High-Intensity Aerobic or Resistance Exercise in Improving Physical Function and Quality of Life in Patients with Metastatic Prostate Cancer Undergoing Hormone Therapy

Inclusion Criteria

• Histologically documented adenocarcinoma of the prostate with systemic bone or node metastatic disease despite castrate levels of testosterone (< 50 ng/dL) due to orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist; castrate levels of testosterone must be maintained while on study; men can be enrolled prior to starting abiraterone and/or enzalutamide OR already be receiving treatment with abiraterone and/or enzalutamide
• Be on androgen deprivation therapy (ADT) with a gonadotropin-releasing hormone (GnRH) agonist/antagonist or prior bilateral orchiectomy; all patients will be required to be on ADT during the study period
• >= 4 weeks since last major surgery and fully recovered
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Be able to complete a steep ramp test
• Physician consent to participate in vigorous aerobic or resistance exercise training
• Platelet count >= 100,000/uL
• Hepatic and renal dysfunction that would preclude participation in an exercise program, in the opinion of the treating physician
• Serum testosterone =< 50 ng/dL

Exclusion Criteria

• Men with small cell neuroendocrine tumors or features of small cell disease
• Any prior chemotherapy for castrate-resistant prostate cancer * Metastatic CRPC pre-chemo (metastatic castrate-resistant adeno prostate cancer, pre-CRPC chemotherapy), which is given for hormone-sensitive prostate cancer, is allowed; metastatic CRPC post-chemo (metastatic castrate-resistant adeno prostate cancer, post-CRPC chemotherapy) is allowed with the treating physician’s (oncologist) discretion/approval
• History of hypertension that is not well-controlled (>= 160/90) on anti-hypertensive therapy
• Any contraindications to vigorous exercise, including, but not limited to: brain metastases; current congestive heart failure (New York Heart Association class II, III or IV); serious or non-healing wound, ulcer, or bone fracture; spinal cord compromise or instrumentation due to metastatic disease; peripheral neuropathy >= grade 3; no serious cardiovascular events within 12 months including, but not limited to, transient ischemic attack (TIA), cerebrovascular accident (CVA), or myocardial infarction (MI)
• Experiences shortness of breath, chest discomfort, or palpitations when performing activities of daily living (patient with these symptoms can participate in the study with cardiologist clearance)
• Has difficulty climbing a flight of stairs due to physical impairment
• Has been told by a doctor to have a heart condition and recommended only medically supervised activity
• Has chest pain brought on by physical activity (patient can participate in the study with cardiologist clearance)
• Has developed chest pain in the past month (patient can participate in the study with cardiologist clearance)
• Any serious or non-healing wound, ulcer, or bone fracture
• Any spinal cord compromise or instrumentation due to metastatic disease; radiation therapy for metastatic disease is allowed
• Any peripheral neuropathy >= grade 3
• Moderate-to-severe bone pain (i.e., National Cancer Institute’s Common Terminology Criteria for Adverse Events grade 2-3 bone pain)
• Men participating in vigorous exercise for 75 minutes or more per week, and/or structured resistance exercise on three or more days per week are not eligible
• Men who do not complete the baseline lifestyle and quality-of-life questionnaires and food frequency questionnaire (FFQ) will not be eligible