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Diet, exercise intervention improves outcomes for men undergoing androgen deprivation therapy
A personalized, group-mediated diet and exercise intervention appeared associated with improved mobility among men with prostate cancer who underwent androgen deprivation therapy, according to study results.
Brian C. Focht, PhD, associate chair of the department of human sciences and professor of kinesiology in the College of Education and Human Ecology at The Ohio State University, and colleagues from the university’s comprehensive cancer center conducted a single-blind, randomized pilot study with 32 patients.
Half of the men underwent a group-mediated, cognitive-behavioral exercise and diet intervention. The other half served as controls.
Change in mobility performance served as the primary outcome. Body composition and muscular strength served as secondary outcomes.
Researchers observed significant improvement in the primary endpoint at 3 months among men assigned the diet and exercise intervention (P < .02). Men assigned the intervention also demonstrated significant improvements in muscular strength (P < .01), body fat percentage (P < .05), and fat mass (P < .03).
HemOnc Today spoke with Focht about the theory behind this approach, the nature of the intervention and the benefits it may confer, and how such programs could be more widely applied.
Question: Can you describe the rationale behind this approach?
Answer: A number of factors played into it. Exercise had been used fairly consistently in some prior studies as a supportive care intervention for men with prostate cancer on ADT but, interestingly enough, very few studies had looked at the combination of exercise and diet — at least when we wrote the grant. There were no studies looking at the potentially synergistic benefits of putting those two things together. When we really started evaluating what the main concerns from both a longevity perspective and a quality-of-life perspective tend to be for these patients, we felt there could be value to addressing both the energy expenditure side from an exercise perspective, as well as the energy intake side with regard to total caloric values and dietary composition. A caveat is that I’m kind of a weight management researcher in disguise, so this is something that is well established in the weight management literature. We were surprised there were very limited data on this related to patients with prostate cancer, so that was the initial impetus for us. It was clear to us that this worked from the behavioral weight management literature, so we thought it could be a really important population in which to explore it.
Q : Can you explain how diet and exercise interact with ADT?
A: Although androgen deprivation is an incredibly powerful treatment for cancer control purposes, there are adverse effects. By reducing testosterone to castrate levels, individuals lose muscle mass and muscle strength. As a consequence, they develop functional limitation in performing the activities of daily living. As they lose muscle mass, many gain fat mass. This cascade of events leads to risk for sarcopenic obesity. We wanted to see if there was feasibility and efficacy for putting exercise and diet together to try to reverse this risk of sarcopenic obesity, and also the functional quality of life consequences that go with it.
Q: What did the diet and exercise intervention entail?
A : Our approach may be the element that is most unique to this particular study. We use what we call a group-mediated cognitive behavioral approach, or GMCB for short. We have used this for various chronic disease populations to promote change in or adoption and maintenance of lifestyle behaviors, such as exercise and weight modification. For the exercise component, we emphasize personalized resistance exercise. We’re trying to attenuate the loss of lean body mass, and resistance exercise is the most potent tool to accomplish that goal. Although we did complement that aerobic activity, the focus was on strength training. The dietary component also was focused on changing intake in a very personalized manner. In many cases, it resulted in trying to reduce the total caloric intake. Many of our patients were overweight or obese. However, we also wanted to improve dietary composition in shifting toward intake of more of a plant-based diet comprised of lower calorie, nutrient-dense food choices while also focusing upon a reduction of higher fat, high calorie, dense food choices. An important element is that, in both the exercise and diet components, we combined it with group-based cognitive behavioral counseling to help individuals not only learn what changes they need to make, but also help them develop self-regulatory skills such as self-monitoring, goal setting and problem solving around barriers to adopt and maintain those changes in a progressively more independent way. We are combining more traditional approaches to changes to exercise and diet with this group counseling to harness social dynamics.
Q: Have you considered expanding the group-based cognitive behavioral approach through social media or other platforms to use it in a wider population ?
A: Absolutely. As we move forward with the GMCB approach, there are a number of pathways we’re exploring to make it more accessible, and to increase the reach and scale of it. There is definitely a role for digital and e-health platforms. Another step we are focusing on in a different trial is to move this approach from a purely clinical or universal setting into the community. Ultimately, we’d like to have community centers be able to deliver this intervention so it really has an enhanced accessibility to it.
Q: Can you elaborate on how the social dynamics of the group setting can encourage patients to stick to their individual goals?
A: We systematically developed those social dynamics to help patients be part of the behavior change process. Although we are trying to help individuals develop some behavioral skills, we also are trying to harness social dynamics to help individuals be motivated to not only engage in the healthy exercise and dietary practices, but also have some source of support for motivation. They could learn how to do things as they progress. The group provides a number of elements that are beneficial, including a sense of community or belonging in this journey to changing lifestyle. Another key element is accountability. For many of these patients, this is an important piece of the puzzle. They really respond to the need to adopt and maintain these lifestyle changes because they are being held to this standard.
Q: How much impact could your outcomes of improved muscle strength, body fat percentage, and muscle mass have on more standard outcomes like OS or PFS?
A: Any time you’re dealing with oncology populations, those outcomes are critical. Ultimately, we hope to include them in larger or more definitive trials we’re planning. At the same time, the real focus of what we’re doing for men with prostate cancer is to address the fact that, for so many of those patients, we’re seeing significant mortality and morbidity related to other chronic conditions, such as cardiovascular disease and metabolic syndrome. These outcomes, of course, are related to issues with sarcopenic obesity and inactivity. Although we are always interested in these hard outcomes, we really have a strong focus on trying to help mitigate the risk of these other comorbid chronic disease risk factors that seem to be so prevalent in this patient population. – by Rob Volansky
Reference:
Focht BC, et al. Ann Behav Med. 2018;doi:10.1093/abm/kax002.
For more information:
Brian C. Focht , PhD, can be reached at A042 Physical Activity and Educational Services Building, 305 W. 17th Ave., Columbus, OH 43210; email: focht.10@osu.edu.
Disclosure: Focht reports no relevant financial disclosures.