Vigorous aerobic exercise after prostate cancer diagnosis was associated with a 60% lower risk of fatal prostate cancer and a 49% lower risk of all-cause mortality among men initially diagnosed with localized disease. The dose-specific effect of larger quantities of vigorous physical activity having greater survival benefit has also been reported by Friedenreich et al. In addition, one prospective study reported that resistance exercise was associated with a 33% lower risk of all-cause mortality in male and female cancer survivors while overall physical activity was not.6 These findings emphasize the potential benefits of exercise as an adjuvant treatment in prostate cancer. However, data on exercise and cancer survival to date have been from observational studies in which bias from confounding and reverse causation are of concern. Thus, a randomized controlled trial (RCT) is needed to test whether exercise, in particular higher intensity aerobic exercise and resistance exercise, impacts overall survival (OS) in men with prostate cancer. Additionally, treatment-related fatigue is a common side effect in men with advanced prostate cancer, and exercise may decrease fatigue and increase adherence to treatment regimens.
While the prevailing view among patients and clinicians has been that exercise may be problematic for patients with cancer with advanced disease, recent research has demonstrated tailored resistance and aerobic exercise to be well tolerated, safe and effective for improving physical structure and function. Moreover, in patients with bone metastases, a highly tailored exercise prescription implementing a modular, multimodal approach and avoiding excessive loading of the skeletal lesions has been demonstrated to be safe and effective.
