Exercise should be prescribed to prostate cancer patients to protect men from the debilitating side effects of treatment, an NHS trial has found.
The study, published in The Lancet Oncology, found that supervised gym sessions reduced deterioration in quality of life by up to one third.
Researchers said the findings should lead to exercise being prescribed as part of mainstream prostate cancer care rather than simply recommended as healthy behaviour.
Professor Derek Rosario, chief investigator and a consultant urological surgeon at Sheffield Teaching Hospitals NHS Foundation Trust, described the findings as a “huge step forward” which should have an “immediate impact” on patients.
“The importance of optimising quality of life for men with prostate cancer cannot be overstated,” he said.
Professor Rosario said improving quality of life and reducing fatigue through exercise could also have “potential beneficial effects on overall survival”.
He said doctors had been “crying out” for an evidence-based intervention for men suffering “devastating treatment-related side effects” such as loss of muscle and bone strength.
The Telegraph is campaigning for improvements in prostate cancer diagnosis and care, including the introduction of targeted screening.
Professor Liam Bourke, of Sheffield Hallam University, said the findings marked a “definitive step-change” in how men with prostate cancer should be supported.
He said lifestyle programmes should now be “integrated comprehensively into routine prostate cancer care”.
Exercise can help the body withstand the side effects of hormone therapy by maintaining muscle and bone strength and cardiovascular fitness, making everyday activities less tiring.
The programme was tested on men receiving androgen deprivation therapy (ADT), which lowers testosterone to slow the growth of prostate cancer.
The treatment can cause severe fatigue, weight gain and loss of muscle and bone strength, as well as affecting patients’ emotional wellbeing.
About 600,000 men in Britain are living with prostate cancer, and around half are prescribed hormone therapy at some stage. Up to 77% of men receiving the treatment suffer fatigue.
The Stamina trial involved 700 men receiving ADT at 15 NHS hospitals in England, with an average age of 72.
Of these, 389 were assigned to the lifestyle programme, while 311 received an enhanced version of usual care.
Those on the programme received free gym membership and began with two supervised exercise sessions a week for 13 weeks, combining aerobic and resistance training alongside dietary advice and behavioural support.
Men initially received one-to-one coaching before moving into small groups. They continued exercising for another nine months, with supervision reduced as they became more confident exercising independently.
Dr Davina Deniszczyc, charity and medical director at Nuffield Health, which delivered the programme, said: “Exercise can and should play a central role in cancer care.”
Writing for The Telegraph, Alex Perry, chief executive of Nuffield Health, said: “For too long, we have accepted that the debilitating side effects of hormone therapy are simply the price men must pay for survival. We no longer have that excuse.
“My message to ministers and NHS leaders is straightforward. Supervised exercise and lifestyle support should become a routine, funded part of prostate cancer care for every man starting hormone therapy, regardless of where he lives.”
Compared with men receiving enhanced usual care, the programme reduced deterioration in prostate cancer-specific quality of life by 26%.
It reduced worsening fatigue by 30%, while the decline in overall cancer-related quality of life was 37% lower.
The benefits to general quality of life also exceeded the threshold considered clinically meaningful, meaning they were large enough to make a noticeable difference to patients.
Professor Bourke said the findings could underestimate the benefits compared with those experienced by patients receiving normal NHS care.
Men in the comparison group received “Optimised Usual Care”, which provided considerably more advice and support about exercise than is normally available.
Bourke said: “The clinically meaningful results of the trial are also likely to be a conservative estimation of the benefit for patients.” He added that “‘real-world’ benefits for patients could be of even greater magnitude”.
The trial did not test whether exercise extended patients’ lives.
However, Rosario said evidence linking quality of life and fatigue with outcomes meant tackling the side effects of treatment could have wider benefits, such as increased survival.
Nuffield Health, which provided the gyms and specially trained personal trainers, has launched a free Cancer Activity Programme.
It will initially offer exercise support to men undergoing prostate cancer treatment at its Fitness and Well-being clubs.
Nuffield Health plans to expand the programme to breast and bowel cancer patients, providing more than 50,000 free places by 2030. The programme costs less than £1000 (NZ$2300) per patient per year and was found to be highly cost-effective.
Researchers calculated a cost of £13,920 per quality-adjusted life year (Qaly), a measure used by the NHS to assess the value of treatment.
This is well below the £30,000 per Qaly commonly regarded as representing value for money in the NHS.
NHS England highlighted that official guidance already says men receiving hormone therapy should be offered supervised exercise twice a week for 12 weeks, although researchers said this rarely happens in practice.
The NHS has promised new standards for prehabilitation and rehabilitation of cancer patients by 2028, but details have yet to be agreed.
Professor Peter Johnson, the NHS national clinical director for cancer, said: “This research adds to the growing amount of evidence about the benefits of physical activity for people affected by cancer; and our specialist teams across England are there to help patients be as active as possible before, during and after treatment.
“Prehab and rehab are essential components of the best cancer care, and the National Cancer Plan sets out how the NHS will make it easier for patients – via ways that work best for them – to improve their fitness to support treatment, recover faster and live well with and beyond cancer.”
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