However, most trials employ supervised exercise (almost always facility-based),1,3 whose implementation in the public health domain may present several challenges (e.g., patients’ travel time, equipment, space, supervision by a qualified exercise professional, etc.).4 A few studies have demonstrated that delivery of exercise at home also leads to several health benefits in men on ADT. Nonetheless, no direct comparisons of the effects of supervised- versus home-based training on clinically relevant outcomes and cost-effectiveness have been performed in the ADT setting.5
The present study was a multi-centre, non-inferiority randomized trial that tested a home-based exercise program (HOME) against group-based exercise (GROUP) training in patients with PC of any stage on ADT and with moderate to severe fatigue (measured by a Functional Assessment of Cancer Therapy-Fatigue, or FACT-F, score of <45/52), with co-primary endpoints of fatigue (using FACT-F) and functional endurance (measured by the 6-minute walk test, or 6MWT) at six months along with a cost-effectiveness analysis.6 A total of 38 participants were enrolled in HOME (n=18) and GROUP (n=20) arms, which consisted of aerobic and resistance training sessions of 60 minutes each, 4-5 times a week (240-300 minutes/week) for six months.6 Aerobic exercise comprised 30 minutes each session (120-150 minutes/week). The absolute workload of aerobic exercise was set at 60-70% of heart rate reserve, which was determined at baseline. The resistance exercises used body weight, resistance bands, free weights, stability balls, and exercise mats to focus on all muscle groups, in 2-3 sets of 8-12 repetitions at 60-75% of the estimated one-repetition maximum.
GROUP sessions comprised 4-8 participants and were supervised by a qualified exercise professional (QEP). HOME participants were in weekly contact with a QEP by phone or email to optimize intervention adherence but without direct supervision.
Throughout the study, there was a planned reduction in supervised sessions and contact, in the GROUP and HOME arms respectively, with the goal of transitioning to independent exercise.
We found an 89.8% probability that HOME is non-inferior to GROUP for both co-primary endpoints of fatigue and functional endurance. Moreover, HOME was cost-effective compared to GROUP (mean difference $ -4,122). Although HOME led to lower triglyceride levels compared to GROUP, no other significant differences were found in other secondary outcomes between groups.6
While recruiting, although 2,089 patients were screened and 568 were eligible, only 38 consented to the study. Living too far from the study centre (n=243) and not being interested (n=331) were the most common reasons for the decline in participation. This could be attributed to the distance and time investment required for follow-up visits in person and speaks to challenges in implementing behavioral interventions among cancer survivors.6 Home-based exercise programs may substantially circumvent this difficulty. A recent systematic review on recruitment of older adults with cancers to exercise trials reported two major recruitment barriers including distance from the treatment centre and lack of interest.7
Further, the attrition rate in our study, while similar in both arms (about 50%), was relatively high. This may be ameliorated by using home-based exercise for older patients.
Our study suggests that a HOME exercise program may be implemented with fewer resources than GROUP exercise in men on ADT yet resulting in comparable health benefits, but given the study limitations highlighted above, further evaluation of home-based exercise interventions in this patient population is warranted.
Written by: Neha Pathak,1 Efthymios Papadopoulos,2 Shabbir M.H. Alibhai3,4
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, United States
- Departments of Medicine and Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto
- Andersen MF, Midtgaard J, Bjerre ED. Do Patients with Prostate Cancer Benefit from Exercise Interventions? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health [Internet]. 2022 Jan 15 [cited 2024 Jan 3];19(2):972.
- Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. Journal of Pain and Symptom Management [Internet]. 2012 Jan 1 [cited 2024 Jan 3];43(1):96–110.
- Yunfeng G, Weiyang H, Xueyang H, Yilong H, Xin G. Exercise overcome adverse effects among prostate cancer patients receiving androgen deprivation therapy: An update meta-analysis. Medicine (Baltimore). 2017 Jul;96(27):e7368.
- Jansons P, Robins L, O’Brien L, Haines T. Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. J Physiother. 2018 Jan;64(1):48–54.
- Wang Y, McCarthy AL, Hayes SC, Gordon LG, Chiu V, Bailey TG, et al. Economic evaluation of exercise interventions for individuals with cancer: A systematic review. Preventive Medicine [Internet]. 2023 Jul 1 [cited 2024 Jan 3];172:107491.
- Alibhai SMH, Papadopoulos E, Mina DS, Ritvo P, Tomlinson G, Sabiston CM, et al. Home-based versus supervised group exercise in men with prostate cancer on androgen deprivation therapy: A randomized controlled trial and economic analysis. Journal of Geriatric Oncology [Internet]. 2024 Jan 1 [cited 2024 Jan 3];15(1):101646.
- Reynolds SA, O’Connor L, McGee A, Kilcoyne AQ, Connolly A, Mockler D, et al. Recruitment rates and strategies in exercise trials in cancer survivorship: a systematic review. J Cancer Surviv [Internet]. 2023 Apr 6 [cited 2024 Jan 3]
- Kanera IM, Willems RA, Bolman CAW, Mesters I, Verboon P, Lechner L. Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: a randomized controlled trial. Int J Behav Nutr Phys Act [Internet]. 2017 Feb 10 [cited 2024 Jan 3];14:19.