Importance
Sexual dysfunction is a common adverse effect of prostate cancer treatment, and current management strategies do not adequately address physical and psychological causes. Exercise is a potential therapy in the management of sexual dysfunction.
Objective
To investigate the effects of supervised, clinic-based, resistance and aerobic exercise with and without a brief psychosexual education and self-management intervention (PESM) on sexual function in men with prostate cancer compared with usual care.
Design, seing, and prticipants
A 3-arm, parallel-group, single-center randomized clinical trial was undertaken at university-affiliated exercise clinics between July 24, 2014, and August 22, 2019. Eligible participants were men with prostate cancer who had previously undergone or were currently undergoing treatment and were concerned about sexual dysfunction. Data analysis was undertaken October 8 to December 23, 2024.
Interventions
Participants were randomized to (1) 6 months of supervised, group-based resistance and aerobic exercise (n = 39 [34.8%]), (2) the same exercise program plus PESM (n = 36 [32.1%]), or (3) usual care (n = 37 [33.0%]). Exercise was to be undertaken 3 days per week.
Main outcomes and measures
The primary outcome was sexual function assessed with the International Index of Erectile Function (IIEF). Secondary outcomes included body composition, physical function, and muscle strength. Analyses were undertaken using an intention-to-treat approach.
Results
In total, 112 participants (mean [SD] age, 66.3 [7.1] years) were randomized. Mean adjusted difference in IIEF score at 6 months favored exercise compared with usual care (3.5; 95% CI, 0.3-6.6; P = .04). The mean adjusted difference for intercourse satisfaction was not significant (1.7; 95% CI, 0.1-3.2; P = .05). PESM did not result in additional improvements. Compared with usual care, exercise also significantly improved fat mass (mean adjusted difference, −0.9 kg; 95% CI, −1.8 to −0.1 kg; P = .02), chair rise performance (mean adjusted difference, −1.8 seconds; 95% CI, −3.2 to −0.5 seconds; P = .002), and upper (mean adjusted difference, 9.4 kg; 95% CI, 6.9-11.9 kg; P < .001) and lower (mean adjusted difference, 17.9 kg; 95% CI, 7.6-28.2 kg; P < .001) body muscle strength.
Conclusions and relevance
In this randomized clinical trial of supervised exercise, erectile function in patients with prostate cancer was improved. PESM resulted in no additional improvements. Patients with prostate cancer should be offered exercise following treatment as a potential rehabilitation measure.
Trial registration
ANZCTR Identifier: ACTRN12613001179729
In this study, 112 men with previous and/or current prostate cancer treatment were randomised to one of three groups: supervised exercise only; supervised exercise and psychosexual education and self-management (PESM) intervention; or standard care (standard medical care, with participants asked to maintain their current physical activity level for 6 months).
Notably, more than half of the patients had undergone previous surgery and one in three had received prior radiotherapy (RT). More than one third were undergoing androgen deprivation therapy (ADT) as their current treatment.
Overall, adjusted difference in IIEF (International Index of Erectile Function) scores at 6 months was in favour of exercise (5.1 points) compared with usual care (1.0 points; adjusted mean difference, 3.5; 95% CI, 0.3-6.6; P = .04). Change in intercourse satisfaction scores were not significant and PESM did not result in additional improvements in erectile function or intercourse satisfaction.
Interestingly, the effects of exercise for erectile function were larger for the subgroups who received radiotherapy and ADT compared to surgery (non-nerve sparing procedure was an exclusion criteria), although statistical significance was not reached. Those with the lowest tertile values at IIEF prior to the initiation of exercise benefited the most for sexual desire, intercourse satisfaction, and overall satisfaction. Additional benefits of supervised exercise were noted in body composition, physical function and strength. Authors concluded exercise should be considered as an integral part of treatment to improve sexual function in men with prostate cancer.
It’s crucial to consider certain study limitations and practical challenges that may be difficult to implement in real-world scenarios. Almost three out of four patients were excluded during the screening phase; approximately half declined to participate, possibly due to low motivation and another half due to failing the study’s inclusion criteria. Hence, not all but only a minority (approximately one third according to the study) of prostate cancer patients may benefit from this intervention and the current work is representative of a selected subgroup.
Also, training was performed under supervision which is a good point in favour of the trial’s scientific rigor but is less attractive when applied in modern healthcare systems currently facing significant strain due to patient ageing and other important issues.
Finally, the study was conducted at a single centre and did not reach the target sample size (less than half of the required numbers were reached).
To overcome these limitations, we will need to wait for additional studies with a larger number of patients potentially more representative of the majority of men suffering from PCa. Nevertheless, if no medical contraindications exist, physical exercise should be considered routinely in patients counselling due to possible benefits on sexual activity and surely, many other benefits physical exercise yields.