Community-based football in men with prostate cancer: 1-year follow-up on a pragmatic, multicentre randomised controlled trial

Autoři: Eik Dybboe Bjerre aff001;  Thomas Hindborg Petersen aff001;  Anders Bojer Jørgensen aff001;  Christoffer Johansen aff002;  Peter Krustrup aff003;  Bente Langdahl aff005;  Mads Hvid Poulsen aff006;  Søren Sørensen Madsen aff008;  Peter Busch Østergren aff009;  Michael Borre aff010;  Mikael Rørth aff011;  Klaus Brasso aff012;  Julie Midtgaard aff001
Působiště autorů: University Hospitals’ Centre for Health Research, Rigshospitalet, Copenhagen, Denmark aff001;  Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark aff002;  Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark aff003;  Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom aff004;  Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark aff005;  Department of Urology, Odense University Hospital, Odense, Denmark aff006;  Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark aff007;  Department of Urology, Hospital of Southwest Denmark/Esbjerg, Esbjerg, Denmark aff008;  Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark aff009;  Department of Urology, Aarhus University Hospital, Aarhus, Denmark aff010;  Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark aff011;  Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark aff012;  Department of Public Health, University of Copenhagen, Copenhagen, Denmark aff013
Vyšlo v časopise: Community-based football in men with prostate cancer: 1-year follow-up on a pragmatic, multicentre randomised controlled trial. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002936
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002936



Physical exercise has been shown to be effective in relation to fatigue, aerobic fitness, and lower body strength in men with prostate cancer. However, research into the clinically relevant effects of interventions conducted in heterogeneous patient populations and in real-life clinical practice settings is warranted.

Methods and findings

We conducted a pragmatic, multicentre, parallel randomised controlled trial in 5 Danish urological departments. Recruitment began in May 2015, the first participant was randomised in June 2015, and the last participant was included in February 2017. In total, 214 men with prostate cancer were randomly assigned to either 6 months of free-of-charge football training twice weekly at a local club (football group [FG]) (n = 109) or usual care (usual care group [UG]) (n = 105), including brief information on physical activity recommendations at randomisation. Participants were on average 68.4 (SD 6.2) years old, 157 (73%) were retired, 87 (41%) were on castration-based treatment, 19 (9%) had received chemotherapy, and 41 (19%) had skeletal metastases at baseline. In this 1-year follow-up study, we evaluated the effects of community-based football training on the following outcomes: primary outcome, quality of life; secondary outcomes: continuation of football after 6 months, hip and lumbar spine bone mineral density (BMD), mental health score, fat and lean body mass, and safety outcomes, i.e., fractures, falls, and hospital admissions. Intention to treat (ITT) and per protocol (PP) analyses were conducted. No statistically significant between-group difference was observed in change in prostate-cancer-specific quality of life (ITT: 1.9 points [95% CI −1.9 to 5.8], p = 0.325; PP: 3.6 points [95% CI −0.9 to 8.2], p = 0.119). A statistically significant between-group difference was observed in change in total hip BMD, in favour of FG (0.007 g/cm2 [95% CI 0.004 to 0.013], p = 0.037). No differences were observed in change in lumbar spine BMD or lean body mass. Among patients allocated to football, 59% chose to continue playing football after the end of the 6-month intervention period. At 1-year follow-up in the PP population, FG participants had more improvement on the Mental Component Summary (2.9 [95% CI 0.0 to 5.7], p = 0.048 points higher) than UG participants, as well as a greater loss of fat mass (−0.9 kg [95% CI −1.7 to −0.1], p = 0.029). There were no differences between groups in relation to fractures or falls. Hospital admissions were more frequent in UG compared to FG (33 versus 20; the odds ratio based on PP analysis was 0.34 for FG compared to UG). There were 3 deaths in FG and 4 in UG. Main limitations of the study were the physically active control group and assessment of physical activity by means of self-report.


In this trial, participants allocated to football appeared to have improved hip BMD and fewer hospital admissions. Men who played football more than once a week for 1 year lost fat mass and reported improved mental health. Community-based football proved to be acceptable, even when club membership was not subsidised.

Trial registration NCT02430792.

Klíčová slova:

Exercise – Fats – Hip – Hospitals – Mental health and psychiatry – Prostate cancer – Sports


1. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59. doi: 10.1016/S0140-6736(17)32154-2 28919117

2. Nguyen PL, Alibhai SM, Basaria S, D’Amico AV, Kantoff PW, Keating NL, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67(5):825–36. doi: 10.1016/j.eururo.2014.07.010 25097095

3. Wang Y, Jacobs EJ, Gapstur SM, Maliniak ML, Gansler T, McCullough ML, et al. Recreational physical activity in relation to prostate cancer-specific mortality among men with nonmetastatic prostate cancer. Eur Urol. 2017;72(6):931–9. doi: 10.1016/j.eururo.2017.06.037 28711382

4. Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS. Physical activity and survival after prostate cancer. Eur Urol. 2016;70(4):576–85. doi: 10.1016/j.eururo.2015.12.032 26774959

5. Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for men with prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;69(4):693–703. doi: 10.1016/j.eururo.2015.10.047 26632144

6. Donovan KA, Walker LM, Wassersug RJ, Thompson LM, Robinson JW. Psychological effects of androgen-deprivation therapy on men with prostate cancer and their partners. Cancer. 2015;121(24):4286–99. doi: 10.1002/cncr.29672 26372364

7. Segal RJ, Reid RD, Courneya KS, Sigal RJ, Kenny GP, Prud’Homme DG, et al. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. J Clin Oncol. 2009;27(3):344–51. doi: 10.1200/JCO.2007.15.4963 19064985

8. Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, et al. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 radar. Eur Urol. 2014;65(5):856–64. doi: 10.1016/j.eururo.2013.09.041 24113319

9. Winters-Stone KM, Dobek JC, Bennett JA, Maddalozzo GF, Ryan CW, Beer TM. Skeletal response to resistance and impact training in prostate cancer survivors. Med Sci Sports Exerc. 2014;46(8):1482–8. doi: 10.1249/MSS.0000000000000265 24500540

10. Taaffe DR, Newton RU, Spry N, Joseph D, Chambers SK, Gardiner RA, et al. Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: a year-long randomised controlled trial. Eur Urol. 2017;72(2):293–9. doi: 10.1016/j.eururo.2017.02.019 28249801

11. Bourke L, Stevenson R, Turner R, Hooper R, Sasieni P, Greasley R, et al. Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study. Sci Rep. 2018;8(1):8374. doi: 10.1038/s41598-018-26682-0 29849032

12. Parsons JK. Prostate cancer and the therapeutic benefits of structured exercise. J Clin Oncol. 2014;32(4):271–2. doi: 10.1200/JCO.2013.53.4289 24344219

13. Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. Lancet. 2016;388(10051):1337–48. doi: 10.1016/S0140-6736(16)30728-0 27475273

14. Bruun DM, Krustrup P, Hornstrup T, Uth J, Brasso K, Rorth M, et al. “All boys and men can play football”: a qualitative investigation of recreational football in prostate cancer patients. Scand J Med Sci Sports. 2014;24(Suppl 1):113–21. doi: 10.1111/sms.12193 24944135

15. Uth J, Hornstrup T, Christensen JF, Christensen KB, Jorgensen NR, Schmidt JF, et al. Efficacy of recreational football on bone health, body composition, and physical functioning in men with prostate cancer undergoing androgen deprivation therapy: 32-week follow-up of the FC Prostate randomised controlled trial. Osteoporos Int. 2016;27(4):1507–18. doi: 10.1007/s00198-015-3399-0 26572756

16. Bjerre E, Bruun DM, Tolver A, Brasso K, Krustrup P, Johansen C, et al. Effectiveness of community-based football compared to usual care in men with prostate cancer: protocol for a randomised, controlled, parallel group, multicenter superiority trial (The FC Prostate Community Trial). BMC Cancer. 2016;16(1):767. doi: 10.1186/s12885-016-2805-0 27716218

17. Bjerre ED, Brasso K, Jorgensen AB, Petersen TH, Eriksen AR, Tolver A, et al. Football compared with usual care in men with prostate cancer (FC Prostate Community Trial): a pragmatic multicentre randomized controlled trial. Sports Med. 2019;49(1):145–58. doi: 10.1007/s40279-018-1031-0 30506427

18. Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337:a2469. doi: 10.1136/bmj.a2469 19066253

19. Esper P, Mo F, Chodak G, Sinner M, Cella D, Pienta KJ. Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument. Urology. 1997;50(6):920–8. doi: 10.1016/S0090-4295(97)00459-7 9426724

20. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. J Clin Epidemiol. 1998;51(11):1171–8. doi: 10.1016/s0895-4356(98)00109-7 9817135

21. International Physical Activity Questionnaire. IPAQ scoring protocol. 2019 [cited 2019 Jun 28]. Available from:

22. Hernán MA, Hernandez-Diaz S, Robins JM. Randomized trials analyzed as observational studies. Ann Intern Med. 2013;159(8):560–2. doi: 10.7326/0003-4819-159-8-201310150-00709 24018844

23. Hernán MA, Robins JM. Per-protocol analyses of pragmatic trials. N Engl J Med. 2017;377(14):1391–8. doi: 10.1056/NEJMsm1605385 28976864

24. Siminoski K, O’Keeffe M, Brown JP, Burrell S, Coupland D, Dumont M, et al. Canadian Association of Radiologists technical standards for bone mineral densitometry reporting. Can Assoc Radiol J. 2013;64(4):281–94. doi: 10.1016/j.carj.2013.07.006 24314581

25. Lees A, Nolan L. The biomechanics of soccer: a review. J Sports Sci. 1998;16(3):211–34. doi: 10.1080/026404198366740 9596356

26. Lanyon LE. Using functional loading to influence bone mass and architecture: objectives, mechanisms, and relationship with estrogen of the mechanically adaptive process in bone. Bone. 1996;18(1 Suppl):37s–43s. doi: 10.1016/8756-3282(95)00378-9 8717546

27. Bhindi B, Kulkarni GS, Finelli A, Alibhai SM, Hamilton RJ, Toi A, et al. Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly. Eur Urol. 2014;66(5):841–8. doi: 10.1016/j.eururo.2014.06.005 24954793

28. Gao W, Bennett MI, Stark D, Murray S, Higginson IJ. Psychological distress in cancer from survivorship to end of life care: prevalence, associated factors and clinical implications. Eur J Cancer. 2010;46(11):2036–44. doi: 10.1016/j.ejca.2010.03.033 20447824

29. Galvao DA, Hayne D, Frydenberg M, Chambers SK, Taaffe DR, Spry N, et al. Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial. BMJ Open. 2018;8(4):e022331. doi: 10.1136/bmjopen-2018-022331 29678994

30. van Poppel MNM, Chinapaw MJM, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults. Sports Med. 2010;40(7):565–600. doi: 10.2165/11531930-000000000-00000 20545381

Interní lékařství

Článek vyšel v časopise

PLOS Medicine

2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…

Kurzy Doporučená témata Časopisy
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!