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To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise.Randomized controlled trial.Academic medical center.PCS (N=51; mean age, 70.2y) on ADT.PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year.Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates.Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P.05).One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.

Older women (aged 65+) constitute the largest group of U.S. breast cancer survivors (BCS) (National Cancer Institute). Today, more than 1.6 million U.S. women aged 65+ are BCS (Centers for Disease Control and Prevention, 2011). The long-term physiological symptoms reported by BCS, such as cognitive difficulty, neuropathy, osteoporosis, muscle weakness, weight loss, slow walking speed, and fatigue, may be similar to those of older women without cancer, but may begin at an earlier age (Clough-Gorr, Stuck, Thwin, & Silliman, 2010; Klepin et al., 2010; Maccormick, 2006). A useful approach may be to consider the long-term effects of cancer and cancer treatment as accelerated aging or early-onset frailty (Maccormick, 2006). Frailty is an overall weakened physiological state, usually associated with advanced age. In 2001, a measureable Frailty Phenotype model was proposed by Fried and colleagues that has been widely adopted in geriatric research and practice. The Frailty Phenotype is a conceptual cycle of inactivity and increasing weakness that cascades into eventual disability and dependence. Fried et al. proposed five criteria to measure frailty and demonstrated that older adults with at least three of the five frailty criteria (unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity) were at increased risk of worsening mobility, hospitalization, and death (Fried et al., 2001; Gill, Gahbauer, Han, & Allore, 2010). Frailty, measured by the Frailty Phenotype, has been strongly associated with older age, hospitalization, development of disability, reduced cardiac and pulmonary function, and reduced exercise capacity in older adults without cancer (Avila-Funes et al., 2008; Bandeen-Roche et al., 2006; Boyd, Xue, Simpson, Guralnik, & Fried, 2005; Fernandez-Bolanos et al., 2008; Santos-Eggimann, Cuenoud, Spagnoli, & Junod, 2009; Szanton, Seplaki, Thorpe, Allen, & Fried, 2010; Weiss, Hoenig, Varadhan, Simonsick, & Fried, 2010; Wong et al., 2010; Woo, Chan, Leung, & Wong, 2010). It is not yet known whether cancer survivors are measurably more frail than other adults of the same age, because frailty has rarely been measured in cancer studies. However, there have been recent calls to include assessment of frailty in research studies and clinical care of cancer patients and survivors (Audisio & van Leeuwen, 2011; Bylow, Mohile, Stadler, & Dale, 2007; Maccormick, 2006; Monfardini & Basso, 2007; Pal, Katheria, & Hurria, 2010; Retornaz et al., 2008). To our knowledge, only one published study has reported frailty in cancer survivors. In that study, 8% of 71 men on androgen deprivation therapy (ADT) were frail, and 56% were prefrail (had one or two criteria for frailty) (Bylow et al., 2011). The purpose of this study was to measure frailty in 216 older BCS using the five criteria of the Frailty Phenotype. To provide a context for our findings, we present published data on frailty from older women in the Cardiovascular Health Study (CHS) and Women’s Health and Aging Study (WHAS) and a regression model of our BCS data to evaluate characteristics associated with frailty.

Our randomized controlled trial in prematurely menopausal breast cancer survivors showed that impact + resistance training prevented increases in percentage of body fat compared with controls and also improved BMD at the hip and prevented BMD loss at the spine among exercise-trained women who were menopausal for1 year.Cancer treatment-related menopause worsens bone health and body composition in breast cancer survivors (BCS). We investigated whether impact + resistance training could improve bone mineral density (BMD), reduce bone turnover, build muscle, and decrease fat mass in BCS with premature menopause.We conducted a randomized controlled trial in 71 BCS (mean age, 46.5 years) within 5 years of treatment-related menopause. Women were randomly assigned to one of two groups: (1) impact + resistance training (prevent osteoporosis with impact + resistance (POWIR)) or (2) exercise placebo (FLEX) 3×/week for 1 year. Outcomes were hip and spine BMD (in grams per square centimeter) and body composition (percent body fat (%BF) and lean and fat mass (in kilograms)) by DXA and bone turnover markers (serum osteocalcin (in nanograms per milliliter) and urinary deoxypryrodinoline (in nanomoles per milliliter).There were no significant group × time interactions for bone outcomes when using an intent-to-treat approach on the full sample. In analyses restricted to BCS who were menopausal for ≥1 year, POWIR increased BMD at the hip and slowed BMD loss at the spine compared with FLEX (femoral neck-POWIR, 0.004 ± 0.093 g/cm(2) vs. FLEX, -0.010 ± 0.089 g/cm(2); p 0.01; spine-POWIR, -0.003 ± 0.114 g/cm(2) vs. FLEX, -0.020 ± 0.110 g/cm(2); p = 0.03). POWIR prevented increases in %BF (POWIR, 0.01 % vs. FLEX, 1.3 %; p 0.04). Women with attendance to POWIR at ≥64 % had better improvements in %BF than women attending less often (p 0.03).Impact + resistance training may effectively combat bone loss and worsening body composition from premature menopause in BCS.

Older breast cancer survivors (BCS) report more falls and functional limitations than women with no cancer history. Exercise training could reduce risk factors for future falls and disability.We conducted a randomized, controlled trial in 106 early-stage, postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment. Women were randomly assigned to a 1-year resistance + impact exercise program or a stretching placebo program. Endpoints were one repetition maximum bench press and leg press strength, timed five chair stands, 4 m usual walk speed, timed stance tests, handgrip strength, self-report physical function, and fatigue. We also examined the influence of age, adjuvant hormone therapy use, and exercise adherence on study outcomes.Women in the resistance + impact training program significantly improved maximal leg (p 0 .02) and bench (p 0 .02) press strength compared to the stretching group. Women who attended 50% or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women.Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement.Older BCS can safely engage in resistance exercise that improves lower and upper body strength, thereby reducing a risk factor for falls and future disability. However, the ability of resistance training to shift other indices of fall and disability risk, i.e., balance and function, is unclear. Strategies to promote adherence to resistance training could lead to greater improvements in strength.