Existing evidence demonstrates that 1:1 personal training (PT) improves many adverse effects of androgen deprivation therapy (ADT). Whether less resource-intensive exercise delivery models are as effective remains to be established.
We determined the feasibility of conducting a multi-center non-inferiority randomized controlled trial comparing PT with supervised group (GROUP) and home-based (HOME) exercise programs, and obtained preliminary efficacy estimates for GROUP and HOME compared to PT on quality of life (QOL) and physical fitness.
Men with prostate cancer on ADT were recruited from one of two experienced Canadian centres and randomized 1:1:1 to PT, GROUP, or HOME. Randomization was stratified by length of ADT use and site. Participants completed moderate intensity aerobic and resistance exercises 4-5 days per week for 6 months with a target 150 min per week of exercise. Exercise prescriptions were individualized and progressed throughout the trial. Feasibility endpoints included recruitment, retention, adherence, and participant satisfaction. The efficacy endpoints QOL, fatigue, and fitness (VO2 peak, grip strength, and timed chair stands) in GROUP and HOME were compared for non-inferiority to PT. Descriptive analyses were used for feasibility endpoints. Between-group differences for efficacy endpoints were examined using Bayesian linear mixed effects models.
Fifty-nine participants (mean age 69.9 years) were enrolled. The recruitment rate was 25.4% and recruitment was slower than projected. Retention was 71.2%. Exercise adherence as measured through attendance was high for supervised sessions but under 50% by self-report and accelerometry. Satisfaction was high and there was no difference in this measure between all three groups. Between-group differences (comparing both GROUP and HOME to PT) were smaller than the minimum clinically important difference on most measures of QOL, fatigue, and fitness. However, two of six outcomes for GROUP and four of six outcomes for HOME had a > 20% probability of being inferior for GROUP.
Feasibility endpoints were generally met. Both GROUP and HOME interventions in men with PC on ADT appeared to be similar to PT for multiple efficacy outcomes, although conclusions are limited by a small sample size and cost considerations have not been incorporated. Efforts need to be targeted to improving recruitment and adherence. A larger trial is warranted.
ClinicalTrials.gov: NCT02046837 . Date of registration: January 20, 2014.
BMC cancer. 2019 Jan 03*** epublish ***
Shabbir M H Alibhai, Daniel Santa Mina, Paul Ritvo, George Tomlinson, Catherine Sabiston, Murray Krahn, Sara Durbano, Andrew Matthew, Padraig Warde, Meagan O'Neill, Narhari Timilshina, Roanne Segal, Nicole Culos-Reed
University Health Network, University of Toronto, Toronto, ON, M5G 2C4, Canada. ., University Health Network, University of Toronto, Toronto, ON, M5G 2C4, Canada., Cancer Care Ontario, York University, Toronto, ON, M3J 1P3, Canada., University of Toronto, Toronto, ON, M5S 2J7, Canada., The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, K1N 6N5, Canada., University of Calgary, Calgary, AB, T2N 1N4, Canada.