At the consultation where androgen deprivation starts, prescribe exercise as you would a drug. Aim for supervised aerobic and resistance exercise two to three times a week, progressing over months. Resistance work matters most for the loss of muscle and bone that ADT causes.
Check for bone metastases that affect loading, falls risk and cardiac symptoms first. Add a baseline bone density scan and a cardiovascular risk review, since ADT affects both.
- Supervised aerobic plus resistance exercise, 2–3 times weekly.
- Screen for skeletal metastases and falls risk before loading.
- Baseline DEXA and cardiovascular risk review.
- Dietary advice to limit weight gain.
Why it matters
The harms of ADT start early, and so should the countermeasure.
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