The effect of exercise training on cardiometabolic health in men with prostate cancer receiving androgen deprivation therapy: a systematic review and meta-analysis

Background: Growing evidence suggests that men exposed to androgen deprivation therapy (ADT) have an increased risk of cardiovascular disease. While exercise has shown to attenuate some adverse effects of ADT, the effects on cardiometabolic health have not been systematically evaluated. Objective: To evaluate the effect of exercise on cardiometabolic health in men with prostate cancer (PCa) receiving ADT. Methods: A systematic literature search of MEDLINE, EMBASE, CINHAL, SCOPUS, WEB OF SCIENCE and SPORTSDICUS from database inception to April 2020 was performed. A quantitative synthesis using Cohens d effect size and a meta-analysis using random-effects models were conducted. Results: Overall, fourteen randomised controlled trials (RCTs) and four non-randomised studies were included. Eleven RCTs (n = 939 patients) were included in the meta-analysis. Exercise training improved the 400-m-walk test (MD −10.11 s, 95% CI [−14.34, −5.88]; p < 0·00001), diastolic blood pressure (−2.22 mmHg, [−3.82, −0.61]; p = 0.007), fasting blood glucose (−0.38 mmol/L, [−0.65, −0.11]; p = 0.006), C-reactive protein (−1.16 mg/L, [−2.11, −0.20]; p = 0.02), whole-body lean mass (0.70 kg, [0.39, 1.01]; p < 0.0001), appendicular lean mass (0.59 kg, [0.43, 0.76]; p < 0.00001), whole-body fat mass (−0.67 kg, [−1.08, −0.27]; p = 0.001), whole-body fat percentage (−0.79%, [−1.16, −0.42]; p < 0.0001), and trunk fat mass (−0.49 kg, [−0.87, −0.12]; p = 0.01), compared to usual care. No significant effects on systolic blood pressure or blood lipid metabolism were detected. Conclusions: In a small subset of evaluated studies, exercise may favourably improve some but not all markers of cardiometabolic health. Future exercise intervention trials with cardiometabolic outcomes as primary endpoints are needed to confirm these initial findings.