Supervised exercise to reduce cardiovascular morbidity of androgen deprivation therapy for prostate cancer

Abstract

EDITORIAL Supervised exercise to reduce cardiovascular morbidity of ADT 5 disease and diabetes was seen in patients who received GnRH agonists for a period as short as 1 to 4 months. Patients with preexisting heart disease are at even higher risk of cardiac events after using ADT. 6 Despite the findings of these observational studies, there is controversy with regard to the cardiovascular effects of ADT on patient survival. Randomized trials using ADT with radiation have failed to show an increase in cardiovascular death among men randomized to receive GnRH agonists. 7Exercise can mitigate the cardiovascular and metabolic side effects of ADT. In a study by Corme el al, 8 63 patients were randomized to either 3 months of supervised exercise or usual care at the time of initiation of ADT. At the end of the intervention, patients in the exercise group had better preservation of lean muscle mass, less gain in fat mass, and improved cardiovascular fitness. Gaskin et al 9 showed that a 12 -week community -based exercise program was feasible. Patients in the exercise group achieved significantly better 6 -minute walk test distance and other parameters of physical strength. In another randomized study, patients assigned to a 6 -month dietary and physical activity intervention achieved a significant reduction in weight, body mass index, and percentage fat mass compared with the usual -care group. 10A systematic review concluded that exercise training resulted in improvement in muscle strength, cardiorespiratory fitness, functional task performance, lean body mass, and fatigue. 11 However, most of the published studies have a relatively small number of patients and short duration of intervention as well as follow -up.In this issue of the Polish Archives of Internal Medicine (Pol Arch Intern Med), Hojan et al 12 reported the results of a randomized study to evaluate the effects of a 12 -month exercise program on inflammatory and cardiometabolic factors as well as functional status on patients receiving ADT and Prostate cancer (PA) is the most common cancer in men in the United States. With prostate--specific antigen (PSA) screening, most new cases are diagnosed at a localized stage with an excellent prognosis. As a result, the number of PA survivors has increased significantly. There were over 3.3 million PA survivors in the United States in 2016.1 More than 64% of them were older than 70 years of age, and many of them had medical comorbidities. A study by Epstein et al 2 concluded that men with PA in the United States have a higher chance of dying from other causes than cancer.2 Ischemic heart disease accounts for 24% of all deaths, compared to 16% from PA.Androgen deprivation therapy (ADT) is the main treatment for metastatic PA. More recently, the use of ADT has been expanded to include patients with localized disease. The current National Comprehensive Cancer Network guidelines (version 1.2017) include the options of external beam radiation with 4 to 6 months of ADT for intermediate -risk PA, and with 2 to 3 years of A...