Embedding supervised exercise training for men on androgen deprivation therapy into standard prostate cancer care: a feasibility and acceptability study (the STAMINA trial)

Lifestyle interventions involving exercise training offset the adverse effects of androgen deprivation therapy in men with prostate cancer. Yet provision of integrated exercise pathways in cancer care is sparse. This study assessed the feasibility and acceptability of an embedded supervised exercise training intervention into standard prostate cancer care in a single-arm, multicentre prospective cohort study. Feasibility included recruitment, retention, adherence, fidelity and safety. Acceptability of behaviourally informed healthcare and exercise professional training was assessed qualitatively. Despite the imposition of lockdown for the COVID-19 pandemic, referral rates into and adherence to, the intervention was high. Of the 45 men eligible for participation, 79% (n = 36) received the intervention and 47% (n = 21) completed the intervention before a government mandated national lockdown was enforced in the United Kingdom. Patients completed a mean of 27 min of aerobic exercise per session (SD = 3.48), at 77% heart rate maximum (92% of target dose), and 3 sets of 10 reps of 3 resistance exercises twice weekly for 12 weeks, without serious adverse event. The intervention was delivered by 26 healthcare professionals and 16 exercise trainers with moderate to high fidelity, and the intervention was deemed highly acceptable to patients. The impact of societal changes due to the pandemic on the delivery of this face-to-face intervention remain uncertain but positive impacts of embedding exercise provision into prostate cancer care warrant long-term investigation.

Embedding Exercise Training in Prostate Cancer Care: A Feasibility and Acceptability Study

The STAMINA trial is a programme of work that aimed to define, develop, implement, and evaluate a 12-month lifestyle intervention for people receiving hormone treatment for prostate cancer, to be embedded within the NHS prostate cancer care pathways and implemented across the UK. The intervention was designed to address the side effects of hormone treatment that men with prostate cancer can experience.

This paper reported the results of an initial study, as part of that programme of work, that investigated how easy it would be to embed an exercise intervention into the current NHS prostate cancer care pathways, and to assess if this was acceptable to patients, healthcare professionals and exercise trainers. The intervention in this study involved patients taking part in 12 weeks of supervised aerobic exercise and resistance training twice weekly. The intervention was facilitated by 26 healthcare professionals (HCPs) and delivered by 16 exercise trainers (ETs). The findings showed that the HCPs and ETs were able to deliver the intervention in real-life contexts, and it was highly acceptable to patients. Despite the COVID-19 pandemic, HCPs referred patients to the intervention and a high number of patients completed it. There were no serious adverse events.

This study is important because it looks at how easy it is to add supervised exercise training into NHS care that is currently available to men with prostate cancer who are on hormone treatment. It also looks at if those patients think this type of intervention is a good addition to their care. It addresses the gap between what guidelines recommend as optimal care and what patients receive. The study demonstrates that National Institute of Health and Care Excellence recommendations can be delivered by embedding exercise into the prostate cancer care pathway, in collaboration with community partners. This research highlights the positive impacts of embedding exercise provision into prostate cancer care, which warrants long-term investigation.

Key Takeaways:

1. This is the first study to report on the feasibility and acceptability of a supervised exercise program embedded into standard NHS prostate cancer care.

2. The intervention design has provided preliminary data to suggest good uptake and retention to a supervised exercise program embedded into prostate cancer care.

3. The exercise programme was considered acceptable in a community-gym environment by patients, with twice weekly supervision deemed the optimal frequency of exercise training.

4. Adherence to the exercise prescription was high, with most men achieving the prescribed exercise dose (intensity and volume) and attending most scheduled sessions.

5. The intervention was deemed highly acceptable by HCPs, ETs and patients.

6. The study highlights the positive impacts of embedding exercise provision into prostate cancer care, which warrants long-term investigation.

7. Further studies in the programme of work will look at extending the intervention to 12-months.