Comparing Pre-prostatectomy and Post-prostatectomy Exercise Intervention for Prostate Cancer Patients.

A randomized controlled trial study design will be used to evaluate and compare the effectiveness of a 6- week comprehensive individually supervised pre-surgical exercise program, with assessments conducted at Edith Cowan University Exercise Medicine Institute (EMRI). The exercise group (PresurgEx) will exercise prior to surgery and receive usual care after surgery. The delay-exercise usual care control group (Delay) will only be provided with the current usual care prior to surgery and offered 6 weeks of exercise post-surgery. Testing will be conducted at baseline, pre-surgery, 6 weeks post-surgery (6PS), and 12 weeks post-surgery (12PS). In addition, a 24-hr pad test will be undertaken after discharge from hospital. The Delay group will start exercise after 6PS. The intervention involves resistance (chest press, leg press, seated row, leg curls, leg extension, bicep curls, and calf raises) and aerobic training (Treadmill) undertaken thrice weekly in an exercise setting. Patients will be invited to participate by their attending specialists, who are part of this project. This replicates an existing collaboration between EMRI and the urologist at the participating hospitals. Information about the program will be provided and those that express interest will be contacted by the research team. A sample size calculation (2-tailed, alpha = 0.05 and power = 95%) based on expected effect size differences in muscle strength reported in previous studies and using G*Power indicated that each group requires a sample of 16 participants. It is estimated that we will be able to recruit approximately 20 participants per group (factoring in a 30% attrition rate) over a one year period. The eligibility criteria to participate includes: localised PCa; at least seven weeks between diagnosis of cancer and surgery date; absence of any acute illness or any musculoskeletal, cardiovascular or neurological disorder that could inhibit the ability to walk 400m unassisted and undertake upper- and lower-body exercise; medically cleared by their physician; and written consent. Exercise intervention Each supervised exercise session will be ~90 minutes in duration. Sessions will commence with a 5-minute warm-up consisting of a moderate level of aerobic exercise (~60% heart rate maximum (HRmax)), as well as stretching exercises of the major muscle groups. This will be followed by a previously used resistance-training regime targeting upper- and lower-limb exercises. Progression of resistance exercise will follow guidelines previously outlined. Specifically, training phases were: week 1 – 2 (two sets 12 repetition maximum (RM)), week 3 (three sets of 10 RM), week 4 – 5 (three sets of 8 RM), and week 6 (four sets of 6 RM). This will be followed by 15 minutes of exercises focusing on the trunk stabilising muscles which includes three sets of three different exercises [planks (anterior abdominals), reverse bridge on Swiss ball (back extensors) and side planks (oblique abdominals)] with a rest of 30 to 60 seconds between sets. Finally the session will conclude with 20 minutes of aerobic exercise at 60 – 80% (intensity) of the estimated HRmax (220 – age in years) followed by a 5-minute cool-down. All sessions will be conducted by an accredited exercise physiologist (RA) to ensure safety and adherence (number of sessions attended, number of sessions missed will be compiled).