Our aim with this randomized controlled trial was to compare the effectiveness of a structured 6-week supervised multimodal exercise program before surgery to that of the same exercise program administered 6 weeks after prostatectomy surgery. The supervised exercise regimen was undertaken thrice weekly and included a combination of resistance exercises that targeted the major upper and lower body muscle groups and aerobic exercise. A total of 38 patients aged 48-73 years enrolled, with the primary endpoint being dynamic muscle strength and secondary endpoints including physical function (repeated chair rise, stair climb, 400-meter, 6-meter usual, fast, and backward walk), body composition (lean and fat mass), urinary incontinence, hospital length of stay (LOS), fatigue, and quality of life (QoL). Assessments were conducted at various time points based on study outcomes from baseline to 12 weeks post-surgery.
Exercise before surgery significantly enhanced (p=<0.001–0.028) muscle strength (leg press by 17.2 kg, chest press by 2.9 kg), physical function (-14.9 sec for 400-m walk, -1.3 sec in chair rise, -0.2 and -1.8 sec in 6-m fast and backward walk tests, respectively), and reduced fatigue levels by 6.5 points (p=0.002) meeting the Minimally Important Difference reported for the EORTC QLQ-C30. These changes would likely serve as a buffer to the effects of surgery and the immediate postoperative period. In a similar fashion, exercise initiated in the postoperative phase resulted in significant improvements (p=≤0.001–0.012) in muscle strength (6.7 kg for leg press) and physical function (-9.8 sec in the 400-m walk, -0.8 sec in chair rise, -0.4, -0.2 and -2.8 sec for 6-m usual, fast, and backward walk tests, respectively), recouping losses that would normally occur in the early post-surgery period. Both groups experienced a decrease in whole-body lean mass post-surgery (prehabilitation 1.6 kg, p=0.008; rehabilitation 1.1 kg, p=0.004). There was a transient decline in QoL immediately post-surgery, followed by a recovery to baseline levels at 12 weeks post-surgery for both groups indicating the importance of exercise in helping patients cope with the challenges posed by treatment. Exercise undertaken either before or following surgery did not significantly impact urinary incontinence or hospital LOS (prehabilitation, 2.9 ± 1.4 days vs. rehabilitation, 2.5 ± 1.3 days; p=0.473).
Our findings underscore the role of exercise as an adjunctive therapeutic strategy for patients with prostate cancer undergoing surgery. Early initiation of exercise can lead to tangible improvements in muscle strength, physical function, and fatigue levels, enhancing the patient's overall well-being before surgery which may help to buffer the effects of surgery and the early post-surgical period. Conversely, postoperative exercise facilitates faster recovery, aiding patients in regaining lost strength and physical function. Despite increases in muscle strength prior to surgery, there was no significant impact on body composition which was likely due to the relatively short duration of the exercise program to induce substantial increases in lean mass as well as reductions in fat mass. Additionally, most participants underwent robotic-assisted laparoscopic prostatectomy which may have contributed to the lack of significant differences in urinary incontinence between the groups.
In conclusion, integrating exercise medicine into the treatment and recovery paradigm for patients with prostate cancer undergoing surgery represents a promising avenue for improving patient outcomes. Tailoring exercise prescriptions to suit the patient's unique needs will likely maximise the benefits of exercise, ultimately leading to a more comprehensive and patient-centric approach for surgically managed prostate cancer.
Written by: Favil Singh,1,2 Robert U. Newton,1-3 Dennis R. Taaffe,1,2 Pedro Lopez,1,2,4 Jeff Thavaseelan,5 Matthew Brown,5-7 Elayne Ooi,8 Kazunori Nosaka,1,2 Dickon Hayne,6,7 Daniel A Galvão1,2
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia.
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.
- Perth Urology Clinic, Perth, WA, Australia.
- Fiona Stanley Hospital, Murdoch, WA, Australia.
- UWA Medical School, University of Western Australia, Crawley, WA, Australia.
- Swan Urology, Perth, WA, Australia.