Effect of exercise in individuals with prostate cancer and bone metastases - a systematic review

To summarize the evidence on the effect of exercise on muscle strength, physical function and HRQoL for individuals with prostate cancer and bone metastases

PubMed, EMBASE, PEDro and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials. Risk of Bias Tool 2 was used for risk of bias assessment. Data for muscle strength, physical function, and HRQoL were synthesized and standardized mean differences (SMD) were estimated. The certainty of evidence was assessed with GRADE.

Fifteen randomized controlled trials (RCTs) were included, representing 13 trials and involving 811 participants, of whom 40% had bone metastases. The risk of bias across the included trials ranged from low to high. The evidence was of low certainty for structured exercise improving lower body muscle strength and certain aspects of physical function. Structured exercise appeared to have minimal or no effect on HRQoL. No adverse effects of exercise were reported.

The findings in the current review suggests low-certainty evidence that structured exercise improves lower body muscle strength and certain aspects of physical function in individuals with prostate cancer and bone metastases. There is an uncertainty of the effect of exercise on HRQoL in this population. The findings should be interpreted with caution due to low representation of participants with bone metastases.

Given the limited number of trials focusing exclusively on patients with prostate cancer and bone metastases, there is a clear need for more targeted research in this area. The current uncertainty surrounding the balance of potential benefits against the risks of skeletal complications highlights this necessity. Despite these concerns, the capacity of exercise to reduce morbidity and counteract the negative impacts of cancer treatments presents a compelling case for its integration into patient care. Consequently, physiotherapists are encouraged to actively support, guide, and prescribe tailored exercise regimens for this population.