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Training after radical prostatectomy?

Just do it at home!

  • Progressive resistance training increases muscle strength and exercise capacity
  • Well-being and health related quality of life improve
  • Supervised training at home is safe and realistic

Men who underwent robot assisted radical prostatectomy for prostate cancer benefit from progressive resistance training at home with remote supervision: after six months they are fitter, stronger, and feel better than men who only received the advice to exercise following a similar surgical procedure. British scientists conclude this after conducting a randomised effect study including 42 men which they randomly divided into two groups.

Improved well-being

Moreover, the training group reported a higher sense of well-being than the control group. This was shown in scores on the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire, which measures health related quality of life in patients with prostate cancer. The authors believe that this is an important finding, because many patients with prostate cancer suffer from mental health issues and a reduced health related quality of life in post-diagnostic years. Again, progressive resistance training might be a means to improve these aspects according to the research team.

Safe and realistic

Compliance after three months of training was 90 percent. At six months this figure was over 75 percent. Only one patient suffered a shoulder injury during the exercises, because he (against advice) increased the resistance too quickly. Therefore the researchers conclude that at home training with remote guidance is safe, realistic, and also has benefits considering the current COVID-19 pandemic. Patients do not have to visit training facilities and can exercise at home instead.

Flow-mediated dilatation

The primary objective of this study was to investigate the effect of progressive resistance training on cardiovascular health parameters, such as blood pressure and heart rate. For this purpose, they measured the flow-mediated dilatation of the upper arm artery, which is a predictor of cardiovascular diseases. This gives an estimate of the extent to which the artery is able to dilate in response to a sudden increase of blood flow. No significant differences were found between the two groups. The authors argue that this might be due to the limited sample size, not revealing the true effect; the observed differences between groups were smaller than expected. The researchers propose that a larger, multi-centre effect study is needed to unravel the true effect.

> From: Ashton, Support Care Cancer (2021) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary. Translation by Robert van den Heuvel

Methodological quality according to the author of the extended summary: excellent (PEDro score 9/10)

Want to read the rest of the paper? You can find the full article online here!

Expert opinion by Martijn Stuiver, PhD

The ACSM guidelines for physical activity in people living with or after cancer recommend endurance and resistance training in prostate cancer to limit or reduce symptoms, improve quality of life, and to attain potential survival benefits. To achieve and maintain these advantages it is necessary for patients to adhere to these guidelines in the long term. In many cases, training under supervision has advantages at first, but it is not desirable or suited for each individual. Especially long-term healthcare based guidance is not desirable; training independently should always be the aim. In this study the training was initially supervised, but supervision was reduced progressively. After four weeks there was only guidance by telephone and after eleven weeks guidance had stopped completely.

The programme applied in this study is accessible, easy to instruct, and led to clinically relevant effects in the studied population. Remarkably, given the lack of endurance training, VO2max improved as well. For this reason the intervention proves valuable for the reduction of cardiovascular risks, even though no effect on FMD was found. 

The NEXT programme, which is currently being implemented in the Netherlands, offers training instructions that are mostly aimed at training in fitness centres. This is not desirable or feasible for all men. Therefore at this moment additional protocols are being developed. These protocols will include the transition of supervised training in a healthcare setting to exercising independently.

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