In men with prostate cancer, do diet and lifestyle interventions improve quality of life?

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In men with prostate cancer, do diet and lifestyle interventions improve quality of life?

No randomised controlled trials assessed the effects of dietary interventions on quality of life. Several studies investigated the effects of such interventions on clinical indicators of disease progression and these are covered in Chapter 8 Complementary and alternative therapies in these guidelines. Five low-quality studies and one high-quality study assessed the effects of physical activity interventions on symptom side effects and quality of life.

Culos-Reed[1] in a small uncontrolled study (n=31) showed that a 12-week theory-based physical activity intervention in men receiving hormone therapy for at least six months could increase strenuous physical activity (p<0.01) and fitness levels (p<0.01) in participants. However, the post-test effects on quality of life were less clear. A non-significant increase occurred in global quality of life and a reduction in fatigue was marginally significant (p=0.05).

Carmack-Taylor[2] undertook a low-quality randomised controlled trial with 134 men with prostate cancer receiving continuous androgen ablation to compare a lifestyle group with general psychoeducation. The study had three arms: a group-based lifestyle program where participants were taught cognitive-behavioural skills to enhance self-efficacy in maintaining an active lifestyle versus a groupbased educational support program versus a control group. No significant differences in physical activity levels, body composition or quality of life were found between the three groups of men over a 12-month period despite good adherence to both intervention arms.

Berglund[3] 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[4] 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[5]; 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[6] 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.

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Evidence summary and recommendations

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 [2], [4], [6]
Evidence-based recommendationQuestion mark transparent.png Grade
Men with advanced prostate cancer should be advised that resistance exercise and moderate to strenuous physical activity with expert supervision/support can improve quality of life and muscular fitness and reduce fatigue and the impact of fatigue on daily living. Unstable bone lesions and co-morbidities such as cardiovascular disease are exclusion criteria for studies on this topic and so are likely contraindications for this approach.
D


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References

  1. Culos-Reed SN, Robinson JL, Lau H, O'Connor K, Keats MR. Benefits of a physical activity intervention for men with prostate cancer. J Sport Exerc Psychol 2007 Feb;29(1):118-27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17556779.
  2. 2.0 2.1 Carmack Taylor CL, Demoor C, Smith MA, Dunn AL, Basen-Engquist K, Nielsen I, et al. Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. Psychooncology 2006 Oct;15(10):847-62 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16447306.
  3. Berglund G, Petersson LM, Eriksson KC, Wallenius I, Roshanai A, Nordin KM, et al. "Between Men": a psychosocial rehabilitation programme for men with prostate cancer. Acta Oncol 2007;46(1):83-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17438709.
  4. 4.0 4.1 Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003 May 1;21(9):1653-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12721238.
  5. Galvão DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc 2006 Dec;38(12):2045-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17146309.
  6. 6.0 6.1 Windsor PM, Nicol KF, Potter J. A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer 2004 Aug 1;101(3):550-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15274068.

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Appendices