Supervised exercise improved quality of life and fatigue in men on androgen deprivation

Design

Multicentre randomised trial (5:4), open-label

Population

700 men on androgen deprivation therapy for prostate cancer, 15 NHS trusts

Primary outcome

FACT-P quality of life and FACIT-F fatigue at 12 months

Effect

FACT-P +4.5 (97.2% CI 1.7–7.2); FACIT-F +1.9 (0.4–3.4)

STAMINA randomised 700 men on androgen deprivation therapy for prostate cancer at 15 NHS trusts in England to a 12-month programme of supervised aerobic and resistance exercise with dietary advice, behavioural support and free gym membership, or to optimised usual care with clinician training, education and safety-to-exercise checks. Median age was about 72. It was published on 4 September.

At 12 months the programme improved prostate cancer-specific quality of life (FACT-P, adjusted difference 4.5 points) and fatigue (FACIT-F, 1.9 points) more than optimised usual care. Three intervention-related serious adverse events occurred, all with recovery.

Guidelines already recommend supervised exercise for men on androgen deprivation, but it is rarely provided. This trial shows a programme can be embedded in routine cancer services and works. The effect on quality of life is moderate; the fatigue gain is smaller. The trial was open-label and almost all participants were White, so applying it in India means adapting delivery to local services and expecting some variation. The core message, to prescribe structured exercise alongside the hormone therapy, transfers.

• Refer men starting androgen deprivation to a supervised exercise programme combining aerobic and resistance training.
• Screen for safety to exercise, including cardiac and bone risk, before starting.
• Include dietary advice and behavioural support, which were part of the effective programme.
• Where supervised programmes are not available, give a structured home exercise plan and review it.

Why it matters

It turns a guideline recommendation that is rarely followed into a service that has been shown to work.

Don't overread it

The trial was open-label, so self-reported outcomes may be inflated by knowing the allocation.

The statistics, in plain English

A 4.5-point gain on FACT-P is modest; how large a change patients notice on this scale is debated. The analysis used a stricter confidence level (97.2%) because there were two primary outcomes, and both remained significant.

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