as a potential countermeasure

Abstract

Apart from the well-established adverse musculoskeletal and sexual health effects of androgen deprivation therapy (ADT), evidence is accumulating of substantial ADT-related cardiovascular and metabolic complications, which may impact quality of life and overall survival. In this brief review we discuss (1) the incidence of cardiovascular and metabolic complications during/ following ADT from large cohort studies, (2) the increased risk factors for cardiovascular and metabolic disease from cross-sectional and prospective studies and (3) the use of physical exercise as a countermeasure in this new era of ADT-related toxicity. It is clear that exercise has the potential to provide a myriad of benefits to men undergoing ADT that may result in reduced morbidity and mortality, and subsequently improve quality of life.

Effects of resistance exercise in prostate cancer patients: a meta-analysis

“…On the one side, leg press performance was untypically low in the study by Winters-Stone et al (2016) [38]. On the other side, the respective results were untypically high and unsteady in the trial by Galvao et al (2006) [27] (Fig. 3).…”

“…However, it might be limited regarding the development of sheer leg strength, especially when the participants are elderly PCaPs receiving cancer treatment and when strength outcome is measured with a standard 1RM test on the leg press. Galvao et al (2006) [27], on the other hand, who reported very high outcomes, did not only assess 1RM but also measured muscle endurance. Their participants performed the maximal number of repetitions at 70% of their 1RM and, in contrast to the participants of the other studies, might therefore have had a learning effect when performing at complete exhaustion, which might be a decisive factor for 1RM performance [81].…”

“…PCaPs receiving ADT are susceptible to loss of muscle strength and muscle mass, as well as increase of fat mass [12–14]. Further side effects of ADT are alterations in lipolysis profile [26, 27] and insulin metabolism [14, 27, 28] as well as increased arterial stiffness [27, 28]. These changes are accompanied with an increased risk for developing cardiovascular disease [27, 29–31], diabetes mellitus type II [29], and osteoporosis [13, 32].…”

Prospective study of exercise intervention in prostate cancer patients on androgen deprivation therapy

“…Supervised group sessions have been shown to provide a socially stimulating and motivating environment that is more conducive to adherence and retention than home‐based exercises alone . This is concordant with our own findings, with the majority of participants in the group sessions reporting them to be motivating, and continuing to exercise 6 months after commencing the programme.…”

Intermittent Androgen Suppression Therapy for Prostate Cancer Patients: A Choice for Improved Quality of Life?

“…The well-known side effects of CAS like sexual dysfunction, hot flushes, fatigue, cardiovascular complications, osteoporosis, weight gain and anemia have significant implications for quality of life (Malone, et al, 2005;Freedland, et al, 2009;Galvão, et al 2009). Since androgens are essential for the regulation of fat distribution, insulin sensitivity and lipid and bone metabolism, recent publications focussed on the concept that CAS may also be associated with an increase in overall and in particular cardiovascular morbidity and mortality (Corona, et al, 2011).…”