An exploratory study to determine if exercise can impact the gut microbiota composition of men receiving androgen deprivation therapy for prostate cancer.

Men with prostate cancer receiving androgen deprivation therapy will attend three clinic-based supervised exercise sessions each week, for 12 weeks (3 months), consisting of moderate-to-high intensity resistance and aerobic exercise (interval and continuous). Each session will take approximately 60 minutes, including warm-up and cool-down, and will be supervised by accredited exercise physiologists (AEP; Exercise and Sport Science Australia, Brisbane, Australia), face-to-face (in groups of up to 8 people per session). The exercise program is designed to provide optimal stimulus to the cardiorespiratory and neuromuscular systems while maximising safety, compliance and retention, thus will be tailored, progressive, periodised and autoregulated in collaboration with the patient (i.e. adjusted based on the patient’s presentation at each session). Resistance exercise will be prescribed using repetition maximums (RM), where patients will be required to perform 6-8 different resistance exercises using major muscle groups, at 6-12 RM (the maximal weight that can be lifted 6 to 12 times each set, equivalent to ~60-85% of 1RM) for 3-4 sets per exercise to achieve moderate-to-high intensity and volume. Aerobic exercise will include 20 to 30 minutes of moderate-to-vigorous intensity activity (equating to ~60-85% of estimated maximum heart rate; or a rating of perceived exertion (RPE) between 6-9 using the BORG-10 scale) involving a variety of modes including walking, jogging, cycling or rowing, using treadmills and/or stationary ergometers respectively. Aerobic intensity will be monitored using heart rate monitors (Polar M400, H10 Sensor, Polar Electro, NSW, Australia) and an RPE chart for assessment. Patients will also be encouraged to perform additional aerobic exercise outside of their supervised exercise clinic visits, such as brisk walking, with the goal of achieving at least 150 minutes of moderate-to-vigorous intensity aerobic exercise each week (i.e. a further ~60-90 minutes self-managed). Flexibility exercises for all joints considered important for function and for all muscles engaged during the session will be provided during the cool-down phase of each exercise session. The exercise program will be periodised, progressive and autoregulated, to allow for transient changes in patient presentation to exercise sessions in accordance with their cancer therapy or treatment cycles. All exercise sessions will be fully supervised by an accredited exercise physiologist (AEP; Exercise and Sport Science Australia). All exercise sessions will take place at one of four exercise clinic locations: 1) Edith Cowan University (Joondalup), Vario Health Clinic; 2) Edith Cowan University (Mt Lawley), Gymnasium; 3) University of Western Australia; or 4) Fiona Stanley Hospital (Murdoch). Exercise program adherence and compliance will be assessed through the use of attendance rates to supervised clinic sessions; and percent of exercise session completed; specifically using exercise record sheets with prescribed programming variables; with actual versus completed components recorded.