Purpose: Androgen-deprivation therapy is a commonly used treatment for men with prostate cancer; however, the adverse effects can be detrimental to patient health and quality of life. Exercise has been proposed as a strategy for ameliorating a range of these treatment-related adverse effects. We conducted a systematic review of the literature regarding the effects of exercise on treatment-related adverse effects in men receiving androgen-deprivation therapy for prostate cancer. Methods: An online electronic search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, SPORTDiscus, and Health Source databases was performed to identify relevant peer-reviewed articles published between January 1980 and June 2013. Eligible study designs included randomized controlled trials as well as uncontrolled trials with pre- and postintervention data. Information was extracted regarding participant and exercise intervention characteristics as well as the effects of exercise on bone health, body composition, physical performance, cardiometabolic risk, fatigue, and quality of life. Results: Ten studies were included, with exercise interventions involving aerobic and/or resistance training. Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task performance, lean body mass, and fatigue, with inconsistent effects observed for adiposity. The impact of exercise on bone health, cardiometabolic risk markers, and quality of life are currently unclear. Conclusion: Among patients with prostate cancer treated with androgen-deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects. Ongoing research of high methodologic quality is required to consolidate and expand on current knowledge and to allow the development of specific evidence-based exercise prescription recommendations.

Background: Breast cancer survivors treated with anthracycline-based chemotherapy (AC) have increased risk of functional limitation and cardiac dysfunction. We conducted a 12-month randomized controlled trial in 104 patients with early-stage breast cancer scheduled for AC to determine whether 12 months of exercise training (ExT) could attenuate functional disability (primary end point), improve cardiorespiratory fitness (VO ₂ peak), and prevent cardiac dysfunction. Methods: Women 40 to 75 years of age with stage I to III breast cancer scheduled for AC were randomized to 3 to 4 days per week aerobic and resistance ExT for 12 months (n=52) or usual care (UC; n=52). Functional measures were performed at baseline, at 4 weeks after AC (4 months), and at 12 months, comprising: (1) cardiopulmonary exercise testing to quantify VO ₂ peak and functional disability (VO ₂ peak ≤18.0 mL·kg ⁻¹ ·min ⁻¹ ); (2) cardiac reserve (response from rest to peak exercise), quantified with exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output, and stroke volume; (3) standard-of-care echocardiography-derived resting left ventricular ejection fraction and global longitudinal strain; and (4) biochemistry (troponin and BNP [B-type natriuretic peptide]). Results: Among 104 participants randomized, greater study attrition was observed among UC participants ( P =0.031), with 93 women assessed at 4 months (ExT, n=49; UC, n=44) and 87 women assessed at 12 months (ExT, n=49; UC, n=38). ExT attenuated functional disability at 4 months (odds ratio, 0.32 [95% CI, 0.11–0.94]; P =0.03) but not at 12 months (odds ratio, 0.27 [95% CI, 0.06–1.12]; P =0.07). In a per-protocol analysis, functional disability was prevented entirely at 12 months among participants adherent to ExT (ExT, 0% versus UC, 20%; P =0.005). Compared with UC at 12 months, ExT was associated with a net 3.5-mL·kg ⁻¹ ·min ⁻¹ improvement in VO ₂ peak that coincided with greater cardiac output, stroke volume, and left and right ventricular ejection fraction reserve ( P <0.001 for all). There was no effect of ExT on resting measures of left ventricular function. Postchemotherapy troponin increased less in ExT than in UC (8-fold versus 16-fold increase; P =0.002). There were no changes in BNP in either group. Conclusions: In women with early-stage breast cancer undergoing AC, 12 months of ExT did not attenuate functional disability, but provided large, clinically meaningful benefits on VO ₂ peak and cardiac reserve. Registration: URL: https://www.anzctr.org.au/ ; Unique identifier: ACTRN12617001408370.

BRUCE, C. R., M. E. ANDERSON, S. F. FRASER, N. K. STEPTO, R. KLEIN, W. G. HOPKINS, and J. A. HAWLEY. Enhancement of 2000-m rowing performance after caffeine ingestion. Med. Sci. Sports Exerc., Vol. 32, No. 11, pp. 1958–1963, 2000. To investigate the effect of caffeine ingestion on short-term endurance performance in competitive rowers. In this randomized double-blind crossover study, eight competitive oarsmen (peak oxygen uptake [V̇O2peak] 4.7 ± 0.4 L·min−1, mean ± SD) performed three familiarization trials of a 2000-m rowing test on an air-braked ergometer, followed by three experimental trials at 3- to 7-d intervals, each 1 h after ingesting caffeine (6 or 9 mg·kg−1 body mass) or placebo. Trials were preceded by a standardized warm-up (6 min at 225 ± 39 W; 75 ± 7.7% V̇O2peak). Urinary caffeine concentration was similar before ingestion (∼1 mg·L−1) but rose to 6.2 ± 3.6 and 14.5 ± 7.0 mg·L−1 for the low and high caffeine doses, respectively. Plasma free fatty acid concentration before exercise was higher after caffeine ingestion (0.29 ± 0.17 and 0.39 ± 0.20 mM for 6 and 9 mg·kg−1, respectively) than after placebo (0.13 ± 0.05 mM). Respiratory exchange ratio during the warm-up was also substantially lower with caffeine (0.94 ± 0.09 and 0.93 ± 0.06 for the low and high dose) than with placebo (0.98 ± 0.12). Subjects could not distinguish between treatments before or after the exercise test. Both doses of caffeine had a similar ergogenic effect relative to placebo: performance time decreased by a mean of 1.2% (95% likely range 0.4–1.9%); the corresponding increase in mean power was 2.7% (0.4–5.0%). Performance time showed some evidence of individual differences in the effect of caffeine (SD 0.9%; 95% likely range 1.5 to −0.9%). Ingestion of 6 or 9 mg·kg−1 of caffeine produces a worthwhile enhancement of short-term endurance performance in a controlled laboratory setting.

Obesity is associated with impairments of physical function, cardiovascular fitness, muscle strength and the capacity to perform activities of daily living. This review examines the specific effects of exercise training in relation to body composition and physical function demonstrated by changes in cardiovascular fitness, and muscle strength when obese adults undergo energy restriction. Electronic databases were searched for randomised controlled trials comparing energy restriction plus exercise training to energy restriction alone. Studies published to May 2013 were included if they used multi-component methods for analysing body composition and assessed measures of fitness in obese adults. Fourteen RCTs met the inclusion criteria. Heterogeneity of study characteristics prevented meta-analysis. Energy restriction plus exercise training was more effective than energy restriction alone for improving cardiovascular fitness, muscle strength, and increasing fat mass loss and preserving lean body mass, depending on the type of exercise training. Adding exercise training to energy restriction for obese middle-aged and older individuals results in favourable changes to fitness and body composition. Whilst weight loss should be encouraged for obese individuals, exercise training should be included in lifestyle interventions as it offers additional benefits.

BACKGROUND: The purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer.METHODS: This was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12‐week exercise program comprising 2 supervised gym sessions and 1 home‐based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self‐reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression.RESULTS: A significant intervention effect was observed for vigorous‐intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09‐0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, −0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9‐7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, −0.02 to 0.70; P = .06) and depression symptoms (effect size: d, −0.35; 95% CI, −0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program.CONCLUSIONS: The clinician referral and 12‐week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations. Cancer 2015;121:2646–2654. © 2015 American Cancer Society.