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DHN 510: Advanced Nutrition Literature Review Author: Chloe Sapienza Affiliation: Dietetics Student, University of Kentucky, Lexington, Kentucky Date: April 18, 2016 Title: The Correlation Between Exercise and Risk for Prostate Cancer Across the globe prostate cancer is the second most frequently diagnosed cancer. The CDC estimates that as of 2012 177,489 men in the United States were diagnosed with prostate cancer. 27,244 men in the United States died from prostate cancer. With regards to the United States, alongside non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States with it being one of the leading causes of cancer death among men of all races. Each day more than 500 men are diagnosed with prostate cancer. Prostate cancer can be addressed using treatment methods such as prostatectomy, radiation therapy, hormone therapy, chemotherapy, cryotherapy, and other emerging therapies. Androgen deprivation therapy is a hormone therapy method used commonly and specifically throughout all five reviews during the course of this paper. This therapy focuses on the reduction of androgens, which are key factors in the growth of prostate cancer cells. With this therapy come many side effects such as decreased bone mass, total lean mass, muscle strength, increased risk for skeletal fractures and fat mass, and more not mentioned. [1] It is also likely to develop metabolic conditions such as diabetes, cardiovascular disease, abdominal obesity, and osteoporosis. [2] Because of the effects mentioned above exercise has become a focal point for prostate cancer research. It is also important to note other effects that come with the cancer itself such as decreased quality of life, depression, decreased cognitive function, and cardiovascular fitness. It is also with these effects that exercise is important. The objectives in the present review are to provide an integrated overview of current knowledge regarding the link between exercise and prostate cancer. In addition it is proposed that this subject has potentially promising avenues for future research. The literature research articles were found using PubMed. Articles were narrowed down using key words such as exercise and prostate cancer, correlation between exercise and prostate cancer, and effects of exercise on prostate cancer. Studies were conducted on humans, specifically males. Additional information was found using the CDC and Prostate Cancer Foundation. The specific articles were chosen based on date published, within the last 6 years, and relativity to purpose of the review. The studies conducted over the five reviews focused on resistance exercise training as well as aerobic exercise training. It is also important to note that nutrition intervention was used in the studies but will not be addressed in this review. A study by Buffart examined the effects of a 12-month resistance and endurance exercise program on cancer-specific, health related quality of life with regards to older long-term survivors of prostate cancer. The study conducted is referred to as RADAR (randomized androgen deprivation and radiology therapy study). The participants were separated in two randomized groups one being (EX) which consisted of six months supervised resistance and aerobic exercise followed by six months of home-based exercise and the other being (PA) which focused on printed material. Through this study it was found that supervised aerobic and resistance exercise improved quality of life and maintained physical and social function. It was found that patients, who were married, started exercising sooner after diagnosis and previously used bisphoshonates had larger intervention effects on health related quality of life. The beneficial effects of health related quality of life could be partially explained by the exercise-induced improvements in lower body functional performance. [1] A similar study conducted by Teleni used seven randomized controlled trial groups to evaluate the effect of exercise on quality of life, androgen deprivation symptoms, and or metabolic risk factors. Four of the studies were intervention groups that combined resistance training with aerobic exercise training, two studies using only resistance exercise training, one study using only aerobic training and one study using football training sessions. It was found that exercise intervention over 12-24 weeks with two to three days per week of resistance and aerobic training had significant improvements with health and disease related quality of life. With that being said this specific study found no significant improvements with lipid profiles, blood glucose levels, blood pressure, body weight or body composition. It is important to note that with this study it is possible that no improvements were shown in those specific areas due to few studies in the current analysis as well as intervention periods being too short to capture the effects. [2] While the previous two studies focused on the effects of exercise a study conducted by Craike focused on adherence to programs and factors that influence. This study was done as a secondary analysis to the ENGAGE study, which aimed to determine efficacy of clinician referral and exercise program to improve exercise levels and quality of life for men with prostate cancer. Through this study a positive correlation was found between vigorous-intensity exercises, meeting exercise guidelines, improved cognitive function and reduced symptoms of depression. Because these interventions were found to have positive effects Craike and team sought to examine demographic, clinical, behavioral, and psychosocial predictors of adherence. It was found that men with hormonal symptoms that follow androgen deprivation therapy might require additional physical and emotional support and assistance with participation in exercise programs. With this study behavior change techniques, clinician referral, setting program goals, prompting practice, and self monitoring were incorporated which may also explain high levels of adherence to exercise programs. [3] Similar to the study by Craike and team a study by Livingston focused on the importance of cancer clinician endorsement of physical activity recommendations. Demark- Wahnefried W found only 20% of clinicians promote lifestyle changes to their patients. Using intervention evaluation, Livingston and team found that 80% of it’s participants reported that clinician’s referral influenced their decision to participate in the exercise program, 75% reported that they would recommend the exercise program to others living with prostate cancer, 91.5% stated that the exercise program was rewarding, 88% reported that the program was extremely or quite beneficial to their health and well-being, and 45% expressed an intention to continue the program by joining a gym. “Engagement with medical and allied health professionals in the establishment of a clinician referral pathway for exercise-based programs could reduce the barriers to exercise among prostate cancer survivors.” [4] A study conducted by Havid took an approach at a larger time period of two years focusing specifically on PSA (prostate specific antigen) doubling time. Studies have shown that exercise training in prostate cancer patients specifically on androgen deprivation therapy leads to increased fitness levels, reductions in body weight by decreased fat mass, and also maintenance of muscle mass and functional capacity. In this study it was aimed to find possible effects of PSA doubling time and metabolic parameters of home-based endurance training in out-clinic patients who have biochemical recurrence following radical prostatectomy or managed on active surveillance. It was found that PSA doubling time was strongly correlated with changes in VO2max but not body composition. The data from this study supports the epidemiological finding that physical activity may delay cancer progression. This has also provided insight that suggests intrinsic systemic change induced during physical exertion, which give raise to improvements in VO2max are also involved in the molecular suppression of tumor progression. All of these factors come together to give support to the idea that increased level of physical activity leading to improved fitness level may be a factor contributing to delay prostate cancer progression. [5] It was shown in two of the five studies that clinicians role, as health promotion advocates are crucial in execution and adherence of exercise in patients. While working to become registered dietitians, physicians, and other specializations in the health field, it is important to hone in on this finding and implementing health promotion in future endeavors. With prostate cancer being such a prominent cancer among men more studies are being conducted to give relief and possible preventions of the cancer. It is important to start studying the variety of exercise techniques now to narrow down specifics with the most effect. It is with hope that with these studies and more being conducted in the future exercise will become a standard requirement in cancer treatment and prevention and health care providers can show the overall benefits to patients and families. 1. 1. Li AW and Laurien M Buffart. The Effect, Moderators, and Mediators of Resistance and Aerobic Exercise on Health-Related Quality of Life in Older Long-Term Survivors of Prostate Cancer. Cancer. 2015; 16: 2821-2830. 2. Li AW Laisa Teleni. Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systemic review of randomized controlled trials. Bioscientifica Ltd. 2015; 23: 101-112. 3. Li AW Melinda Craike. Predictors of adherence to a 12-week exercise program among men treated for prostate cancer: ENGAGE study. Cancer Medicine. 2016; Online early access: 1-8. 4. Li AW Patricia M. Livingston. Effects of a Clinician Referral and Exercise Program for Men Who Have Completed Active Treatment for Prostate Cancer: A Multicenter Cluster Randomized Controlled Trial (ENGAGE). Cancer. 2015; 15: 2646-2654. 5. Li AW Thine Hvid. Effect of a 2-year home-based endurance training intervention on physiological function and PSA doubling time in prostate cancer patients. Cancer Causes & Control. 2016; 27: 165-174. 6. Center for Disease Control and Prevention. Prostate Cancer Statistics. Updated March 23, 2016. http://www.cdc.gov/cancer/prostate/statistics/index.htm Accessed March 10, 2016. 7. Prostate Cancer Foundation. Faces of Prostate Cancer. Updated March 16, 2016. http://www.pcf.org/site/c.leJRIROrEpH/b.5699537/k.BEF4/Home.htm Accessed March 10, 2016.