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Prostate cancer can negatively impact quality of life of the patient and his spouse caregiver, but interventions rarely target the health of both partners simultaneously. We tested the feasibility and preliminary efficacy of a partnered strength training program on the physical and mental health of prostate cancer survivors (PCS) and spouse caregivers. Sixty-four couples were randomly assigned to 6 months of partnered strength training (Exercising Together, N = 32) or usual care (UC, N = 32). Objective measures included body composition (lean, fat and trunk fat mass (kg), and % body fat) by DXA, upper and lower body muscle strength by 1-repetition maximum, and physical function by the physical performance battery (PPB). Self-reported measures included the physical and mental health summary scales and physical function and fatigue subscales of the SF-36 and physical activity with the CHAMPS questionnaire. Couple retention rates were 100 % for Exercising Together and 84 % for UC. Median attendance of couples to Exercising Together sessions was 75 %. Men in Exercising Together became stronger in the upper body (p

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.

We have previously reported that 1 year of supervised resistance + impact training stopped bone loss and built muscle strength in older breast cancer survivors. The purpose of this study was to determine whether these benefits persisted 1 year after completion of the intervention. Sixty-seven women from the original trial completed baseline and post-intervention body composition and muscle strength tests, and 44 women were available 1 year later for follow-up assessments. Bone mineral density (grams per square centimeter) of the hip and spine, muscle mass (kilograms), and fat mass (kilograms) were measured by dual-energy X-ray absorptiometry and maximal upper and lower body strength were measured by one-repetition maximum tests (kilograms). We compared between group changes across baseline (pre-intervention), 1 (post-intervention), and 2 years (1 year follow up) on study outcomes using repeated-measures analysis of covariance, adjusting for age. Significant group by time interactions were found for spine bone mineral density (BMD) (p

The purpose of this study was to determine the degree to which a novel training program based on activities of daily living (ADL) would affect performance of ADLs, as well as the fitness of older adults. Fourteen individuals (mean age 82 years) took part in a 10-week control period followed by a 10-week ADL-based training program. Pre- and posttests included the Physical Performance Test (PPT), the Physical Functional Performance–10 (PFP-10), and the Senior Fitness Test (SFT). After the training period, improvements ranging from 7% to 33% (p < .05) were seen on the PPT and PFP-10 and on three items of the SFT. After conversion to standard scores, the magnitude of change in the PPT and the PFP-10 was significantly greater (p < .05) than the magnitude of change in the SFT. These data support the idea that this novel ADL-based training program was able to facilitate improved performance of ADLs, as well as select measures of fitness among older adults.

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.

134 Background: Androgen deprivation therapy (ADT) treatment for prostate cancer is associated with muscle loss, weakness and weight gain that could lead to falls and frailty, but the prevalence of these conditions in prostate cancer survivors (PCS) is poorly understood. The aim of this study is to describe the prevalence of falls and frailty in PCS on ADT and their associations with modifying factors, such as age and timing of ADT. Methods: Health history, cancer treatment and falls were self-reported by 146 PCS on ADT (mean age: 74+8 years). ADT usage and current versus past usage was confirmed against electronic medical records. Frailty was determined by self-report to 5 questions asking about presence or absence of fatigue, weakness, mobility difficulty, comorbidities, and weight loss, which could represent sarcopenia. Presence of each condition was summed to categorize men into one of three frailty phenotypes: frail (3-5), pre-frail (1-2) or not frail (0) groups. Since fat gain, rather than weight loss, is common with ADT and can impact function we also recalculated frailty as an “obese frailty” phenotype substituting obesity (BMI > 30 kg/m2) for weight loss. Comparisons were performed using chi-square. Results: 38% of PCS on ADT experienced a fall in the past year and among fallers, 61% experienced a fall that resulted in an injury. Using the frailty phenotype, 29% of PCS were pre-frail and 10% were frail; however, using the obese frailty phenotype, 47% of PCS were pre-frail and 15% were frail. The absence of frailty was significantly less in older men than younger men using the frail (p = 0.013), but not obese frail phenotype (p = 0.54). Fall and frailty rates did not significantly differ between PCS who were current versus past users of ADT (p = 0.65 and 0.26 for falls and frailty, respectively). Conclusions: Regardless of the frailty phenotype used, the rate of falls and prevalence of frailty among PCS on ADT was greater than fall rate (25%) and the frailty prevalence (4%) reported in large community-based samples of similarly aged men. These data also suggest that falls and frailty may continue after men stop ADT use. Research to identify risk factors for falls and frailty in PCS on ADT is warranted so that effective interventions can be developed and tested.