This randomized pilot clinical trial compares vigorous or moderate exercise in enhancing active surveillance in patients with prostate cancer that has not spread to nearby lymph nodes or to other parts of the body. Active surveillance involves watching the patient's condition but not giving any treatment unless test results show that the patient's condition is getting worse. Exercise may improve fitness, quality of life, brain health, and blood biomarkers in patients with prostate cancer on active surveillance. It is not yet known whether vigorous or moderate exercise works better in enhancing active surveillance in patients with localized prostate cancer.
PRIMARY OBJECTIVES: I. To determine the feasibility of performing vigorous intensity aerobic exercise using progressive, high-intensity interval training (HIIT) with standard stationary cycling and 'cybercycling' compared to moderate intensity aerobic exercise with standard stationary cycling in prostate cancer (PCa) survivors on active surveillance (AS). II. To explore the potential effects of vigorous intensity aerobic exercise (HIIT) using standard cycling and 'cybercycling' compared to moderate intensity standard cycling on changes in quality of life (QoL), cognition, fitness circulating inflammatory biomarkers and PCa-specific markers of progression (prostate specific antigen \[PSA\], time to AT) in PCa survivors in active surveillance (AS); and, to explore if these effects may be mediated by changes in body fat. OUTLINE: Patients are randomized to 1 of 3 arms. ARM I: Patients perform moderate intensity exercise on a stationary bike for 20-50 minutes, three days a week for 16 weeks. ARM II: Patients perform HIIT exercise on a standard stationary bike, three days a week for 16 weeks. ARM III: Patients perform HIIT exercise on a cybercycle using racing or other games, three days a week for 16 weeks. After completion of study, patients are followed up at 6 and 12 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Perform moderate exercise therapy
Perform HIIT exercise therapy on a standard stationary bike
Ancillary studies: Functional Assessment of Cancer Therapy-General (FACT-G), Godin Leisure-Time Exercise questionnaire, 24-hour diet recalls, USDA 5 Step Multiple Pass Method, Memorial Anxiety Scale for Prostate Cancer, Pittsburgh Sleep Quality Index (PSQI)
Overall attendance
Average number of people who attend each session
Time frame: Up to 16 weeks
Overall adherence to the exercise protocol as measured by average time in HIIT intervals for HIIT groups
Average number of minutes in HIIT intervals which are defined as exercising at 80-90% WR\_peak
Time frame: Up to 16 weeks
Adherence to the exercise protocol as measured by average time in the target heart rate (THR) zone
the target heart rate zone will be determined using the Karvonen formula: THR=((HRmax - HRrest) × % Intensity) + HRrest. Total time in this zone will be recorded every 5 minutes and the overall average will be recorded
Time frame: Up to 16 weeks
Average change in the Exercise Motivations Inventory (EMI-2)
The EMI-2 is a validated, 51 item instrument where each question is scored 0-5 and higher scores indicate greater motivation. Average changes will be analyzed using t-tests as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in quality of life, measured using the Functional Assessment of Cancer Therapy (FACT)
A 25 item scale scored 0-4 where lower indicate greater quality of life. Paired t-tests will be used to evaluate change as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Average change in fitness
Difference in VO2 maximum 30 second intake from beginning of study to end of treatment. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
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Correlative studies
perform HIIT exercise on cybercycles aided by electronic racing and other games
The exercise physiologists will keep exercise logs and tracking sheets that log the date, start and stop time (duration) of exercise sessions as well as time in the THR and RPE for each exercise session.
We will assess barriers to adhering to the exercise protocol by asking an open-ended question to solicit barriers. If the patient calls to cancel an exercise session, he will be called and probed for reasons
Height will be measured to the nearest 0.1 cm and weight will be measured to the nearest 0.1 kg. Waist and hip circumference will be measured to the nearest 1/8 inch. Whole body dual-energy X-ray absorptiometry scans will be conducted at baseline and end of treatment to quantify total body fat.
Time frame: Baseline up to 16 weeks
Change in body mass index as a measure of body composition
Change in body mass index (function of height and weight) from baseline to end of treatment. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in cognition
Average change in score of cognitive survey. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in eating behaviors
61 items where higher scores indicate healthier eating behaviors. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in leptin
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in insulin
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in adiponectin
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in resistin
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in IGF-1
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in IGFBP-1
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in IGFBP-3
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in TNF-alpha
Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Average change in the Exercise Causality Orientations Scale (ECOS)
The ECOS is a validated, 21 item instrument where each question is scored 1-7 and higher scores indicate greater motivation. Average changes will be analyzed using t-tests as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in waist/hip circumference ratio as a measure of body composition
Change in waist and hip circumference ratio from baseline to end of treatment. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks
Change in total body fat as a measure of body composition
Change in total body fat from baseline to end of treatment as measured by whole body dual-energy X-ray absorptiometry scans. Paired t-tests will be used to evaluate changes as well as mixed linear models adjusted for potential confounding factors.
Time frame: Baseline up to 16 weeks