Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study

Harvard University, Cambridge, Massachusetts, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2011; 29(6):726-32. DOI: 10.1200/JCO.2010.31.5226
Source: PubMed


To determine whether higher physical activity after prostate cancer (PCa) diagnosis decreases risk of overall and PCa-specific death.
We evaluated physical activity in relation to overall and PCa mortality among 2,705 men in the Health Professionals Follow-Up Study diagnosed with nonmetastatic PCa observed from 1990 to 2008. Proportional hazards models were used to evaluate physical activity and time to overall and PCa-specific death.
Among men who lived at least 4 years after their postdiagnosis physical activity assessment, we documented 548 deaths, 20% of which were a result of PCa. In multivariable analysis, men who were physically active had lower risk of all-cause mortality (P(trend) < .001) and PCa mortality (P(trend) = .04). Both nonvigorous activity and vigorous activity were associated with significantly lower overall mortality. Those who walked ≥ 90 minutes per week at a normal to very brisk pace had a 46% lower risk of all-cause mortality (hazard ratio [HR] 0.54; 95% CI, 0.41 to 0.71) compared with shorter durations at an easy walking pace. Men with ≥ 3 hours per week of vigorous activity had a 49% lower risk of all-cause mortality (HR, 0.51; 95% CI, 0.36 to 0.72). For PCa-specific mortality, brisk walking at longer durations was suggestively inverse but not statistically significant. Men with ≥ 3 hours per week of vigorous activity had a 61% lower risk of PCa death (HR, 0.39, 95% CI, 0.18 to 0.84; P = .03) compared with men with less than 1 hour per week of vigorous activity. Men exercising vigorously before and after diagnosis had the lowest risk.
In men with PCa, physical activity was associated with lower overall mortality and PCa mortality. A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for ≥ 3 hours a week may substantially improve PCa-specific survival.

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    • "In a study following over 2,000 men with prostate cancer, it was found that men who were more active lived significantly longer [40]. Furthermore, men who walked 90 or more minutes per week at a brisk pace experienced half the risk of dying versus those who did not walk, or did so at a slow pace. "
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    ABSTRACT: Over the past decade,significantdata haveshownthat obese men experience a survival detrimentafter treatment for prostate cancer. While methods to combat obesity are of utmost importance for the prostate cancer patient, newer data revealthe overall metabolic improvements that accompany increased activity levels and intense exercisebeyond weight loss. Along these lines, a plethora of data haveshown improvement in prostate cancer-specific outcomes after treatmentaccompanied with these activity levels. This review discusses the metabolic mechanismsin which increased activity levels and exercise can help improve both outcomes for men treated for prostate cancer while lowering the side effects of treatment.
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    • "Sufficient levels of PA may also be important to improve disease free and overall survival. Observational studies showed higher levels of moderate-tovigorous PA to be associated with lower mortality risk in survivors [16] of breast, [17] [18] [19] colon, [20] [21] and prostate cancer, [22] [23] with physically active survivors having approximately 50% lower mortality. However, to establish a causal relationship between PA and survival, randomized controlled trials (RCTs) are needed. "
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    ABSTRACT: Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. This paper aims to discuss the existing physical activity guidelines for cancer survivors and to describe future research directions to optimize prescriptions. Studies on physical activity during and after cancer treatment were searched in PubMed,, Australian New Zealand Clinical Trials Registry, and Dutch Trial registry. Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining ‘for whom’ or ‘under what circumstances’ interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines.
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    • "Within the last decade, an increasing number of studies were able to demonstrate that physical activities in general, as well as defined and controlled exercise programs are beneficial for prostate cancer patients. Kenfield and colleagues [1] provided evidence that regular physical activity may reduce overall mortality and prostate cancer specific mortality. Other well designed studies show a positive influence of exercise interventions regarding treatment related side effects like urinary incontinence after surgery [2,3] and body composition changes during Antiandrogen therapy [4]. "
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    ABSTRACT: Background: Exercise seems to minimize prostate cancer specific mortality risk and treatment related side effects like fatigue and incontinence. However the influence of physical activity on the immunological level remains uncertain. Even prostate cancer patients undergoing palliative treatment often have a relatively long life span compared to other cancer entities. To optimize exercise programs and their outcomes it is essential to investigate the underlying mechanisms. Further, it is important to discriminate between different exercise protocols and therapy regimes. Methods/design: The ProImmun study is a prospective multicenter patient preference randomized controlled trial investigating the influence of a 24 week endurance exercise program in 80-100 prostate cancer patients by comparing patients undergoing Antiandrogen therapy combined with exercise (AE), Antiandrogen therapy without exercise (A), Chemotherapy with exercise(CE) or Chemotherapy without exercise (C). The primary outcome of the study is a change in prostate cancer relevant cytokines and hormones (IL-6, MIF, IGF-1, Testosterone). Secondary endpoints are immune cell ratios, oxidative stress and antioxidative capacity levels, VO2 peak, fatigue and quality of life. Patients of the intervention group exercise five times per week, while two sessions are supervised. During the supervised sessions patients (AE and CE) exercise for 33 minutes on a bicycle ergometer at 70-75% of their VO2 peak. To assess long term effects and sustainability of the intervention two follow-up assessments are arranged 12 and 18 month after the intervention. Discussion: The ProImmun study is the first trial which primarily investigates immunological effects of a six month endurance exercise program in prostate cancer patients during palliative care. Separating patients treated with Antiandrogen therapy from those who are additionally treated with Chemotherapy might allow a more specific view on the influence of endurance training interventions and the impact of different therapy protocols on the immune function. Trial registration: German Clinical Trials Register: DRKS00004739.
    Full-text · Article · Jun 2013 · BMC Cancer
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