Progressive resistance training and muscle strength in older men with prostate cancer undergoing androgen deprivation therapy: systematic review

Serejo, André Henrique Haddad; Alexandrino, João Pedro Mendonça; Casemiro, Francine Golghetto

doi:10.1590/1981-22562025028.250115.pt

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Review Articles • Rev. bras. geriatr. gerontol. 28 • 2025 • https://doi.org/10.1590/1981-22562025028.250115.en linkcopy

Progressive resistance training and muscle strength in older men with prostate cancer undergoing androgen deprivation therapy: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To synthesize the evidence on the effects of progressive resistance training on muscle strength in older men with prostate cancer undergoing androgen deprivation therapy.

Methods A systematic review of randomized clinical trials was carried out in the PubMed, Scopus, Embase, LILACS and ClinicalTrials databases. Studies of older men aged 60 years or older with prostate cancer undergoing androgen deprivation therapy comparing progressive resistance training to an active control group were included. Risk of bias and quality of evidence were assessed using the RoB 2.0 and GRADE tools, respectively.

Results Ten randomized clinical trials were included, with a total of N=481 participants. Progressive resistance training promoted significant gains in muscle strength, ranging from 7,0% to 23,0%. Supervised protocols, with structured load progression, high adherence and a minimum duration of 12 weeks, showed the most consistent gains. In contrast, home-based or unsupervised interventions showed inconsistent or non-significant results. The one-repetition maximum test was the most sensitive method for detecting changes in dynamic muscle strength. None of the interventions resulted in serious adverse events.

Conclusion Progressive resistance training is a safe and effective therapeutic strategy for increasing muscle strength in older men with prostate cancer undergoing androgen deprivation therapy. Supervised and structured protocols are superior and should be integrated as a standard component in oncology rehabilitation programs for this population.

Keywords
Prostate Cancer; Androgen Antagonists; Resistance Training; Muscle Strength; Aged.

Database	Full Search Strategy
PubMed/MEDLINE	((("prostatic neoplasms"[MeSH Terms]) OR "prostate cancer"[tiab] OR "prostatic neoplasm"[tiab])) AND (("androgen antagonists"[MeSH Terms]) OR "androgen deprivation therapy"[tiab] OR "antiandrogens"[tiab])) AND (("resistance training"[MeSH Terms]) OR "strength training"[tiab])) AND (("aged"[MeSH Terms]) OR "elderly"[tiab]))
Scopus	( TITLE-ABS-KEY ( prostate cancer ) OR TITLE-ABS-KEY ( prostatic neoplasms ) OR TITLE-ABS-KEY ( prostate tumor ) AND TITLE-ABS-KEY ( antiandrogen therapy ) OR TITLE-ABS-KEY ( antiandrogen ) AND TITLE-ABS-KEY ( weight lifting ) AND TITLE-ABS-KEY ( elderly people ) OR TITLE-ABS-KEY ( aged ) OR TITLE-ABS-KEY ( older adults ) OR TITLE-ABS-KEY ( older people ) )
EMBASE	('prostate disease'):ab,ti OR (('prostate cancer'):ab,ti) AND (('antiandrogen'):ab,ti) OR (('antiandrogen therapy'):ab,ti) AND (('muscle strength'):ab,ti) AND (('resistance training'):ab,ti) AND (('aged'):ab,ti)
LILACS	"Neoplasia da Próstata" OR “Câncer de Próstata” OR “Neoplasias Prostáticas” AND "Força Muscular" AND "Antagonistas de Androgênios" OR "Antiandrogênios" OR “Efeito Antiandrogênico” AND "Treinamento Resistido" OR “Treinamento de Força” OR “Treino de Força” OR “Treinamento com Pesos” AND “Idoso” OR “Pessoa Idosa”
ClinicalTrials	Prostate Cancer OR Prostate Adenocarcinoma OR Prostate Carcinoma OR Prostate Neoplasm \| Other terms: Androgen Deprivation Therapy OR Elderly People OR Elderly OR Elderly Patients OR Aged OR Older Adults \| Resistance Training OR Resistance Exercise OR Resistance exercise training OR Strength Training \| Muscle Strength

Study (Author, Year) – Locale (City, Country)	Design	N (I/C) – Age (Years) (Mean+SD)	Primary Objective	ADT Duration (Mean+SD)	Gleason Score (Mean+SD)
Buffart et al., 2014²⁸ – Amsterdam Holland	Parallel RCT	29/28 – 69.9+7.3	Mediators of exercise effect	IG 18.2+38.5 months; CG 10.1+26.8	NR
Winters-Stone et al., 2015²⁹ – Portland, United States	Parallel RCT	29/22 – 70.2+8.6	Reduction of functional disability	IG 39.0+36.1 months; CG 28.5+29.2 months.	NR
Kim et al., 2018³⁰ – Seoul, South Korea	Pilot RCT	26/25 – 70.8+5.3	Effects on strength and bone health	IG 22.5+26.5 months; CG 21.6+19.1 months.	7.8+1.0 (IG/CG)
Gazova et al., 2019³¹ – Bratislava, Slovakia	Parallel RCT	15/8 – 70.0+6.7	Effects on body composition and function	ADT Duration: 5.5–8.2 months (range for both groups)	NR
Villumsen et al., 2019³² – Copenhagen, Denmark	Blinded RCT	23/23 – 68.7+4.5	Effects and safety of “exergaming”	<12.0 months: IG 13.0 / CG 17.0; ≥12.0 months: IG 18.0 / CG 27.0 (categorical).	8.0+1.0 (IG/CG)
Lam et al., 2020³³ – Hong Kong, China	Parallel RCT	13/12 – 70.5+2.1	Effects on body composition and strength	Start of ADT (no cumulative duration)	8.0+0.3 (IG/CG)
Ndjavera et al., 2020³⁴ – Cape Town, South Africa	Parallel RCT	24/26 – 72.0+4.8	Effects of PRT on side-effects of ADT	Start of ADT (no cumulative duration)	7–8 (IG/CG)
Dawson et al., 2021³⁵ – Dublin, Ireland	Pilot RCT	9/8 – 65.0 [60.5-72.5]†	Muscle and function changes with PRT	IG 11.0 [3.0–12.0]†; CG 11.5 [7.0–25.5]†	IG 8.0 [6.5–8.5]†; CG 7.0 [7.0–8.5]†
Houben et al., 2023²⁴ – Viena, Austria	Multi-center RCT	30/30/36 – 71.7+7.0	Strength and hypertrophy with PRT	IG (PLA) 6.2+9.3 months; IG (PTN) 3.5+6.8 months; CG 1.2+1.6 months	8.0+1.0 (IG/CG)
Houben et al., 2024²⁵ – Viena, Austria	RCT (follow-up)	37/31 – 71.0+6.0	Maintenance of gains after supervision	IG 3.8+8.0 months; CG 1.3+1.7 months	8.0+1.0 (IG/CG).

Study (Author, Year)	Protocol of IG (duration; frequ.; sup./home; prog.) vs. CG	Muscle strength assessment	Adherence (%)	Outcome: Δ IG+SD; Δ CG+SD; p between groups
Buffart et al., 2014²⁸	12 wk; 2x/wk; sup; linear prog. 12RM–6RM vs. Usual exercise	1RM (kg)	NR	Bench press: Δ +3.8; Δ +0.5; p: NR; Leg press: Δ +36.2; Δ +7.0; p: NR
Winters-Stone et al., 2015²⁹	56 wk; 2x/wk; sup. + 1x/wk home; linear prog. (+5% every 2 wk) vs. Stretching	1RM (kg)	83.0	Bench press: Δ +3.2; Δ −0.8; p=0.027; Leg press: Δ +21.1; Δ +0.9; p=0.032
Kim et al., 2018³⁰	26 wk; 2-3x/wk; home; prog. (RPE) vs. Stretching	Isometric dynamometry (kg); Chair-stand test (rep)	≥80.0	Right HGS: Δ −0.21+0.55; Δ −1.61+0.61; p=0.008; Leg HGS: Δ IG +0.34+0.73; Δ CG −2.65+0.80; p=0.008; Hip Strength: Δ +1.65+2.37; Δ +2.61+ 2.58; p=0.755; CST: Δ +3.72+1.01; p=0.003*
Gazova et al., 2019³¹	16 wk; 3x/wk; sup.; prog. (30-100% 1RM) vs. Usual exercise	6RM (kg); LL power (W)	78.3	Bench press: Δ +8.1; Δ +0.5; p=0.041*; Leg press: Δ +16.2; Δ +22.3; p=0.510
Villumsen et al., 2019³²	12 wk; 3x/wk; home; automated prog. vs. Usual exercise	Leg ext. power (W)	85.0	Leg ext.: Δ +29.9; Δ +5.0; p=0.227
Lam et al., 2020³³	56 wk; 3x/wk; home; individualized prog. vs. Usual exercise	Isometric dynamometry (kg)	83.0	Tricep ext.: Δ −10.4; Δ −12.1; p=0.350; Leg ext.: Δ −72.2; Δ CG −54.7; p=0.002*; Right HGS: Δ −4.1; Δ −4.7; p=0.200; Left HGS: Δ −4.4; Δ −3.5; p=0.91
Ndjavera et al., 2020³⁴	12 wk sup. + 12 wk home; 2x/wk. prog. (RPE) vs. Usual exercise	Isometric dynamometry (kg)	70.0	HGS: Δ −1.1; Δ −2.2; p=0.910
Dawson et al., 2021³⁵	12 wk; 3x/wk; sup.; prog. (cycles of 60-83% 1RM) vs. Stretching	10RM (kg)	93.0	Leg press: Δ +81.6 [66.0–108.8]†; Δ −2.4 [−9.5–1.1]†; p<0.010; Leg ext.: Δ +43.0 [35.2–56.7]†; Δ +9.0 [3.4–12.4]†; p<0.010; Leg curl: Δ +17.2 [14.8–24.9]†; Δ 0.0 [−8.0–5.7]†; p<0.010*
Houben et al., 2023²⁴	20 wk; 2x/wk; sup; prog. (cycles of 60-70% 1RM) vs. Usual exercise	1RM (kg)	82.0	Leg press: (PLA) 12% + 14%; (PTN) 13% + 11%; %Δ −5% + 11%; p<0.001; Leg ext.: (PLA) 19% + 15%; (PTN) 15% + 19%; %Δ −6% + 15%; p<0.001
Houben et al., 2024²⁵	52 wk (20 sup. + 32 home); 2x/wk; prog. (cycles of 60-70% 1RM) vs. Usual exercise	1RM (kg)	83.0	Leg press: +4% + 11%; −10% + 9%; %Δ +4%–5%; p<0.001; Leg ext.: +5% + 16%; %Δ −11% + 13%; p<0.001

Study (Author, Year)	Outcome Assessed	Measuring Instrument	Effect of intervention: DM (IG–CG); 95%CI; p	Risk of Bias (General)	Certainty of Evidence – Main Factors of Uncertainty
Buffart et al. 2014²⁸	UL; LL Strength	1RM bench press (kg) \| 1RM leg press (kg)	+3.3; 0.5–5.1; p: NR \| +29.2; 19.6–40.6; p: NR.	Some concerns	Both moderate – Risk of Bias and Imprecision
Winters-Stone et al., 2015²⁹	UL: LL Strength	1RM bench press (kg) \| 1RM leg press (kg)	+4.0; 0.8–9.0; p=0.027* \| +20.2; 6.0–40.2; p=0.032*	Low Risk	Both high – No relevant downgrading
Kim et al., 2018³⁰	Grip Strength; Functional Strength	HGS (kg) \| hip isometric dynamometry (kg) \| 30CST (rep)	+3.5; NR; p=0.008* \| +1.1; NR; p=0.755 \| +3.6; NR; p=0.003*	High Risk	Both very low – Serious Risk of Bias and Imprecision
Gazova et al., 2019³¹	UL Strength; LL Power	6RM bench press (kg) \| leg press (W)	+7.5; NR; p=0.041* \| −6.2 W; NR; p=0.510	Some concerns	Low; Very Low – Serious Risk of Bias and Imprecision; Risk of Bias, Imprecision and Inconsistency
Villumsen et al., 2019³²	LL Power	leg ext. power (W)	+20.3; -13.2–53.8; p=0.227	Some concerns	Very Low – Risk of Bias, Imprecision and Inconsistency
Lam et al., 2020³³	Isometric Strength	Isometric dynamometry – elbow ext. (N) \| isometric dynamometry– leg ext. (N) \| HGS (kg)	-5.0; NR; p=0.350 \| −57.7; NR; p=0.002* \| +1.8; NR; p=0.200	High Risk	Both very low – Serious Risk of Bias and Imprecision
Ndjavera et al., 2020³⁴	Isometric Strength	HGS (kg)	−0.1; -0.7–2.7; p=0.910	Low Risk	Low – Imprecision and Inconsistency with other findings
Dawson et al., 2021³⁵	LL Strength	10RM leg press (kg) \| leg ext. (N) \| leg curl (N)	+84.0†; p<0.010* \| +45.3†; p<0.010* \| +17.2†; p<0.010*	High Risk	Both Low – Serious Risk of Bias and Imprecision
Houben et al., 2023²⁴	LL Strength	1RM leg press (kg) \| leg ext. (kg)	%Δ +12.0–13.0%; p<0.001* \| %Δ +15.0–19.0%; p<0.001*	Low Risk	Both Moderate – Indirect Evidence
Houben et al., 2024²⁵	LL Strength	1RM leg press (kg) \| leg ext. (kg)	%Δ +4.0–5.0%; p<0.001* \| %Δ +4.0–5.0%; p<0.001*	High Risk	Both Low – Serious Risk of Bias and Indirect Evidence

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[tfnbe1] Strategies combine controlled descriptors (MeSH, EMTREE, DeCS) and free terms, using Boolean operators 'AND' and 'OR'. Source: author elaboration.