Feasibility of home-based exercise training during adjuvant treatment for metastatic castrate-resistant prostate cancer patients treated with an androgen receptor pathway inhibitor (EXACT)

Malcolm Brown, Marie H. Murphy, Helen McAneney, Ken McBride, Ffiona Crawford, Aidan Cole, Joe M. O’Sullivan, Suneil Jain, Gillian Prue

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Abstract

Background
Exercise is an effective adjuvant therapy that can alleviate treatment-related toxicities for men with prostate cancer (PC). However, the feasibility of delivering exercise training to men with advanced disease and the wider impact on clinical outcomes remain unknown. The purpose of the EXACT trial was to determine the feasibility and effects of home-based exercise training in men with metastatic castrate-resistant prostate cancer (mCRPC).

Methods
Patients with mCRPC receiving ADT + an androgen receptor pathway inhibitor (ARPI) were prescribed 12 weeks of home-based, remotely monitored, moderate intensity, aerobic and resistance exercise. Feasibility was assessed using recruitment, retention and adherence rates. Safety and adverse events were monitored throughout, with functional and patient-reported outcomes captured at baseline, post-intervention and at 3-month follow-up.

Results
From the 117 screened, 49 were deemed eligible and approached, with 30 patients providing informed consent (61% recruitment rate). Of those who consented, 28 patients completed baseline assessments, with 24 patients completing the intervention and 22 completing follow-up (retention rates: 86% and 79% respectively). Task completion was excellent throughout, with no intervention-related adverse events recorded. Self-reported adherence to the overall intervention was 82%. Exercise training decreased mean body mass (−1.5%), improved functional fitness (> 10%) and improved several patient-reported outcomes including clinically meaningful changes in fatigue (p = 0.042), FACT-G (p = 0.054) and FACT-P (p = 0.083), all with moderate effect sizes.

Conclusion
Home-based exercise training, with weekly remote monitoring, was feasible and safe for men with mCRPC being treated with an ARPI. Given that treatment-related toxicities accumulate throughout the course of treatment, and as a result, negatively impact functional fitness and health-related quality of life (HRQoL), it was positive that exercise training improved or prevented a decline in these clinically important variables and could better equip patients for future treatment. Collectively, these preliminary feasibility findings support the need for a definitive, larger RCT, which downstream may lead to the inclusion of home-based exercise training as part of adjuvant care for mCRPC.
Original languageEnglish
Article number442 (2023)
Pages (from-to)1-13
Number of pages13
JournalSupportive Care in Cancer
Volume31
Issue number7
Early online date4 Jul 2023
DOIs
Publication statusPublished online - 4 Jul 2023

Bibliographical note

Funding Information:
This research was supported by the HSC Public Health Agency Research and Development Division (Opportunity Led Funding Scheme; Reference: COM/5310/16). The NIPHRN is an HSC Public Health Agency Research and Development Division funded initiative to support Public Health Research.

Publisher Copyright:
© 2023, The Author(s).

Keywords

  • Metastatic prostate cancer
  • Health-related quality of life
  • Feasibility
  • Functional fitness
  • Exercise

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