[Show abstract][Hide abstract] ABSTRACT: Falls are a major public health concern with at least one third of people aged 65 years and over falling at least once per year, and half of these will fall repeatedly, which can lead to injury, pain, loss of function and independence, reduced quality of life and even death. Although the causes of falls are varied and complex, the age-related loss in muscle power has emerged as a useful predictor of disability and falls in older people. In this population, the requirements to produce explosive and rapid movements often occurs whilst simultaneously performing other attention-demanding cognitive or motor tasks, such as walking while talking or carrying an object. The primary aim of this study is to determine whether dual-task functional power training (DT-FPT) can reduce the rate of falls in community-dwelling older people.
The study design is an 18-month cluster randomised controlled trial in which 280 adults aged ≥65 years residing in retirement villages, who are at increased risk of falling, will be randomly allocated to: 1) an exercise programme involving DT-FPT, or 2) a usual care control group. The intervention is divided into 3 distinct phases: 6 months of supervised DT-FPT, a 6-month 'step down' maintenance programme, and a 6-month follow-up. The primary outcome will be the number of falls after 6, 12 and 18 months. Secondary outcomes will include: lower extremity muscle power and strength, grip strength, functional assessments of gait, reaction time and dynamic balance under single- and dual-task conditions, activities of daily living, quality of life, cognitive function and falls-related self-efficacy. We will also evaluate the cost-effectiveness of the programme for preventing falls.
The study offers a novel approach that may guide the development and implementation of future community-based falls prevention programmes that specifically focus on optimising muscle power and dual-task performance to reduce falls risk under 'real life' conditions in older adults. In addition, the 'step down' programme will provide new information about the efficacy of a less intensive maintenance programme for reducing the risk of falls over an extended period.
Australian New Zealand Clinical Trials Registry: ACTRN12613001161718 . Date registered 23 October 2013.
[Show abstract][Hide abstract] ABSTRACT: Objectives
. To investigate if androgen deprivation therapy exposure is associated with additional risk factors for cardiovascular disease and metabolic treatment-related toxicities.
. One hundred and seven men (42–89 years) with prostate cancer undergoing androgen deprivation therapy completed a maximal graded objective exercise test to determine maximal oxygen uptake, assessments for resting metabolic rate, body composition, blood pressure and arterial stiffness, and blood biomarker analysis. A cross-sectional analysis was undertaken to investigate the potential impact of therapy exposure with participants stratified into two groups according to duration of androgen deprivation therapy (
Advances in Urology 11/2015; 2015(9):1-7. DOI:10.1155/2015/976235
[Show abstract][Hide abstract] ABSTRACT: Background:
Resistance exercise is emerging as a potential adjunct therapy to aid in the management of breast cancer-related lymphedema (BCRL). However, the mechanisms underlying the relationships between the acute and long-term benefits of resistance exercise on BCRL are not well understood.
To examine the acute inflammatory response to upper-body resistance exercise in women with BCRL and to compare these effects between resistance exercises involving low, moderate, and high loads. The impact on lymphedema status and associated symptoms was also compared.
A total of 21 women, 62 ± 10 years old, with BCRL participated in the study. Participants completed low-load (15-20 repetition maximum [RM]), moderate-load (10-12 RM), and high-load (6-8 RM) exercise sessions consisting of 3 sets of 6 upper-body resistance exercises. Sessions were completed in a randomized order separated by a 7- to 10-day wash-out period. Venous blood samples were obtained to assess markers of exercise-induced muscle damage and inflammation. Lymphedema status was assessed using bioimpedance spectroscopy and arm circumferences, and associated symptoms were assessed using Visual Analogue Scales for pain, heaviness, and tightness. Measurements were conducted before and 24 hours after the exercise sessions.
No significant changes in creatine kinase, C-reactive protein, interleukin-6, and tumor necrosis factor-α were observed following the 3 resistance exercise sessions. There were no significant changes in arm swelling or symptom severity scores across the 3 resistance exercise conditions.
The magnitude of acute exercise-induced inflammation following upper-body resistance exercise in women with BCRL does not vary between resistance exercise loads.
Integrative Cancer Therapies 11/2015; DOI:10.1177/1534735415617283 · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Musculoskeletal health is adversely impacted in patients with prostate cancer receiving androgen-deprivation therapy (ADT). Thus, it is of interest to compare muscle and bone characteristics of patients at different stages of disease progression: localised prostate cancer (LPC) versus metastatic prostate cancer (MPC). Methods: Ninety prostate cancer patients were stratified by disease progression into localised (n = 50; age = 69.1 yrs; height = 172.7 cm; weight = 83.8 kg; PSA = 2.16 ng/mL) and metastatic (n = 40; age = 71.4 yrs; height = 174.1 cm; weight = 86.6 kg; PSA = 28.85 ng/mL) groups. Patients underwent regional DXA scans to determine bone mineral content (BMC) of the spine, hip and femoral neck. Whole-body DXA scans were also performed to establish whole-body bone mass, lean mass, fat mass and trunk fat. Results: LPC exhibited lower hip (2.9%) and waist (6.4%) circumferences than MPC. Further, LPC contained lower relative whole-body fat mass (21%) and trunk fat (14%) and higher relative whole-body lean mass (8.7%) than MPC. Relative BMC was higher in LPC for whole-body (3.1%), hip (6.1%) and femoral neck (3.5%) regions; yet higher in MPC for relative spinal BMC (4.2%) potentially due to bone metastatic lesions in the lumbar spine for this group. Conclusions: Considerable musculoskeletal deterioration simultaneous with large increments in total body and trunk fat commensurate with disease progression provides support for the use of exercise to promote muscle-bone preservation and fat reduction across the disease progression.
BJU International 08/2015; 116(S1):56. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To provide initial information on the prevalence of physical activity levels in prostate cancer patients with bone metastases and identify associations with physical and mental health outcomes.
Methods: Self-reported physical activity levels (Modified Godin Leisure-Time Exercise Questionnaire), physical and mental health outcomes (SF-36 Questionnaire), as well as objective physical performance measures (400m walk, 6m walk) were assessed in 48 prostate cancer survivors (mean age 70.7 ± 8.0; BMI 28.5 ± 4.2; PSA 52.7 ± 154.1) with bone metastases (58.8% > 2 regions affected) at baseline of a randomised controlled trial.
Results: Only 14 men (29.2%) met the current aerobic exercise guidelines (150 minutes of moderate intensity or 75 minutes of vigorous exercise per week or an equivalent combination), while 34 (70.8%) were insufficiently active. Men that were not meeting the aerobic exercise guidelines, had lower physical functioning (p<.01), role functioning (physical and emotional) (p<.05), and general health scores (p<.05). The 6m walk (fast pace) and 400m walk times were also slower, indicating reduced physical performance in men who were insufficiently active compared to those meeting aerobic exercise guidelines (p<.05).
Conclusions: Lower levels of aerobic exercise are associated with reduced physical and mental health outcomes in prostate cancer survivors with bone metastases. While previous research has focused primarily on non-metastatic cancer patients, our initial results suggest that meeting aerobic exercise guidelines may preserve health outcomes in prostate cancer patients with advanced bone metastatic disease. Further research is required to confirm and expand these findings.
BJU International 08/2015; 116(Supplement 1):55. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The bone-specific physical activity questionnaire (BPAQ) accounts for activities that affect bone but has not been used in studies with older adults. Relationships exist between the BPAQ-derived physical activity and bone density in healthy middle-aged and older men but not men with prostate cancer. Disease-related treatments detrimental to bone should be considered when administering the BPAQ. The bone-specific physical activity questionnaire (BPAQ) was developed to account for bone-specific loading. In this retrospective study, we examined the relationship between BPAQ-derived physical activity and bone mineral density (BMD) in middle-aged and older men with and without prostate cancer. Two groups, 36 healthy men and 69 men with prostate cancer receiving androgen suppression therapy (AST), completed the BPAQ and had whole body, total hip, femoral (FN) and lumbar spine BMD assessed by dual-energy X-ray absorptiometry. Past (pBPAQ), current (cBPAQ) and total BPAQ (tBPAQ) scores for the healthy men were related to FN BMD (pBPAQ r = 0.36, p = 0.030; cBPAQ r (s) = 0.35, p = 0.034; tBPAQ r = 0.41, p = 0.014), and pBPAQ and tBPAQ were related to total hip (r (s) = 0.35, p = 0.035 and r (s) = 0.36, p = 0.029, respectively) and whole body BMD (r (s) = 0.44, p = 0.007 and r (s) = 0.45, p = 0.006, respectively). In men with prostate cancer, the BPAQ was not significantly associated with BMD. In stepwise regression analyses, body mass and tBPAQ predicted 30 % of the variance in total hip BMD (p = 0.003), cBPAQ predicted 14 % of the variance in FN BMD (p = 0.002), and body mass, age and tBPAQ predicted 47 % of the variance in whole body BMD (p < 0.001) in healthy men. In men with prostate cancer, the BPAQ was not an independent predictor of BMD. Although BPAQ-derived estimates of physical activity are related to bone status in healthy middle-aged and older men, the adverse effect of AST on bone appears to obscure this relationship in men with prostate cancer.
Osteoporosis International 07/2014; 25(11). DOI:10.1007/s00198-014-2797-z · 4.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exercise is being increasingly established as a key adjuvant therapy in clinical oncology. As research has demonstrated the beneficial impact of exercise for cancer management, a growing number of cancer patients are undertaking structured exercise programs.
To determine the safety and feasibility of formal exercise testing in clinical settings as it is becoming increasingly used as a screening tool and for exercise prescription purposes.
One hundred and twelve prostate cancer patients undergoing ADT took part in a physician supervised multistage maximal stress test (Bruce protocol). 60 patients had been on ADT <3 months (acute) whilst 52 had been on ADT for > 3months (chronic).
Of these men, 85% were able to meet the criteria for the attainment of VO2max whilst three positive tests (3.2%) were observed. The three participants who recorded a positive stress test underwent further medical examination and subsequently cleared of clinically significant cardiovascular disease. Apart from the relatively low VO2max (24.7 ± 6.0 ml.kg.min:10-15th percentile), compared to normative data in healthy age-matched controls, the cardiovascular response to exercise was similar in this cancer population. Moreover, treatment duration did not appear to influence cardiovascular responses to exercise. This early evidence suggests that risk of adverse events during maximal exercise testing is relatively low in this population and certainly no higher than age-matched apparently healthy individuals.
Maximal exercise testing was demonstrated to be feasible and safe providing a direct assessment of VO2max. The relatively low number of positive tests in this study suggests the risk of adverse events is relatively low in this population and certainly no higher than age-matched apparently healthy individuals.
Medicine and science in sports and exercise 04/2014; 46(12). DOI:10.1249/MSS.0000000000000353 · 3.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men with prostate cancer; 2) determine if combining exercise and brief psychosexual intervention results in more pronounced improvements in sexual health; and 3) assess if any benefit of exercise and psychosexual intervention on sexual dysfunction is sustained long term.Methods/design: A three-arm, multi-site randomised controlled trial involving 240 prostate cancer survivors will be implemented. Participants will be randomised to: 1) 'Exercise' intervention; 2) 'Exercise + Psychosexual' intervention; or 3) 'Usual Care'. The Exercise group will receive a 6-month, group based, supervised resistance and aerobic exercise intervention. The Exercise + Psychosexual group will receive the same exercise intervention plus a brief psychosexual self-management intervention that addresses psychological and sexual well-being. The Usual Care group will maintain standard care for 6 months. Measurements for primary and secondary endpoints will take place at baseline, 6 months (post-intervention) and 1 year follow-up. The primary endpoint is sexual health and secondary endpoints include key factors associated with sexual health in men with prostate cancer.
Sexual dysfunction is one of the most prevalent and distressing consequences of prostate cancer. Despite this, very little is known about the management of sexual dysfunction and current health care services do not adequately meet sexual health needs of survivors. This project will examine the potential role of exercise in the management of sexual dysfunction and evaluate a potential best-practice management approach by integrating pharmacological, physiological and psychological treatment modalities to address the complex and multifaceted aetiology of sexual dysfunction following cancer.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613001179729.
BMC Cancer 03/2014; 14(1):199. DOI:10.1186/1471-2407-14-199 · 3.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the effects of periodic task-specific test feedback on performance improvement in older adults undertaking community- and home-based resistance exercises (CHBRE). Fifty-two older adults (65-83 years) were assigned to a muscular perfsormance feedback group (MPG, n = 32) or a functional mobility feedback group (FMG, n = 20). Both groups received exactly the same 9-week CHBRE program comprising one community-based and two home-based sessions per week. Muscle performance included arm curls and chair stands in 30 seconds, while functional mobility was determined by the timed up and go (TUG) test. MPG received fortnightly test feedback only on muscle performance and FMG received feedback only on the TUG. Following training, there was a significant (P < 0.05) interaction for all performance tests with MPG improving more for the arm curls (MPG 31.4%, FMG 15.9%) and chair stands (MPG 33.7%, FMG 24.9%) while FMG improved more for the TUG (MPG-3.5%, FMG-9.7%). Results from this nonrandomized study suggest that periodic test feedback during resistance training may enhance task-specific physical performance in older persons, thereby augmenting reserve capacity or potentially reducing the time required to recover functional abilities.
Journal of aging research 01/2014; 2014(1):171694. DOI:10.1155/2014/171694
[Show abstract][Hide abstract] ABSTRACT: To determine if supervised exercise minimises treatment toxicity in prostate cancer patients initiating androgen deprivation therapy (ADT). This is the first study to date which has investigated the potential role of exercise in preventing ADT toxicity rather than recovering from established toxicities.
Sixty-three men scheduled to receive ADT were randomly assigned to a 3-month supervised exercise program involving aerobic and resistance exercise sessions commenced within 10 days of their first ADT injection (n = 32) or usual care (n = 31). The primary outcome was body composition (lean and fat mass). Other study outcomes included bone mineral density, physical function, blood biomarkers of chronic disease risk and bone turnover, general and prostate cancer specific quality of life, fatigue and psychological distress. Outcomes were compared between groups using analysis of covariance adjusted for baseline values.
Compared to usual care, a 3-month exercise program preserved appendicular lean mass (p=0.019) and prevented gains in whole body fat mass, trunk fat mass and percent fat with group differences of -1.4 kg (p=0.001), -0.9 kg (p=0.008) and -1.3% (p<0.001), respectively. Significant between-group differences were also observed favouring the exercise group for cardiovascular fitness (V02 peak 1.1 ml/kg/min, p=0.004), muscular strength (4.0-25.9 kg, p≤0.026), lower body function (-1.1 s, p<0.001), total cholesterol-to-HDL cholesterol ratio (-0.52, p=0.028), sexual function (15.2, p=0.028), fatigue (3.1, p=0.042), psychological distress (-2.2, p=0.045), social functioning (3.8, p=0.015) and mental health (3.6-3.8, p≤0.022). No significant group differences were observed for any other outcomes.
Commencing a supervised exercise program involving aerobic and resistance exercise when initiating ADT significantly reduced treatment toxicity while improving social functioning and mental health. Concurrent prescription of supervised exercise when initiating ADT is therefore advised to minimise morbidity associated with severe hypogonadism.
BJU International 01/2014; 115(2). DOI:10.1111/bju.12646 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exercise may represent an effective adjunct therapy to current medical management strategies for maintaining functional independence and improving quality of life in cancer patients with bone metastatic disease. However, it has yet to be determined if there are any sustained effects following the completion of an exercise program by patients with bone metastases.
The aim of this study is to determine whether a 3-month supervised resistance exercise program results in any sustained functional benefits in prostate and breast cancer patients with bone metastatic disease.
Twenty men and women with bone metastatic disease secondary to prostate or breast cancer completed a 3-month supervised resistance exercise program followed by a 6-month observation period. Outcomes were assessed at baseline, post-exercise, and 6-month follow-up.
Fourteen participants completed the follow-up observation period. Significant improvements in physical function (4-6 %), physical activity levels (~160 min/week), lean mass (3-4 %), and quality of life (5-7 %) were observed at the completion of the exercise program. At the 6-month follow-up, significant improvements in ambulation (4 %), physical activity level (~105 min/week), whole body lean mass (2 %), and quality of life (13 %) remained.
An appropriately designed and supervised 3-month resistance exercise program may lead to significant improvements in functional ability, physical activity level, lean mass, and quality of life that remain 6 months after completion of the program in cancer patients with bone metastases. Future trials involving larger sample sizes are required to expand these preliminary findings.
Supportive Care in Cancer 01/2014; 22(6). DOI:10.1007/s00520-013-2103-1 · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Protein glycosylation via O-linked N-acetylglucosaminylation (O-GlcNAcylation) is an important post-translational regulatory mechanism mediated by O-GlcNAc transferase (OGT) and responsive to nutrients and stress. OGT attaches an O-GlcNAc moiety to proteins, while O-GlcNAcase (OGA) catalyzes O-GlcNAc removal. In skeletal muscle of experimental animals, prolonged increase in O-GlcNAcylation associates with age and muscle atrophy. Here we examined the effects of hormone replacement therapy (HRT) and power training (PT) on muscle OGT and OGA gene expression in postmenopausal women generally prone to age-related muscle weakness. In addition, the associations of OGT and OGA gene expressions with muscle phenotype were analyzed. Twenty-seven 50–57-year-old women participated in a yearlong randomized placebo-controlled trial: HRT (n = 10), PT (n = 8) and control (n = 9). OGT and OGA mRNA levels were measured from muscle samples obtained at baseline and after one year. Knee extensor muscle cross-sectional area (CSA), knee extension force, running speed and vertical jumping height were measured. During the yearlong intervention, HRT suppressed the aging-associated upregulation of OGT mRNA that occurred in the controls. The effects of PT were similar but weaker. HRT also tended to increase the OGA mRNA level compared to the controls. The change in the ratio of OGT to OGA gene expressions correlated negatively with the change in muscle CSA. Our results suggest that OGT and OGA gene expressions are associated with muscle size during the critical postmenopausal period. HRT and PT influence muscle OGT and OGA gene expression, which may be one of the mechanisms by which HRT and PT prevent aging-related loss of muscle mass.
[Show abstract][Hide abstract] ABSTRACT: Sexual dysfunction is one of the most common, distressing and persistent adverse effects of prostate cancer treatment, and has a profound effect on quality of life for the patient and his partner. Current health-care provisions are inadequate to address the demand for the management of sexual dysfunction, with approximately half of prostate cancer survivors reporting unmet sexual health-care needs. Management strategies predominately involve pharmacological interventions to address the direct physiological effects of prostate cancer treatment on erectile function. However, the aetiology of sexual dysfunction is multifaceted and considerable physiological and psychological adverse effects of prostate cancer treatments, which are not addressed by pharmacological intervention, contribute to sexual dysfunction. Exercise has established efficacy for improving many of these factors in men with prostate cancer, including changes in body composition (especially to counteract body feminization), fatigue, physical function, risk of comorbid conditions, depression, anxiety and quality of life. Emerging evidence indicates that exercise also has a positive effect on sexual desire and sexual activity in men with prostate cancer.
[Show abstract][Hide abstract] ABSTRACT: Aging skeletal muscle is associated with not only a reduction in muscle size and strength but also in muscle quality which reflects an increase in fatty infiltration of muscle. In men with prostate cancer, androgen deprivation therapy (ADT) accelerates this loss of muscle size and strength, but it is unknown if muscle quality is also adversely affected. Therefore, we examined the effects of ADT on muscle attenuation, an indirect measure of intramuscular lipid content, as well as the muscle cross-sectional area (CSA) in men with prostate cancer.
Pre- and post-CT scans of the pelvis in 39 men aged 49-78 years receiving leuprorelin were examined. The time between baseline and follow-up scans was 14.6-20 weeks after the commencement of ADT. Changes in skeletal muscle attenuation in Hounsfield units of the rectus femoris and the CSA of the rectus femoris, sartorius and quadricep muscles were assessed.
Muscle attenuation of the rectus femoris muscle was significantly reduced following the initiation of ADT by 18.9% (P < 0.001). In addition, there was a significant decrease (P < 0.001) in the CSA for the sartorius, quadriceps and rectus femoris muscles. There was no effect of Zometa on muscle attenuation or muscle CSA.
Our results indicate that not only muscle size but also muscle quality may be adversely affected by the undertaking of ADT in men with prostate cancer. Consequently, interventions to counteract deteriorations to both muscle mass and possibly muscle quality should be considered in men receiving ADT.
Journal of Medical Imaging and Radiation Oncology 10/2013; 58(2). DOI:10.1111/1754-9485.12124 · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Long-term prostate cancer (PCa) survivors are at increased risk for comorbidities and physical deconditioning.
To determine the effectiveness of a year-long randomised controlled trial of exercise training in PCa survivors >5 yr postdiagnosis on physical functioning.
Between 2010 and 2011, 100 long-term PCa survivors from Trans-Tasman Radiation Oncology Group 03.04 Randomised Androgen Deprivation and Radiotherapy previously treated with androgen-deprivation therapy and radiation therapy were randomly assigned to 6 mo of supervised exercise followed by 6 mo of a home-based maintenance programme (n=50) or printed educational material about physical activity (n=50) for 12 mo across 13 university-affiliated exercise clinics in Australia and New Zealand.
Supervised resistance and aerobic exercise or printed educational material about physical activity.
The primary end point was a 400-m walk as a measure of cardiovascular fitness. Secondary end points were physical function, patient-reported outcomes, muscle strength, body composition, and biomarkers. Analysis of covariance was used to compare outcomes for groups at 6 and 12 mo adjusted for baseline values.
Participants undergoing supervised exercise showed improvement in cardiorespiratory fitness performance at 6 mo (-19 s [p=0.029]) and 12 mo (-13 s [p=0.028]) and better lower-body physical function across the 12-mo period (p<0.01). Supervised exercise also improved self-reported physical functioning at 6 (p=.006) and 12 mo (p=0.002), appendicular skeletal muscle at 6 mo (p=0.019), and objective measures of muscle strength at 6 and 12 mo (p<0.050). Limitations included the restricted number of participants undertaking body composition assessment, no blinding to group assignment for physical functioning measures, and inclusion of well-functioning individuals.
Supervised exercise training in long-term PCa survivors is more effective than physical activity educational material for increasing cardiorespiratory fitness, physical function, muscle strength, and self-reported physical functioning at 6 mo. Importantly, these benefits were maintained in the long term with a home-based programme with follow-up at 12 mo.
The effect of an exercise intervention on cardiovascular and metabolic risk factors in prostate cancer patients from the RADAR study, ACTRN: ACTRN12609000729224.
European Urology 10/2013; 65(5). DOI:10.1016/j.eururo.2013.09.041 · 13.94 Impact Factor