Effects of Nonlinear Aerobic Training on Erectile Dysfunction and Cardiovascular Function Following Radical Prostatectomy for Clinically Localized Prostate Cancer

doi:10.1016/j.eururo.2013.11.009

European Urology

Volume 65, Issue 5, May 2014, Pages 852-855

https://doi.org/10.1016/j.eururo.2013.11.009 Get rights and content

Abstract

Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n = 25 per group) after RP. AT consisted of five walking sessions per week at 55–100% of peak oxygen uptake (VO_2peak) for 30–60 min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow–mediated dilation (FMD), VO_2peak, cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ≤21) decreased by 20% in the AT group and by 24% in the UC group (difference: p = 0.406). There were no significant between-group differences in any erectile function subscale (p > 0.05). Significant between-group differences were observed for changes in FMD and VO_2peak, favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP.

Trial registration

Clinicaltrials.gov identifier NCT00620932.

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Citation Excerpt :
In total, 10 different assessment methods were used to assess sexual dysfunction in the included studies, all of which were questionnaires or single questions. 8 studies (34%) used the specific sexual function questionnaires IIEF-1527,34 and IIEF-5,28,41–44,46 while twelve (52%) studies used questionnaires that included a sexual function subscale.26,27,29,31,33,35–40,45 These are the EORTC QLQ-PR25,26,27,29,31,33,35 the EPIC,27 the EPIC-26,37,40 the UCLA-PCI36,38,45 and the IIS.39
Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment.
The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant.
Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise.
22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group.
The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach.
A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies.
Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients.
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RCTs have explored the effect of light-to-moderate [76], moderate [77–79], moderate-to-vigorous [80–84], and vigorous [85–88] exercise using aerobic training [77,78,80,85–87], resistance training [72,81,82,89,90], and a combination of these modalities [76,79,83,84,88] on a variety of clinical, functional, and psychosocial outcomes. Localized prostate cancer [76–78,84,87]. There are limited RCTs exploring the effect of exercise on QOL and clinical outcomes in localized prostate cancer alone.
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Brief CorrespondenceEffects of Nonlinear Aerobic Training on Erectile Dysfunction and Cardiovascular Function Following Radical Prostatectomy for Clinically Localized Prostate Cancer

Abstract

Trial registration

Eur Urol

Int J Cardiol

Lancet Oncol

The erectile-endothelial dysfunction nexus: new opportunities for cardiovascular risk prevention

Nat Clin Pract Cardiovasc Med

Brief Correspondence
Effects of Nonlinear Aerobic Training on Erectile Dysfunction and Cardiovascular Function Following Radical Prostatectomy for Clinically Localized Prostate Cancer