A recent study underscores the potential of prescribed exercise, specifically targeting improvements in cardiorespiratory fitness (CRF), as a viable strategy to mitigate prostate cancer incidence among men. This article synthesizes findings from key research, highlighting the clinical significance of exercise-induced CRF enhancements in prostate cancer prevention and offering actionable insights for healthcare practitioners.

These findings align with earlier research, including a 2023 study published in JAMA Network Open, which analyzed data from 177,709 men and observed that higher levels of CRF were associated with reduced risks of colon and lung cancer incidence and lower prostate cancer mortality. Furthermore, a 2015 Cooper Center Longitudinal Study study linked higher fitness levels in middle-aged men with decreased risks of cancer and cardiovascular disease mortality. However, it found no direct correlation with prostate cancer incidence.

Understanding Cardiorespiratory Fitness and Prostate Cancer Risk

Cardiorespiratory fitness (CRF) is a reliable marker of physical health. It reflects the body’s capability to supply oxygen to muscles during sustained physical activity. CRF is primarily assessed through VO2max measurements, which indicate the maximum amount of oxygen utilized per minute during intense exercise. 

Weight Resistance Training Also Improves Cardiovascular Fitness

In my practice, I encourage patients to consider weight resistance training two to three times a week. One reason for the suggestion is that sarcopenia is an issue in aging men, and certainly in men on Androgen Deprivation Therapy (ADT). The other is that resistance training improves CRF, but the opposite is not true — one cannot improve muscle volume or strength through aerobic exercise alone.

One systematic review and meta-analysis conducted by Smart et al. (2022), published in Age Ageing, provides compelling evidence of resistance training’s efficacy in improving CRF, a critical determinant of health outcomes. This article distills this research’s key findings and clinical implications, offering healthcare practitioners actionable insights for integrating resistance exercise training (RET) into patient care protocols.

Key Findings include:

• VO2 Peak Improvement
• Anaerobic Threshold (AT) Enhancement: AT improvements were noted indicating better endurance and the capacity to perform physical tasks at higher intensities without fatigue.
• 6-Minute Walk Test (6MWT) Performance: An increase in 6MWT distances (MD 30.89 meters) reflected improved functional exercise capacity.

Clinical Implications and Recommendations

As healthcare practitioners who appreciate exercise’s medicinal properties, we can be more prescriptive with our exercise instruction instead of simply saying, “Go and exercise.”

FITT Principles: Tailoring exercise prescriptions according to the Frequency, Intensity, Time, and Type principles ensures individualized care that addresses patients’ needs, capabilities, and health objectives.

Progressive Overload: Implementing progressive resistance, guided by metrics like the Borg Rating of Perceived Exertion scale, facilitates continuous improvement and adaptation in CRF and muscle function.

Short-Term Programs: Given the evidence pointing to the efficacy of less than 24-week RET programs, practitioners might prioritize initiating and re-evaluating exercise prescriptions within this timeframe to maximize benefits.

Holistic Health Promotion: Beyond CRF enhancement, RET supports muscular strength, counters sarcopenia, and contributes to overall health resilience, making it a valuable component of comprehensive care strategies for aging populations.

Addressing Barriers to Exercise

Recognizing ‘lack of time’ as a prevalent barrier, healthcare providers should advocate for RET as a time-efficient, effective method for improving health outcomes. I often discourage my patients from waiting for motivation to exercise as prescribed – motivation may never happen. Instead, I may suggest just going and doing it, and if in 10 minutes they are not up to it, they can return home. Lastly, patients after a prostate cancer diagnosis are significantly more compliant to exercise than before such a diagnosis.

Final Thoughts

While genetic factors significantly contribute to prostate cancer risk, lifestyle modifications such as increasing physical activity and improving CRF present a modifiable risk factor. The positive association between enhanced CRF and reduced prostate cancer incidence underscores the importance of physical activity in cancer prevention strategies. By integrating exercise prescriptions, especially resistance training, into patient care, healthcare practitioners can play a pivotal role in promoting health and potentially reducing the burden of prostate cancer, empowering them and likely prolonging their longevity and quality of life.

References:

Smart, T.F.F., Doleman, B., Hatt, J., Paul, M., Toft, S., Lund, J.N., & Phillips, B.E. (2022). The role of resistance exercise training for improving cardiorespiratory fitness in healthy older adults: a systematic review and meta-analysis. Age Ageing, 51(6), afac143. https://doi.org/10.1093/ageing/afac143

Bolam KA, et al. Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57,652 Swedish men. Br J Sports Med. 2024.

Ekblom-Bak E, et al. Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men. JAMA Netw Open. 2023.

Oliveria SA, et al. The association between cardiorespiratory fitness and prostate cancer. Med Sci Sports Exerc. 1996.

Smart TFF, et al. The role of resistance exercise training for improving cardiorespiratory fitness in healthy older adults: a systematic review and meta-analysis. Age Ageing. 2022.