Androgen deprivation therapy (ADT) is a commonly prescribed “hormone” treatment for advanced or metastatic prostate cancer that has been shown to improve overall survival. However, treatment-induced hypogonadism is associated with a range of adverse effects, including an accelerated decline in muscle mass and strength, bone density, and an increased fracture risk. While exercise training is recommended to ameliorate some of these effects, the benefits on skeletal health are inconsistent and no known studies have examined the combined effects of exercise training with a nutritional supplement on skeletal health outcomes. Therefore we conducted a 12-month randomised controlled trial investigating whether resistance training and weight-bearing exercise combined with a nutritional supplement could optimize musculoskeletal health in ADT-treated men.
We randomised 70 ADT-treated men (mean age: 71.3 ± 6.2 years) to exercise+supplementation (ExSuppl, n=34) or usual care (CON, n=36). The daily nutritional supplement included 25g whey protein, 1200mg calcium carbonate and 1000IU vitamin D. Key outcomes included: DXA areal hip and spine bone mineral density (aBMD) and total body lean mass and fat mass; pQCT cortical and/or trabecular volumetric BMD, bone structure and strength at the distal (4%) and proximal (66%) tibia and radius; and muscle strength (leg press, chest press and seated row).
ExSuppl resulted in an 11% greater increase in leg press muscle strength compared to CON (p<0.05), but had no effect on lean or fat mass, DXA aBMD or any pQCT bone outcomes. At 12-months, both groups experienced similar and significant losses of total hip and femoral neck aBMD (1.1-2.0%), distal radius trabecular vBMD (2.7-2.9%) and proximal tibia and radius cortical bone area (1.4-2.3%) and strength (2.1-3.5%). In conclusion ADT-treated men who completed a 12-month multicomponent exercise program with daily consumption of a protein, calcium and vitamin D enriched drink improved muscle strength, but not bone and muscle loss.