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Objectives. To investigate if androgen deprivation therapy exposure is associated with additional risk factors for cardiovascular disease and metabolic treatment-related toxicities. Methods. One hundred and seven men (42-89 years) with prostate cancer undergoing androgen deprivation therapy completed a maximal graded objective exercise test to determine maximal oxygen uptake, assessments for resting metabolic rate, body composition, blood pressure and arterial stiffness, and blood biomarker analysis. A cross-sectional analysis was undertaken to investigate the potential impact of therapy exposure with participants stratified into two groups according to duration of androgen deprivation therapy (≥3 months). Results. Maximal oxygen uptake (26.1 ± 6.0 mL/kg/min versus 23.2 ± 5.8 mL/kg/min, p = 0.020) and resting metabolic rate (1795 ± 256 kcal/d versus 1647 ± 236 kcal/d, p = 0.005) were significantly higher in those with shorter exposure to androgen deprivation. There were no differences between groups for peripheral and central blood pressure, arterial stiffness, or metabolic profile. Conclusion. Three months or longer exposure to androgen deprivation therapy was associated with reduced cardiorespiratory capacity and resting metabolic rate, but not in a range of blood biomarkers. These findings suggest that prolonged exposure to androgen deprivation therapy is associated with negative alterations in cardiovascular outcomes. Trial registry is: ACTRN12609000200280. © 2015 Bradley A. Wall et al.

Objectives. To investigate if androgen deprivation therapy exposure is associated with additional risk factors for cardiovascular disease and metabolic treatment-related toxicities. Methods. One hundred and seven men (42-89 years) with prostate cancer undergoing androgen deprivation therapy completed a maximal graded objective exercise test to determine maximal oxygen uptake, assessments for resting metabolic rate, body composition, blood pressure and arterial stiffness, and blood biomarker analysis. A cross-sectional analysis was undertaken to investigate the potential impact of therapy exposure with participants stratified into two groups according to duration of androgen deprivation therapy (≥3 months). Results. Maximal oxygen uptake (26.1 ± 6.0 mL/kg/min versus 23.2 ± 5.8 mL/kg/min, ) and resting metabolic rate (1795 ± 256 kcal/d versus 1647 ± 236 kcal/d, ) were significantly higher in those with shorter exposure to androgen deprivation. There were no differences between groups for peripheral and central blood pressure, arterial stiffness, or metabolic profile. Conclusion. Three months or longer exposure to androgen deprivation therapy was associated with reduced cardiorespiratory capacity and resting metabolic rate, but not in a range of blood biomarkers. These findings suggest that prolonged exposure to androgen deprivation therapy is associated with negative alterations in cardiovascular outcomes. Trial registry is: ACTRN12609000200280.

Exercise is being increasingly established as a key adjuvant therapy in clinical oncology. As research has demonstrated the beneficial effect of exercise for cancer management, a growing number of patients with cancer are undertaking structured exercise programs.Purpose: This study aimed to determine the safety and feasibility of formal exercise testing in clinical settings as it is becoming increasingly used as a screening tool and for exercise prescription purposes.Methods: One hundred and twelve patients with prostate cancer undergoing androgen deprivation therapy (ADT) took part in a physician-supervised multistage maximal stress test (Bruce protocol). Sixty patients had been on ADT for (acute), whereas 52 had been on ADT for (chronic).Results: Of these men, 85% were able to meet the criteria for the attainment of VO2max, whereas three positive tests (3.2%) were observed. The three participants who recorded a positive stress test underwent further medical examination and were subsequently cleared of clinically significant cardiovascular disease. Apart from the relatively low VO2max (24.7 ± 6.0 mLIkg-1Imin-1, 10th-15th percentile), compared with normative data in healthy age-matched controls, the cardiovascular response to exercise was similar in this cancer population. Moreover, treatment duration did not seem to influence cardiovascular responses to exercise. This early evidence suggests that risk of adverse events during maximal exercise testing is relatively low in this population and certainly no higher than that in ages-matched, apparently healthy individuals.Conclusions: Maximal exercise testing was demonstrated to be feasible and safe, providing a direct assessment ofVO2max. The relatively low number of positive tests in this study suggests that the risk of adverse events is relatively low in this population and certainly no higher than that in age-matched, apparently healthy individuals.

BackgroundLaboratory studies that support the hydration guidelines of leading governing bodies have shown that dehydration to only −2% of body mass can lead to increase in body temperature and heart rate during exercise, and decrease in performance. These studies, however, have been conducted in relatively windless environments (ie, wind speed Aim To investigate the effect of blinded hydration status on cycling time-trial performance in the heat with ecologically valid facing wind speed conditions. Methods During three experimental trials, 10 cyclists were dehydrated to −3% body mass by performing 2 h of submaximal exercise (walking and cycling) in the heat, before being reinfused with saline to replace 100%, 33% or 0% of fluid losses, leaving them 0%, −2% or −3% hypohydrated, respectively. Participants then completed a 25 km time trial in the heat (33°C, 40% relative humidity; wind speed 32 km/h) during which their starting hydration status was maintained by infusing saline at a rate equal to their sweat rate. The treatment was participant-blinded and the order was randomised. Completion time, power output, heart rate, rectal temperature and perceptual variables were measured. ResultsWhile rectal temperature was higher beyond 17 km of the time trial in the −3% vs 0% conditions (38.9±0.3°C vs 38.6±0.3°C; p Conclusion When well-trained cyclists performed a 25 km cycling time trial under ecologically valid conditions and were blinded to their hydration status, performance, physiological and perceptual variables were not different between trials. These data do not support the residing basis behind many of the current hydration guidelines.

A common treatment for prostate cancer, which is the most common form of cancer after skin cancer in Australian males, is androgen deprivation therapy (ADT). However, ADT is associated with an array of adverse effects including reduced bone and lean mass, loss of muscle strength, negative change in lipid profile, and increased risk of cardiovascular disease (CVD) as well as diabetes, all of which can compromise physical function and quality of life. Physical exercise has been suggested as a key lifestyle intervention for this group of cancer patients as it has enormous potential to limit and even reverse the effects of such treatment toxicities. This thesis is comprised of a review of the literature and three experimental chapters examining the effects of androgen deprivation therapy (ADT) and the role of exercise in ADT treated prostate cancer patients. The review of literature provides a background to cancer, in particular prostate cancer and the commonly reported side effects of treatment. The review identified gaps in the literature that highlighted the need for well controlled and longer term experimental studies to: 1) investigate the impact of androgen deprivation therapy duration on cardiovascular and metabolic outcomes, and 2) investigate the effects of a long term exercise intervention in reversing cardiovascular risk factors and unfavourable alterations in the metabolic profile. Study 1 examined the feasibility and safety of a maximal treadmill exercise test in ADT treated prostate cancer patients as this was a key assessment of physiological response to the exercise intervention. One hundred and twelve prostate cancer patients undergoing ADT took part in a physician supervised multistage maximal stress test (Bruce protocol). Of these men, 85% were able to meet the criteria for the attainment of VO2max whilst three positive tests (3.2%) were observed. The three participants who recorded a positive stress test were sent for further examination and subseque

Background Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention). Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this pat., Yes.

The purpose of this study was to determine the influence of starting strategy on time trial performance in the heat. Eleven endurance trained male cyclists (30±5 years, 79.5±4.6 kg, V˙O2max 58.5±5.0 ml.kg.−1 min−1) performed four 20-km time trials in the heat (32.7±0.7°C and 55% relative humidity). The first time trial was completed at a self-selected pace (SPTT). During the following time trials, subjects performed the initial 2.5-km at power outputs 10% above (10% ATT), 10% below (10% BTT) or equal (ETT) to that of the average power during the initial 2.5-km of the self-selected trial; the remaining 17.5-km was self-paced. Throughout each time trial, power output, rectal temperature, skin temperature, heat storage, pain intensity and thermal sensation were taken. Despite significantly (P

Background: Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress. Methods/Design: Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/ cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention). Discussion: The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this

Background Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention). Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this pat

Background This study examined the effect of a 5-min cold-water immersion (14°C) recovery intervention on repeated cycling performance in the heat. Methods 10 male cyclists performed two bouts of a 25-min constant-paced (254 (22) W) cycling session followed by a 4-km time trial in hot conditions (35°C, 40% relative humidity). The two bouts were separated by either 15 min of seated recovery in the heat (control) or the same condition with 5-min cold-water immersion (5th—10th minute), using a counterbalanced cross-over design (CP1TT1 → CWI or CON → CP2TT2). Rectal temperature was measured immediately before and after both the constant-paced sessions and 4-km timed trials. Cycling economy and Vo2 were measured during the constant-paced sessions, and the average power output and completion times were recorded for each time trial. Results Compared with control, rectal temperature was significantly lower (0.5 (0.4)°C) in cold-water immersion before CP2 until the end of the second 4-km timed trial. However, the increase in rectal temperature (0.5 (0.2)°C) during CP2 was not significantly different between conditions. During the second 4-km timed trial, power output was significantly greater in cold-water immersion (327.9 (55.7) W) compared with control (288.0 (58.8) W), leading to a faster completion time in cold-water immersion (6.1 (0.3) min) compared with control (6.4 (0.5) min). Economy and Vo2 were not influenced by the cold-water immersion recovery intervention. Conclusion 5-min cold-water immersion recovery significantly lowered rectal temperature and maintained endurance performance during subsequent high-intensity exercise. These data indicate that repeated exercise performance in heat may be improved when a short period of cold-water immersion is applied during the recovery period.

"Background: Laboratory studies have shown during prolonged exercise that 2-3% dehydration can lead to greater increases of body temperature and cardiovascular work, altered metabolic function, and impaired exercise performance, compared to when no fluid deficit occurs. However, previous studies were conducted in relatively windless environments (i.e. wind speeds

Galvao, D. A., Taaffe, D. R., Cormie, P., Spry, N., Joseph, D. J., Chambers, S. K., ... Newton, R. U. (2014). A multicenter yearlong randomized controlled trial of different exercise modalities in prostate cancer survivors on androgen deprivation therapy [Abstract]. Journal of Clinical Oncology, 32(15s), 5037-5037. Available here Please note: This item is Available as an abstract only.

Ball, B.A., Galvão, D.A., Fatehee, N., Taaffe, D.R., Spry, N., Joseph, D., ... Newton, R.U. (2017). Exercise improves VO2max and body composition in androgen deprivation therapy-treated prostate cancer patients. Medicine and Science in Sports and Exercise, 49(8), 1503-1510. Available here.

Wall, Bradley A. (2015). "Reduced Cardiovascular Capacity and Resting Metabolic Rate in Men with Prostate Cancer Undergoing Androgen Deprivation: A Comprehensive Cross-Sectional Investigation". Advances in urology (1687-6369), 65 (5), p. 1. Available here

Wall B.A., Galvao D.A., Fatehee N., Taaffe D.R., Spry N., Joseph D., & Newton R.U. (2014). Maximal exercise testing of men with prostate cancer being treated with androgen deprivation therapy. Medicine and Science in Sports and Exercise, 46(12), 2210-2215. Available here