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Skeletal Response to Resistance and Impact Training in Prostate Cancer Survivors

WINTERS-STONE, KERRI M.1,3; DOBEK, JESSICA C.1; BENNETT, JILL A.1,3; MADDALOZZO, GIANNI F.4; RYAN, CHRISTOPHER W.2,3; BEER, TOMASZ M.2,3

Medicine & Science in Sports & Exercise: August 2014 - Volume 46 - Issue 8 - p 1482–1488
doi: 10.1249/MSS.0000000000000265
Clinical Sciences

Introduction: Androgen deprivation therapy (ADT) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors (PCS). We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density (BMD) among PCS on ADT.

Methods: We randomized 51 PCS (mean age, 70.2 yr) currently prescribed ADT to participate in 1 yr of impact + resistance training (Prevent Osteoporosis with Impact + Resistance (POWIR)) or in an exercise placebo program of stretching exercise (FLEX). Outcomes were proximal femur (total hip, femoral neck, and greater trochanter) and spine (L1–L4) BMD (g·cm−2) and bone turnover markers (serum osteocalcin (ng·mL−1) and urinary deoxypyrodinoline cross-links (nmol·mmol−1 Cr)).

Results: Retention in the 1-yr study was 84% and median attendance to supervised classes was 84% in POWIR and 74% in FLEX. No study-related injuries were reported. There were no significant differences between groups for average L1–L4 BMD or for BMD at any hip site. When examining individual vertebrae, POWIR has a significant effect on preservation of BMD (−0.4%) at the L4 vertebrae compared with losses (−3.1%) in FLEX (P = 0.03).

Conclusion: Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT. Among our limited sample, POWIR did not appear to have a clinically meaningful effect on hip or spine BMD, but some evidence of skeletal adaptation to resistance + impact training in an androgen-deprived state was apparent. Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinically relevant sites.

1School of Nursing, Oregon Health and Science University, Portland, OR; 2School of Medicine, Oregon Health and Science University, Portland, OR; and 3Knight Cancer Institute, Oregon Health and Science University, Portland, OR; 4Department of Exercise and Sport Science, School of Biologic and Population Health, Oregon State University, Corvallis, OR

Address for correspondence: Kerri Winters-Stone, Ph.D., Oregon Health and Science University, 3455 SW US Veteran’s Hospital Rd., Mailcode: SN-ORD, Portland, OR 97239; E-mail: wintersk@ohsu.edu.

Submitted for publication November 2013.

Accepted for publication December 2013.

© 2014 American College of Sports Medicine