For men with prostate cancer, androgen deprivation therapy (ADT) remains a cornerstone of treatment. While effective for controlling disease, ADT often brings significant side effects—loss of muscle mass, increased body fat, fatigue, reduced physical function, emotional distress, and diminished quality of life.
The encouraging news? Exercise is one of the most effective, evidence-based strategies available to counter these effects. A growing body of high-quality research now supports exercise as a core component of care for men receiving ADT
Preserving Muscle and Improving Body Composition
ADT is well known to accelerate muscle loss and fat gain. Multiple randomized trials and meta-analyses show that structured exercise—especially resistance training—significantly improves lean body mass while reducing fat mass in men on ADT. Programs combining aerobic and resistance exercise over six months consistently demonstrate gains in muscle and meaningful reductions in total and trunk fat. These changes are not cosmetic; they directly influence strength, metabolic health, and long-term survivorship
Strength, Function, and Everyday Independence
Loss of strength and physical function can erode independence and confidence. Supervised exercise interventions produce robust improvements in lower- and upper-body strength, including clinically meaningful gains in leg press and chest press performance. These strength improvements translate into better walking ability, improved balance, and enhanced self-reported physical function—key outcomes for aging men undergoing cancer therapy
Cardiorespiratory Fitness and Metabolic Health
Exercise also improves cardiorespiratory fitness, an important predictor of overall survival. Combined aerobic and resistance programs increase VO₂max, improve fat oxidation, and help regulate glucose levels—addressing the heightened cardiovascular and metabolic risks associated with ADT.
Fatigue, Mood, and Quality of Life
Cancer-related fatigue is one of the most common and distressing symptoms reported by men on ADT. Exercise—particularly when sustained for six months or longer—significantly reduces fatigue and improves global quality of life. Studies also show improvements in emotional well-being, depression, anxiety, cognitive function, and even sexual health. Importantly, men who begin with the lowest quality of life often experience the greatest benefit
Safe, Effective, and Treatment-Compatible
Safety is a common concern. Across trials, exercise has been shown to be safe for men on ADT, with no adverse impact on PSA levels, testosterone suppression, or treatment efficacy. Reported adverse events are rare and generally mild, reinforcing that exercise can be confidently prescribed alongside medical therapy
What Kind of Exercise Works Best?
The strongest evidence supports moderate-to-high intensity resistance training combined with aerobic exercise, ideally started early after initiation of ADT and continued for at least six months. Supervision by qualified exercise professionals—preferably in cancer-specific or group-based programs—maximizes safety, adherence, and outcomes. National survivorship guidelines now recognize exercise as a first-line, non-pharmacologic strategy for managing ADT-related symptoms
The CancerFitness.org Takeaway
Exercise is no longer optional—it is medicine for men receiving ADT. Integrating structured, supervised exercise into prostate cancer care can preserve strength, protect independence, improve mental and physical health, and enhance overall quality of life.
Call to Action:
If you or your patients are receiving ADT, ask the care team about referral to an exercise oncology or cancer rehabilitation program.
At CancerFitness.org, we advocate for exercise to be prescribed with the same intent and precision as any cancer therapy—because survivorship is about living stronger, not just longer.
References:
Exercise Medicine for the Management of Androgen Deprivation Therapy-Related Side Effects in Prostate Cancer. Urologic Oncology. 2020. Cormie P, Zopf EM.
The Role of Exercise in the Management of Adverse Effects of Androgen Deprivation Therapy for Prostate Cancer: A Rapid Review. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 2020. Edmunds K, Tuffaha H, Scuffham P, Galvão DA, Newton RU.
PloS One. 2022. Shao W, Zhang H, Qi H, Zhang Y.
Effect of exercise mode specificity on quality of life in prostate cancer patients undergoing androgen suppression. JCO Global Oncology 9, 2023 (suppl 1; abstr 72) doi:10. 2023. Taaffe D, Newton R, Spry N, et al.
The Effect of Resistance and/or Aerobic Training on Quality of Life, Fitness, and Body Composition in Prostate Cancer Patients-a Systematic Review and Meta-Analysis. Cancers. 2024. Kempin S, Buchner A, Brose SF, et al.
