Osteoporosis International

, Volume 27, Issue 4, pp 1507–1518 | Cite as

Efficacy of recreational football on bone health, body composition, and physical functioning in men with prostate cancer undergoing androgen deprivation therapy: 32-week follow-up of the FC prostate randomised controlled trial

  • J. Uth
  • T. Hornstrup
  • J. F. Christensen
  • K. B. Christensen
  • N. R. Jørgensen
  • J. F. Schmidt
  • K. Brasso
  • M. D. Jakobsen
  • E. Sundstrup
  • L. L. Andersen
  • M. Rørth
  • J. Midtgaard
  • P. Krustrup
  • E. W. Helge
Original Article



Androgen deprivation therapy (ADT) for prostate cancer (PCa) impairs musculoskeletal health. We evaluated the efficacy of 32-week football training on bone mineral density (BMD) and physical functioning in men undergoing ADT for PCa. Football training improved the femoral shaft and total hip BMD and physical functioning parameters compared to control.


ADT is a mainstay in PCa management. Side effects include decreased bone and muscle strength and increased fracture rates. The purpose of the present study was to evaluate the effects of 32 weeks of football training on BMD, bone turnover markers (BTMs), body composition, and physical functioning in men with PCa undergoing ADT.


Men receiving ADT >6 months (n = 57) were randomly allocated to a football training group (FTG) (n = 29) practising 2–3 times per week for 45–60 min or to a standard care control group (CON) (n = 28) for 32 weeks. Outcomes were total hip, femoral shaft, femoral neck and lumbar spine (L2-L4) BMD and systemic BTMs (procollagen type 1 amino-terminal propeptide, osteocalcin, C-terminal telopeptide of type 1 collagen). Additionally, physical functioning (postural balance, jump height, repeated chair rise, stair climbing) was evaluated.


Thirty-two-week follow-up measures were obtained for FTG (n = 21) and for CON (n = 20), respectively. Analysis of mean changes from baseline to 32 weeks showed significant differences between FTG and CON in right (0.015 g/cm2) and left (0.017 g/cm2) total hip and in right (0.018 g/cm2) and left (0.024 g/cm2) femoral shaft BMD, jump height (1.7 cm) and stair climbing (−0.21 s) all in favour of FTG (p < 0.05). No other significant between-group differences were observed.


Compared to standard care, 32 weeks of football training improved BMD at clinically important femoral sites and parameters of physical functioning in men undergoing ADT for PCa.


Androgen deprivation therapy Bone mineral density Bone turnover markers Exercise Physical activity Sport 



The authors would like to thank all the participants for their contributions to the study. The authors would also like to thank Ditte Marie Bruun, Christian Frandsen, and Jens Jung Nielsen for expert advice and assistance in collecting data. The study was supported by grants from the Center for Integrated Rehabilitation of Cancer Patients (CIRE), which was established and is supported by the Danish Cancer Society and the Novo Nordisk Foundation. The project was also supported by TrygFonden, Preben and Anna Simonsen Fonden, and The Beckett Foundation.

Compliance with ethical standards

Conflicts of interest


Trial registration NCT01711892

Ethical approval

All procedures performed in the study were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Danish National Committee on Biomedical Research Ethics for the Capital Region of Denmark (registration number H-3-2011-131), and all participants gave informed written consent before any study procedures were undertaken.


  1. 1.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N (2014) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479CrossRefPubMedGoogle Scholar
  2. 2.
    Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR (2003) National practice patterns and time trends in androgen ablation for localized prostate cancer. J Natl Cancer Inst 95:981–989CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, Billiet I, Torecilla JL, Pfeffer R, Cutajar CL, Van der Kwast T, Collette L (2010) External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 11:1066–1073CrossRefPubMedGoogle Scholar
  4. 4.
    Nguyen PL, Alibhai SM, Basaria S, D’Amico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR (2015) Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 67:825–836CrossRefPubMedGoogle Scholar
  5. 5.
    Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM (2005) Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 90:6410–6417CrossRefPubMedGoogle Scholar
  6. 6.
    Alibhai SM, Duong-Hua M, Cheung AM, Sutradhar R, Warde P, Fleshner NE, Paszat L (2010) Fracture types and risk factors in men with prostate cancer on androgen deprivation therapy: a matched cohort study of 19,079 men. J Urol 184:918–923CrossRefPubMedGoogle Scholar
  7. 7.
    Oefelein MG, Ricchiuti V, Conrad W, Resnick MI (2002) Skeletal fractures negatively correlate with overall survival in men with prostate cancer. J Urol 168:1005–1007CrossRefPubMedGoogle Scholar
  8. 8.
    Serpa Neto A, Tobias-Machado M, Esteves MA, Senra MD, Wroclawski ML, Fonseca FL, Dos Reis RB, Pompeo AC, Giglio AD (2012) Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 15:36–44CrossRefPubMedGoogle Scholar
  9. 9.
    Eastham JA (2007) Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol 177:17–24CrossRefPubMedGoogle Scholar
  10. 10.
    Shane E, Burr D, Abrahamsen B et al (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res Off J Am Soc Bone Miner Res 29:1–23CrossRefGoogle Scholar
  11. 11.
    Bolam KA, van Uffelen JGZ, Taaffe DR (2013) The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteoporos Int 24:2749–2762CrossRefPubMedGoogle Scholar
  12. 12.
    Leigey D, Irrgang J, Francis K, Cohen P, Wright V (2009) Participation in high-impact sports predicts bone mineral density in senior Olympic athletes. Sports Health 1:508–513CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Helge EW, Andersen TR, Schmidt JF, Jørgensen NR, Hornstrup T, Krustrup P, Bangsbo J (2014) Recreational football improves bone mineral density and bone turnover marker profile in elderly men. Scand J Med Sci Sports 24(Suppl 1):98–104CrossRefPubMedGoogle Scholar
  14. 14.
    Winters-Stone KM, Dobek JC, Bennett JA, Maddalozzo GF, Ryan CW, Beer TM (2014) Skeletal response to resistance and impact training in prostate cancer survivors. Med Sci Sports Exerc 46:1482–1488CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cormie P, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, Chambers SK, Newton RU (2014) Can supervised exercise prevent treatment toxicity in prostate cancer patients initiating androgen deprivation therapy: a randomised controlled trial. BJU Int 15:256–266Google Scholar
  16. 16.
    Nilsen TS, Raastad T, Skovlund E, Courneya KS, Langberg CW, Lilleby W, Fosså SD Thorsen L (2015) Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy. Acta Oncol Stockh Swed 1–9. doi:  10.3109/0284186X.2015.1037008
  17. 17.
    van Londen GJ, Levy ME, Perera S, Nelson JB, Greenspan SL (2008) Body composition changes during androgen deprivation therapy for prostate cancer: a 2-year prospective study. Crit Rev Oncol Hematol 68:172–177CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Galvao DA, Taaffe DR, Spry N et al (2008) Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis 12:198–203CrossRefPubMedGoogle Scholar
  19. 19.
    Gardner JR, Livingston PM, Fraser SF (2014) Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol 32:335–346. doi: 10.1200/JCO.2013.49.5523 CrossRefPubMedGoogle Scholar
  20. 20.
    Uth J, Schmidt JF, Christensen JF, Hornstrup T, Andersen LJ, Hansen PR, Christensen KB, Andersen LL, Helge EW, Brasso K, Rørth M, Krustrup P, Midtgaard J (2013) Effects of recreational soccer in men with prostate cancer undergoing androgen deprivation therapy: study protocol for the “FC Prostate” randomized controlled trial. BMC Cancer 13:595CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Uth J, Hornstrup T, Schmidt JF, Christensen JF, Frandsen C, Christensen KB, Helge EW, Brasso K, Rørth M, Midtgaard J, Krustrup P (2014) Football training improves lean body mass in men with prostate cancer undergoing androgen deprivation therapy. Scand J Med Sci Sports 24(Suppl 1):105–112CrossRefPubMedGoogle Scholar
  22. 22.
    Taaffe DR, Duret C, Wheeler S, Marcus R (1999) Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J Am Geriatr Soc 47:1208–1214CrossRefPubMedGoogle Scholar
  23. 23.
    Jones CJ, Rikli RE, Beam WC (1999) A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 70:113–119CrossRefPubMedGoogle Scholar
  24. 24.
    Jakobsen MD, Sundstrup E, Krustrup P, Aagaard P (2011) The effect of recreational soccer training and running on postural balance in untrained men. Eur J Appl Physiol 111:521–530CrossRefPubMedGoogle Scholar
  25. 25.
    Melton LJ 3rd, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (1998) Bone density and fracture risk in men. J Bone Miner Res 13:1915–1923CrossRefPubMedGoogle Scholar
  26. 26.
    Serpa Neto A, Tobias-Machado M, Esteves MA, Senra MD, Wroclawski ML, Fonseca FL, dos Reis RB, Pompeo AC, Del Giglio A (2010) A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma. BMC Urol 10:9CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Shahinian VB, Kuo Y-F, Freeman JL, Goodwin JS (2005) Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 352:154–164CrossRefPubMedGoogle Scholar
  28. 28.
    Randers MB, Nybo L, Petersen J, Nielsen JJ, Christiansen L, Bendiksen M, Brito J, Bangsbo J, Krustrup P (2010) Activity profile and physiological response to football training for untrained males and females, elderly and youngsters: influence of the number of players. Scand J Med Sci Sports 20:14–23CrossRefPubMedGoogle Scholar
  29. 29.
    Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR (2004) American college of sports medicine position stand: physical activity and bone health. Med Sci Sports Exerc 36:1985–1996CrossRefPubMedGoogle Scholar
  30. 30.
    Lanyon LE (1996) Using functional loading to influence bone mass and architecture: objectives, mechanisms, and relationship with estrogen of the mechanically adaptive process in bone. Bone 18:37S–43SCrossRefPubMedGoogle Scholar
  31. 31.
    Fritton JC, Myers ER, Wright TM, van der Meulen MCH (2008) Bone mass is preserved and cancellous architecture altered due to cyclic loading of the mouse tibia after orchidectomy. J Bone Miner Res Off J Am Soc Bone Miner Res 23:663–671CrossRefGoogle Scholar
  32. 32.
    Nikander R, Kannus P, Dastidar P, Hannula M, Harrison L, Cervinka T, Narra NG, Aktour R, Arola T, Eskola H, Soimakallio S, Heinonen A, Hyttinen J, Sievänen H (2009) Targeted exercises against hip fragility. Osteoporos Int 20:1321–1328CrossRefPubMedGoogle Scholar
  33. 33.
    Nicola F, Catherine S (2011) Dose-response relationship of resistance training in older adults: a meta-analysis. Br J Sports Med 45:233–234CrossRefPubMedGoogle Scholar
  34. 34.
    Andersen LJ, Randers MB, Westh K, Martone D, Hansen PR, Junge A, Dvorak J, Bangsbo J, Krustrup P (2010) Football as a treatment for hypertension in untrained 30–55-year-old men: a prospective randomized study. Scand J Med Sci Sports 20:98–102CrossRefPubMedGoogle Scholar
  35. 35.
    Banfi G, Lombardi G, Colombini A, Lippi G (2010) Bone metabolism markers in sports medicine. Sports Med Auckl N Z 40:697–714CrossRefGoogle Scholar
  36. 36.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL, American College of Sports Medicine (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426CrossRefPubMedGoogle Scholar
  37. 37.
    Cormie P, Newton RU, Spry N, Joseph D, Taaffe DR, Galvão DA (2013) Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis 16:328–335CrossRefPubMedGoogle Scholar
  38. 38.
    Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, Catto JW, Saxton JM, Rosario DJ (2014) Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Eur Urol 65:865–872CrossRefPubMedGoogle Scholar
  39. 39.
    Gardner JR, Livingston PM, Fraser SF (2014) Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol Off J Am Soc Clin Oncol 32:335–346CrossRefGoogle Scholar
  40. 40.
    Santa Mina D, Alibhai SMH, Matthew AG, Guglietti CL, Pirbaglou M, Trachtenberg J, Ritvo P (2013) A randomized trial of aerobic versus resistance exercise in prostate cancer survivors. J Aging Phys Act 21:455–478CrossRefPubMedGoogle Scholar
  41. 41.
    Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, Lamb DS, Chambers SK, Newton RU (2014) A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Eur Urol 65:856–864CrossRefPubMedGoogle Scholar
  42. 42.
    Oja P, Titze S, Kokko S, Kujala UM, Heinonen A, Kelly P, Koski P, Foster C (2015) Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis. Br J Sports Med 49:434–440CrossRefPubMedGoogle Scholar
  43. 43.
    Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med 16:97–106CrossRefPubMedGoogle Scholar
  44. 44.
    Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412CrossRefPubMedGoogle Scholar
  45. 45.
    Bruun DM, Bjerre E, Krustrup P, Brasso K, Johansen C, Rørth M, Midtgaard J (2014) Community-based recreational football: a novel approach to promote physical activity and quality of life in prostate cancer survivors. Int J Environ Res Public Health 11:5567–5585CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • J. Uth
    • 1
  • T. Hornstrup
    • 2
  • J. F. Christensen
    • 3
  • K. B. Christensen
    • 4
  • N. R. Jørgensen
    • 5
    • 6
  • J. F. Schmidt
    • 2
  • K. Brasso
    • 7
  • M. D. Jakobsen
    • 8
  • E. Sundstrup
    • 8
  • L. L. Andersen
    • 8
    • 9
  • M. Rørth
    • 10
  • J. Midtgaard
    • 1
    • 11
  • P. Krustrup
    • 2
    • 12
  • E. W. Helge
    • 2
  1. 1.The University Hospitals Centre for Health Research (UCSF), RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and HealthUniversity of CopenhagenCopenhagenDenmark
  3. 3.Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
  5. 5.Research Center for Ageing and Osteoporosis, Department of Clinical BiochemistryRigshospitaletGlostrupDenmark
  6. 6.Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  7. 7.Copenhagen Prostate Cancer Center, Department of Urology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  8. 8.National Research Centre for the Working EnvironmentCopenhagenDenmark
  9. 9.Physical Activity and Human Performance group, SMI, Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
  10. 10.Department of Oncology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  11. 11.Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  12. 12.Sport and Health Sciences, College of Life and Environmental SciencesUniversity of ExeterExeterUK

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