Bewegungsinterventionen für Prostatakrebspatienten: Evaluation der internationalen Evidenzlage und des Rehabilitationssports in Deutschland

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The incidence rate of prostate cancer (PCa) is still continuously rising. Annually over 65.000 newly diagnosed men are confronted with the disease and its medical treatment in Germany. While curative treatment generally involves radical prostatectomy and/or irradiation and causes side effects such as erectile dysfunction, urinary incontinence and bowel problems, the systemic-acting hormone treatment brings about changes in body composition and the musculoskeletal system, amongst others. Aside from the physical adverse effects, fatigue and psychosocial burdens can impact a patients physical functioning and quality of life even many years after primary treatment. In the need of supportive measures to counteract disease and treatment related adverse effects and improve quality of life, studies investigating the influence of physical exercise on prostate cancer patients have increased considerably. The current state of the art proves that physical exercise is safe, feasible, and beneficial for prostate cancer patients. However, despite these findings, evidence-based exercise recommendations and specific exercise offers particularly for prostate cancer patients are still missing. Methods: Within the framework of the present thesis and based on a systematic literature research and evidence evaluation, the aim was to identify the evidence of the randomized controlled trials on exercise in prostate cancer patients that have been conducted so far and to examine whether evidence-based recommendations particularly for prostate cancer patients can be derived. The objective of the ProRehab Project of the Cancer Society North-Rhine Westphalia (NRW), the State Sport Association NRW and the German Sport University Cologne, was to implement and evaluate rehabilitative sports groups for prostate cancer patients in NRW, which are stipulated in the German Social Security Code. To do so, prostate cancer sports groups were founded in NRW and 85 prostate cancer patients were recruited into a prospective, multi-center, two-armed patient preference trial shortly after radical prostatectomy. Patients in the intervention group took part in a 15 month exercise program within the groups. Outcomes of interest were aerobic fitness, physical activity levels, quality of life, urinary incontinence, erectile dysfunction and relapse-relevant blood values. Results: Although the evidence of the randomized controlled trials conducted so far can be assessed as “good”, evidence-based exercise recommendations particularly for prostate cancer patients could not be compiled. For the most part, exercise interventions, patient populations, assessment methods and assessment time points varied considerably in the studies. Nevertheless, the first preliminary exercise guidelines for prostate cancer patients during medical treatment and in the aftercare could be published. For cancer patients in general evidence-based exercise recommendations for the rehabilitation phase could be compiled. In the meantime and in consequence of the ProRehab project, 85 sports clubs in NRW offer prostate cancer sports groups. Although there was only a between group difference in the urinary symptom score in favor of the intervention group after completion of the ProRehab intervention, the within group effects in aerobic fitness, urinary incontinence, urinary and bowel symptoms as well as quality of life outcomes suggest further improvements in the intervention group and hint at further possible effects of rehabilitative sports groups for prostate cancer patients. Conclusion: The growing body of evidence regarding physical exercise in prostate cancer patients reflects the great potential of exercise interventions for prostate cancer patients. In order to allow as many patients as possible to benefit from such measures and ensure a seamless transition of the scientific findings into practice, systematic reviews with resulting exercise recommendations and specific exercise offers are necessary. Both the preliminary exercise recommendations particularly for prostate cancer patients and the initiated prostate cancer sports groups are a first step, which, however, has to be reassessed and adapted regularly based on the current state of the art.
Original languageGerman
Place of PublicationKöln
PublisherDeutsche Sporthochschule Köln
Number of pages114
Publication statusPublished - 2014

ID: 408399

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