The impact of different exercise modalities on health-related quality of life in patients with prostate cancer undergoing androgen deprivation therapy: a systematic review and network meta-analysis.

BACKGROUND: Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse effects including fatigue, muscle weakness, adiposity, and impaired health-related quality of life (HRQoL). Exercise interventions may mitigate these side effects, but the comparative efficacy of different exercise modalities remains unclear. PURPOSE: To determine the effects of various exercise programs on HRQoL and physical functioning in prostate cancer patients undergoing ADT, and to provide evidence-based recommendations for clinical practice. METHODS: We systematically searched Chinese and English databases (PubMed, Embase, Cochrane Library) from inception to May 2024 for randomized controlled trials. Two independent reviewers performed screening, data extraction, and risk of bias assessment. A network meta-analysis was conducted using StATA 17.0, with mean differences (MDs) and 95% confidence intervals (CI) as effect measures. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA). FINDINGS: 41 RCTs were found in total and comprised 3, 588 participants. Combined aerobic and resistance exercise (AE+RE) was most effective for improving global HRQoL (FACT-P: MD = 7.96, 95% CI: 2.95-12.96). Resistance exercise (RE) ranked highest for increasing lean body mass (MD = 2.79, 95% CI: 0.68-6.31) and muscle strength (lower limbs: MD = 38.03; upper limbs: MD = 6.71). AE+RE was most effective for exercise capacity (6-minute walk test: MD = 51.10). For fatigue reduction, low-to-moderate intensity exercise ranked highest, though between-intervention differences were non-significant. CONCLUSION: AE+RE is the optimal intervention for improving overall HRQoL and exercise capacity in ADT patients. RE confers superior benefits for muscle strength, while AE is more effective for reducing adiposity. A combined exercise regimen should be recommended as standard care, with individualization based on patient needs. Long-term follow-up studies are warranted. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420250408942, identifier CRD420250408942.