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17.11.2017
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Football training for men with prostate cancer
Jacob Uth
Postdoc, MHS, PT
Copenhagen University Hospital Rigshospitalet
CIRE
A center established and supported by The Danish Cancer Society
and The Novo Nordisk Foundation
The FC Prostate and FC Prostate Community Trials have received funding from:
• The Novo Nordisk Foundation
• The Danish Cancer Society
• TrygFonden
• The Beckett Foundation
• Preben & Anna Simonsen Fonden
• The Lundbeck Foundation
Total: 11 million DKK ~ 1,7 million USD
Disclosure
Agenda
• Prostate cancer treatment and side-effects
• Why introduce football in side-effect management?
• The FC Prostate RCT: Design and results
• The next step: A community based trial (ongoing)
• Most common cancer in Danish men (~ 24 %)
• 4400 new cases each year in Denmark
(~750,000 in the developed world)
• Mortality ~1200/year in Denmark
(~150,000 in the developed world)
• ~ 50 % of men diagnosed with prostate cancer undergo
androgen deprivation therapy (ADT) -> No testosterone
Nordcan 2010-2014; The Danish Cancer Registry 2012, Alibhai et al. 2010, Global cancer statistics 2011
PROSTATE CANCER
Adverse effects of Androgen Deprivation Therapy
van Londen GJ et al. Crit Rev Oncol Hematol. 2008, Shabbir M.H. Alibhai et al. JCO 2010, Shahinian et al. N Engl J Med. 2005, Haseen et al. J Cancer Surviv. 2010
Lean mass (2-4%)
Fat mass (8-
10%)
BMD (2-4%)
Fracture risk (62%)
Agenda
• Prostate cancer treatment and side-effects
• Why introduce football in side-effect management?
• The FC Prostate RCT: Design and results
• The next step: A community based trial (ongoing)
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EXERCISE AND PROSTATE CANCER
� Exercise may counteract side effects and improve quality of life in PC patients.
� Moderate physical activity may have a positive effect
on disease progression and survival.
� Less than half of PC patients are meeting the official guidelines regarding physical activity.
7Keogh et al, 2012; Gardner et al., 2014; Kenfield et al., 2011; Chipperfield et al., 2013; Hasenoehl et al., 2015
Benefits of football in healthy men� Football training improves physical fitness and body composition
� Football training provides peer-based psychosocial support and social capital
Krustrup et al. 2010, Ottesen et al., 2010
Agenda
• Prostate cancer treatment and side-effects
• Why introduce football in side-effect management?
• The FC Prostate RCT: Design and results
• The next step: A community based trial (ongoing)
Uth et al. 2013, BMC Cancer, Uth et al. 2014, Scand J Med Sci Sports
The FC Prostate RCT
Design Randomized Controlled Trial
Population 57 men undergoing ADT for Prostate Cancer
Age 66.8 (± 6) years
Intervention (N=29) 32 weeks football training 2-3 times per week
Control (N=28) No intervention
Primary outcome Lean Body Mass after 12 weeks
Secondary
outcomes
(selected)
Bone mineral density, Physical capacity, Bone
turnover markers
Primary study outcome
Group difference in mean change score = 0.7 kg, P = 0.02
Uth et al. 2014, Scand J Med Sci Sports
Effects after 12 weeks
Group difference in mean change score = 6.7 kg, P < 0.001
Uth et al. 2014, Scand J Med Sci Sports
Effects after 12 weeks
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Group difference in mean change score = -0.7, P = 0.08
Uth et al. 2014, Scand J Med Sci Sports
Effects after 12 weeks
Group difference in mean change score = 0.7 mL O2/ kg/min, P = 0.11
VO2 Max
Uth et al. 2014, Scand J Med Sci Sports
Effects after 12 weeks
CIRE - Center for Integrated Rehabilitation of Cancer Patients
With-in group changes in femoral and spine BMD after 32 weeks
Uth et al. 2016, Osteoporosis International
Group difference in mean change score = 0.015 to 0.024 g/cm2, P = 0.015 to 0.030Group difference in mean change score = 0.21 s, P = 0.007
Effects after 32 weeks
Uth et al. 2016, Osteoporosis International
Group difference in mean change score = 1.7 cm, P = 0.015
Effects after 32 weeks
Uth et al. 2016, Osteoporosis International
Paper III
Group difference in mean change score = 1.9 repetitions, P = 0.062
Effects after 32 weeks
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Injuries related to football training
• Fibula fractures (n = 2)
• Muscle- or tendon injuries (n =3)
• All injuries managed conservatively
• 3 out of 5 injuried participants started playing after recovery
• 1 participant withdrew from the study
• 1 participant was excluded due to a neuropathic disease
In conclusion, what we found
was that…
… Compared to control, football
training improved lean body mass,
muscle strength, bone mass and
functional performance in men
undergoing ADT for prostate
cancer…
…Larger studies are needed to verify these results and examine safety
Agenda
• Prostate cancer treatment and side-effects
• Why introduce football in side-effect management?
• The FC Prostate RCT: Design and results
• The next step: A community based trial (ongoing)
Ongoing study: FC PROSTATE COMMUNITY
• Population:
• Men with prostate cancer (all stages, n=214)
• Intervention:
• Football training in 5 local football clubs across Denmark
• Primary outcome:
• Quality of Life
• Secondary outcomes:
• Lean body mass, fat mass, bone density, safety
Bjerre E et al. BMC Cancer 2016
A big thank you to all participants and the scientific team
Mikael Rørth
Peter Krustrup
Eva Wulff Helge
Lis Adamsen
Julie Midtgaard
Klaus Brasso
Jesper Frank Christensen
Karl Bang Christensen
Niklas Rye Jørgensen
Ditte Marie Bruun
Jakob Friis Schmidt
Therese Hornstrup
Lars L. Andersen
Peter Riis Hansen
Emil Sundstrup
Markus D. Jakobsen
Lars Juel Andersen
Jørn Wulff Helge
Jens Jung Nielsen
Marie Hagmann
Josh Horton
Helle Pedersen
Eik Bjerre
Christian Frandsen
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WEB:
UCSF.DK
Mail:
“It’s awesome when we finish a training session. My legs are sore and my ankle
it is a healthy sign, a healthy fatigue. It’s great.” Bruun et al. 2014hurts the next day (…)
