PURPOSE: Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine effects of targeted exercise modes on BMD in men with PCa undergoing ADT. METHODS: Between 2009 and 2012, 154 PCa patients aged 43 to 90 years on ADT were randomised to exercise targeting the musculoskeletal system (impact loading plus resistance training; ImpRes n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic plus resistance training; AerRes n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). Endpoints were lumbar spine, hip and whole-body BMD measured by DXA with secondary endpoints of lean and fat mass, appendicular skeletal muscle mass (ASM) and neuromuscular strength. Analysis of covariance was used to compare the exercise groups to DelAer at 6 and 12 months. RESULTS: There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months p = 0.039; 12 months p = 0.035) and femoral neck (6 months p = 0.050), with decline attenuated in ImpRes (approximately -1.0% versus approximately -2.0%). Compared to DelAer, ImpRes increased ASM at 6 months (0.3 kg, p = 0.045) and improved muscle strength at 6 and 12 months (p <= 0.012) by 9 to 34%. A limitation was inclusion of well-functioning patients. CONCLUSION: Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT.

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