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Exercise prescription dose for castrate-resistant prostate cancer patients: a phase I prescription dose escalation trial

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Abstract

Purpose

To determine the start exercise prescription dose in metastatic castrate-resistant prostate cancer (mCRPC) patients receiving second-line hormone treatment and recommended phase II exercise prescription.

Methods

Patients were enrolled in a 3 + 3 dose escalation phase I trial of aerobic, resistance, and flexibility exercises to evaluate dose-limiting tolerance and safety. Tolerance was defined as Borg score ≤ 16 and safety (pain) as a visual analogue scale score (VAS) ≤ 3 and CTCAE grade < 2. Dose level 1 (escalation start dose) was set at 15 min. Aerobic training (50–80% HRmax warm-up and cooling-down; and 65–80% HRmax. core), 1 set with 8–10 repetitions (reps.) resistance training (50–60% 1-RM, 8 exercises), and 1 set (30s) with 2 reps flexibility training (5 exercises). The prescription dose escalation was designed in four levels (from dose −1 to 3), with a dose escalation in volume and intensity of the exercises.

Results

Nine patients were included in two dosing cohorts and were under active treatment (n = 4 abiraterone acetate and n = 5 enzalutamide). Dose limiting safety concerns were observed in 2 out of 3 patients in dose level 2 and 1 patient out of 6 in dose level 1 due to VAS > 3 during resistance training and/or flexibility training. No tolerance issues were observed in the two dosing cohorts. The optimal start exercise prescription dose was set at dose level 1 due to safety issues at dose level 2.

Conclusion

Our findings suggest that exercise is perceived tolerable in mCRPC patients receiving second-line hormone therapy. Caution is indicated on safety during performance of the exercises.

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Abbreviations

ADT:

Androgen Deprivation Therapy

ACSM:

American College of Sport Medicine

BIA:

Bioelectrical Impedance Analysis

BPI:

Brief Pain Inventory

CPET:

Cardiopulmonary Exercise Test

mCRPC:

Metastatic Castrate-resistant Prostate Cancer

CTCAE:

Common Terminology Criteria for Adverse Events

HRQoL:

Health-related Quality of Life

IPAQ:

International Physical Activity Questionnaire

KPS:

Karnofsky Performance Score

MTP:

Maximum Tolerated Prescription

PCa:

Prostate Cancer

VAS:

Visual Analog Scale

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Acknowledgements

RB is supported by a PhD fellowship of The Research Foundation—Flanders (FWO).

Author information

Authors and Affiliations

  1. Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Renée Bultijnck, Elke Rammant, Valérie Fonteyne, Karel Decaestecker, Nicolaas Lumen & Piet Ost

  2. Research Foundation, Flanders (FWO), Brussels, Belgium

    Renée Bultijnck & Piet Ost

  3. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

    Benedicte Deforche

  4. Department of Physical Activity, Nutrition and Health, Vrije Universiteit Brussel, Brussels, Belgium

    Benedicte Deforche

  5. Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium

    Noëmi Borrey, Jörgen Van Bauwel, Maarten Lievens & Adelheid Steyaert

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  1. Renée Bultijnck
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Contributions

RB: conception and design, protocol development, data collection and analysis, manuscript writing. BD: conception and design, protocol development, data analysis, manuscript editing. NB: protocol development, data collection, manuscript editing. JVB: protocol development, manuscript editing. ML: conception and design, protocol development, data collection and analysis, manuscript editing. ER: protocol development, manuscript editing. VF: protocol development, manuscript editing. KD: protocol development, manuscript editing. AS: conception and design, protocol development, data collection and analysis, manuscript editing. NL: protocol development, manuscript editing. PO: conception and design, protocol development, data analysis, manuscript editing, project supervision.

Corresponding author

Correspondence to Renée Bultijnck.

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The authors declare that they have no conflict of interest with respect to the research, authorship and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of the University Hospital of Ghent, number 2017/1099) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bultijnck, R., Deforche, B., Borrey, N. et al. Exercise prescription dose for castrate-resistant prostate cancer patients: a phase I prescription dose escalation trial. World J Urol 39, 357–364 (2021). https://doi.org/10.1007/s00345-020-03098-y

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