A novel physical activity intervention using Wii-fit in older prostate cancer patients on androgen deprivation therapy: A RCT

Abstract

Purpose: Androgen Deprivation Therapy (ADT) leads to physical impairment and frailty in older men with Prostate Cancer (PC). In older men on ADT, there are no randomized controlled studies of physical activity interventions in older adults. Furthermore, no studies have assessed the use of Nintendo's Wii fit device for improving physical performance in older adults with cancer. We tested the feasibility and efficacy of either a tailored, multi-component exercise intervention of either a home-based exercise program (EXCAP) or a home-based computer-generated exercise program for PC patients utilizing Nintendo's Wii fit technology (Wii) for older men on ADT. Methods: PC patients were recruited at the Universities of Rochester (n=20) and Chicago (n=7). Men aged 70+, with stable, asymptomatic PC receiving ADT for N3 monthswere randomly assigned to EXCAP, Wii, or usual care (UC). The interventions provided similar mode, intensity, and duration of aerobic and strength exercises. Assessments were completed at baseline, 6 weeks and12 weeks. The primary outcome was change in Short Physical Performance Battery (SPPB; 0–12) score. Secondary outcomes were comparisons of changes in lean muscle mass on DEXA scan, maximum chest press repetitions, handgrip strength on dynamometer, and bodymass index. ANCOVA analysis was conducted to compare outcomes among the 3 groups from pre-intervention to postintervention (6 weeks, and 12 weeks). Results: Twenty-sevenmen have enrolled (10 inWii, 8 in EXCAP, and 9 in UC); the mean age was 76.5 years (SD 6.7) and mean baseline SPPB score was 8.48 (SD 2.5). Participant drop-out rate was 7 (1 in Wii, 3 in EXCAP, 3 in UC). The mean (n, SD) SPPB score changes at 6 weeks were −0.67 (6, 2.25) for UC, 0.22 (9, 1.56) for Wii, and 1.00 (5, 0.71) for EXCAP. The SPPB score increase for EXCAP from baseline was statistically significant (p=0.034), but the ANCOVA for differences among the 3 armswas not (p=0.69). The SPPB followupmean changes (12 weeks–baseline) were 0.20 (5, 1.92) for UC, 0.78 (9, 1.64) for Wii, and 1.40 (5, 1.82) for EXCAP. None of these changes reached statistical significance, nor did the ANCOVA comparison of the 3 arms (p=0.41). Lean muscle mass at 12 weeks vs baseline showed a statistically significant difference between arms (p=0.032), where there was a mean decrease of 596 g (3, 887) for the control subjects, a decrease of 929 g (6, 533) for the Wii subjects, and an increase of 1034 g (4, 1396) for the EXCAP subjects. There were no other statistically-significant differences for the secondary outcomes. No significant adverse events were noted. Participants stated thatWii “makes exercise fun”, and 2Wii participants requested to keep theirWii at study end. Patients in EXCAP arm commented that “the exercise was great, but bands became a chore”. Conclusions: In this preliminary analysis, the exercise interventions were feasible and safe. While they showed improved SPPB scores vs UC, there was not a statistically significant difference. Participants in the Wii arm had the lowest drop-out rate and most positive patient reports.