Jacob Uth

Football training improves lean body mass in men with prostate cancer undergoing androgen deprivation therapy

Androgen deprivation therapy (ADT) remains a cornerstone in the management of patients with prostate cancer (PCa) despite adverse effects on body composition and functional parameters. We compared the effects of football training with standard care in PCa patients managed with ADT (> 6 months). Fifty‐seven men aged 67 (range: 43–74) were randomly assigned to a football group (FG, n = 29) or a usual care control group (CON, n = 28). The primary outcome was change in lean body mass (LBM) assessed by dual‐energy X‐ray absorptiometry scanning. Secondary outcomes included changes in knee‐extensor muscle strength (one repetition maximum), fat percentage, and maximal oxygen uptake (VO2max). Mean heart rate during training was 137.7 (standard deviation 13.7) bpm or 84.6 (3.9)% HRmax. In FG, LBM increased by 0.5 kg [95% confidence interval (CI) 0.1–0.9; P = 0.02] with no change in CON (mean group difference 0.7 kg; 95% CI 0.1–1.2; P = 0.02). Also, muscle strength increased in FG (8.9 kg; 95% CI 6.0–11.8; P < 0.001) with no change in CON (mean group difference 6.7 kg; 95% CI 2.8–10.7; P < 0.001). In FG, VO2max increased (1.0 mL/kg/min; 95% CI 0.2–1.9; P = 0.02) and fat percentage tended to decrease (0.7%; 95%CI 1.3–0.0; P = 0.06), but these changes were not significantly different from CON. In conclusion, football training over 12 weeks improved LBM and muscle strength compared with usual care in men with prostate cancer receiving ADT.

All boys and men can play football: a qualitative investigation of recreational football in prostate cancer patients.

Evidence is accumulating that exercise‐based rehabilitation improves physical capacity and quality of life in cancer survivors. However, recruitment and persistence of male cancer patients in rehabilitation and physical activity are low and novel health promotion strategies are warranted. The purpose of this study was to gain an understanding of the meaning of recreational football as a team and interaction‐oriented health‐promoting activity in men with prostate cancer (n = 26). Qualitative data were collected through six focus group interviews (n = 4–6) and 20 h of participant observations. The two data sets were analyzed using framework analysis. The analysis produced 11 subthemes that were structured into three overarching themes: (a) motivational drivers; (b) united in sport; and (c) confirmation of own capacity. The findings indicated that participants regarded football as a welcome opportunity to regain control and acquire a sense of responsibility for own health without assuming the patient role, and football training legitimized and promoted mutual caring behavior in a male‐oriented context. In conclusion, the study suggests that football, due to its cultural representation of masculine ideals, may be a potent and unique strategy for increasing recruitment and adherence to physical activity in prostate cancer patients.

Broad-spectrum health improvements with one year of soccer training in inactive mildly hypertensive middle-aged women

The study tested the hypothesis that long‐term soccer training has positive impact on cardiovascular profile, body composition, bone health, and physical capacity in inactive, pre‐menopausal women with mild hypertension. The study applied a randomized controlled design in which physically inactive middle‐aged women were separated into a soccer training group (n=19; SOC) and a control group (n=12; CON). SOC performed 128±29 (±SD) one‐h small‐sided soccer training sessions over one year. Blood pressure, body composition, blood lipid profile, and fitness level were determined pre‐ and post‐intervention. Over one year, mean arterial pressure decreased more in SOC than in CON (−5±7 vs +4±5 mmHg; P<.05). Total‐body fat mass decreased more (P<.05) in SOC than in CON (−2.5±2.5 vs +0.6±3.2 kg; P<.05), while the change scores for lean body mass were not significantly different in SOC (2.6±2.7 kg) compared to CON (1.1±1.9 kg, P=.09). Over one year, change scores in whole‐body bone mineral density (0.004±0.032 vs −0.019±0.026 g·cm2) as well as bone mineral content (30±70 vs −39±113 g) were positive in SOC compared to CON (P<.05). Post‐intervention plasma triglycerides decreased more (−0.1±0.7 vs +0.2±0.2 mmol·L−1) and HDL cholesterol increased more (0.2±0.7 vs −0.2±0.2 mmol·L−1) in SOC than in CON (P<.05). Yo‐Yo intermittent endurance level 1 (122±105 vs 2±21%) and 20‐m sprint performance (6±6 vs −1±2%) increased more (P<.05) in SOC than in CON. In conclusion, long‐term soccer training resulted in broad‐spectrum improvements in the health profile of untrained, pre‐menopausal women with mild hypertension, including cardiovascular, metabolic, and musculo‐skeletal benefits.

Exercise for managing cancer- and treatment-related side effects in older adults

The incidence of cancer in adults aged 60 years and older is expected to rise, and because cancer is associated with aging, the overall prevalence of cancer will rise as well. With advances in cancer treatment, more older adults will receive treatment but they will also suffer the biopsychosocial consequences of cancer and cancer treatment. In this review, we describe the importance of assessing biopsychosocial needs in this vulnerable population and highlight studies supporting the use of exercise in addressing these needs. We discuss challenges and research gaps in several areas including 1) Identifying the exercise doses and modes for specific outcomes, 2) Understanding risks and safety of exercise, and 3) Implementing exercise programs into clinical practice at the individual, health care team, and organizational levels, including strategies to increase adherence.

The "Football is Medicine" platform-scientific evidence, large-scale implementation of evidence-based concepts and future perspectives

Krustrup, Peter; Williams, C A; Mohr, Magni; Hansen, Peter Riis; Helge, Eva Wulff; Elbe, Anne-Marie; de Sousa, M; Dvorak, J; Junge, A; Hammami, A; Holtermann, Andreas; Larsen, Malte Nejst; Kirkendall, D; Schmidt, Jakob Friis; Andersen, Thomas Rostgaard; Buono, P; Rørth, M; Parnell, D; Ottesen, Laila; Bennike, Søren; Nielsen, Jens Jung; Mendham, A E; Zar, A; Uth, Jacob; Hornstrup, Therese; Brasso, Klaus; Nybo, Lars; Krustrup, Birgitte Rejkjær; Meyer, T; Aagaard, Per; Andersen, J L; Hubball, H; Reddy, P A; Ryom, Knud; Lobelo, F; Barene, S; Helge, Jørn Wulff; Fatouros, I G; Nassis, G P; Xu, J C; Pettersen, S A; Calbet, J A; Seabra, A; Rebelo, A N; Figueiredo, P; Póvoas, S; Castagna, C; Milanovic, Z; Bangsbo, Jens; Randers, Morten B; Brito, J

Body composition in prostate cancer patients: novel insights suggest diverse prognostic roles of lean and fat mass.

Few advances have led to such profound progress in clinical oncology as the pioneering work by Huggins et al. who unveiled the therapeutic potential of surgical/chemical castration in the control of prostatic adenocarcinoma more than 70 years ago [1]. By lowering circulating androgen levels, most importantly testosterone, cancer-specific outcomes are markedly improved, and today, androgen deprivation therapy (ADT) is a mainstay in prostate cancer management. However, ADT-induced hypogonadism causes a plethora of adverse reactions, which may predispose to poor clinical outcomes. In particular, increase in whole-body and visceral fat mass with concomitant progressive loss of lean bodymass and impaired bone mass density (BMD) have been extensively documentedover the last decade [2].These unfavorable changes can lead to a high incidence of osteoporosis and bone fractures [3] and are associated with increased risk of Type 2 DiabetesMellitus and cardiovascular disease observed inmen undergoing ADT [4]. In this issue of Endocrine, Buttigliero et al. [5] report body composition changes in 53 patients [mean age 71 years (range 44–83) and mean BMI 25 kg m (range 19–39)] over the course of 2 years of ADT. Furthermore, the authors followed the subjects for a median of 7.1 years, until death or final clinical follow-up, to explore associations between body composition changes and overall survival (OS), progression-free-survival (PFS), and time-toskeletal-related-events (TTSRE), respectively. The authors show that patients with prostate cancer undergoing ADT experience a progressive, significant decrease in BMD at the lumbar spine of approx. -0.02 g cm (p\ 0.03), a mean loss of approx. -0.9 kg lean body mass (p\ 0.03), and a mean gain of approx. ?2.2 kg fat mass (p\ 0.0001) over the initial 2 years of treatment. To explore the prognostic role of body composition, the authors present the following outcome measures: (I) baseline levels (pre-ADT); (II) changes over the first year of treatment; and (III) progressive change from first year to second year of treatment, and investigates their predictability of OS, PFS, and TTSRE. A high gain of fat mass during the first year of treatment was associated with a 2.4fold increase in overall mortality risk (HR 2.4, 95 % CI 1.0–5.6, p = 0.04) and a threefold higher risk of a skeletalrelated events (HR 3.0, 95 % CI 1.0–10.4, p = 0.02). During the same period, a borderline significant association was observed between a large decrease in lean mass and time to tumor progression (HR 1.6, 95 % CI 0.7–3.6, p = 0.06). In contrast, neither baseline levels nor changes occurring over the second year of treatment in any of the body composition measures were associated with prostate cancer outcomes. As outlined by the authors, these findings are based on a small-scaled, non-controlled (no non-ADT or healthy control groups) study using unplanned post hoc analyses, and thus should be interpreted with care. But despite these limitations, this investigation extends upon the current evidence describing the sequalae of treatment-related changes in body composition in the oncology setting. A considerable number of studies have explored associations between body composition and cancer outcomes, but & Jesper Frank Christensen jesper.frank.christensen@regionh.dk