Introduction
Prostate cancer (PCa) is the most common cancer in men in the UK, with approximately 47 700 new cases diagnosed per year nationally.1 In recent years, there has been an increasingly heightened interest among clinical researchers in exercise and physical activity (PA) as an adjunctive therapy in the treatment of PCa.2 3 This interest has been driven by research showing exercise and PA to be potentially beneficial to men with PCa in a number of ways that encompass the areas of physical composition and function,4–6 alleviation of treatment side effects,7 psychological well-being8 and PCa-specific survival.9–14
There is consensus that exercise is beneficial to people with cancer, and the amount of exercise recommended for people with cancer is the same as for healthy individuals.15 16 Appropriately designed and administered exercise programmes are generally considered to be safe for men with PCa, including those with advanced disease or bony metastatic deposits.3 This is reflected in UK national guidelines on the diagnosis and management of PCa (NICE-CG175), which currently recommend offering ‘men who are starting or having androgen deprivation therapy supervised resistance and aerobic exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life’ (p. 22).17
In reality, however, a translational gap remains in the UK regarding the systematic delivery of exercise support to men diagnosed with PCa.18 This was recently highlighted in a useful study by Bourke et al 18 that described the state of exercise programme provision for men with PCa across 79 National Health Service (NHS) trusts across the UK. The results from a telephone and email survey indicated that 38 of these 79 trusts were considered ‘moderately’ or ‘highly’ capable of delivering an exercise programme to men diagnosed with PCa. However, responders from just two of these NHS trusts indicated that such exercise programmes were embedded into a standard PCa care pathway. A qualitative component within the same paper demonstrated the breadth of obstacles to providing a robust, integrated service, with the identified themes covering patient motivation, patient capability, financial governance, organisational culture, organisational processes and the availability of relevant expertise.18
The interventional study protocol presented here aims to address patient motivation. We draw on preliminary evidence indicating that due to their shared experience, sometimes men with PCa can motivate other men with PCa to engage with exercise or PA behaviours, in a context that is undeliverable by a healthcare professional.19–22 We aim to deliver a brief behavioural intervention, based on this observation, systematically to all men due to undergo radical prostatectomy for PCa within an NHS trust. Our aim is to capitalise on a phenomenon known in social sciences as the ‘teachable moment’. In the healthcare setting, this generally refers to a period of time following a significant health event (eg, a cancer diagnosis), in which an individual may be particularly amenable to changing their health behaviour.23
Hence, the brief behavioural intervention to be piloted consists of a man with a previous history of treatment for PCa and a good experience of engagement with exercise, giving a 10 min talk to men who are due to undergo, or have recently undergone, radical prostatectomy for PCa. This intervention will be piloted in both mandatory presurgery seminars for men undergoing radical prostatectomy (enabling all men receiving radical prostatectomy for PCa to be targeted) and non-mandatory post-treatment health and well-being seminars.
Patient seminars are an economically efficient and effective method of delivering crucial information to men undergoing radical prostatectomy.24 It has been evidenced that patient seminars are effective at equipping patients with the information they need, while using just a small fraction of the nursing hours that would be required for multiple individual consultations (as low as 5.5%).24 This makes patient seminars a useful medium through which to engage men with PCa in a dialogue about PA, given that overstretched uro-oncology clinicians do not have adequate time to engage in this dialogue with patients in a 1:1 clinic consultation.25 26
Patient seminars that are conducted at Guy’s and St Thomas’ NHS Foundation Trust and The Royal Marsden NHS Foundation Trust, where each of these two pilot studies will take place, already contain a 20 min segment on PA, which is delivered by someone with a background in exercise physiotherapy. This segment contains empirical promotion of the benefits of PA for men with PCa, guidance on what PA to do, and assurance that PA is safe for men with PCa. This approach aims to address some of the empirically suggested barriers to PA in this population.22 27–30 Attendees are also given contact details for the local in-house Cancer Exercise Physiotherapy services. Thus, the seminar provides a useful way of systematically nudging large amounts of patients towards an already established behaviour change pathway, offered by Cancer Exercise Physiotherapy, while preserving the patient’s autonomy, which is thought to be important in promoting sustained health behaviour change.31 This established pathway engages patients with individualised exercise plans, established behaviour change techniques (such as motivational interviewing and goal setting) and long-term follow-up (up to 1 year). Early data have indicated that this pathway may be facilitating sustained PA behaviour change in men with PCa.32
These pilot studies aim to determine whether this support structure for PA engagement might be enhanced by supplementing the existing PA segment in the seminar with another 10 min PA segment delivered by a man with a history of treatment for PCa. The intervention acknowledges the theoretical framework of Ryan and Deci’s resilient 1985 macro-theory of ‘self-determination’.33 Hence, the intervention aims to influence exercise ‘behavioural regulations’ via a process of social identification and comparison.34–36 We thus hypothesise that: (1) patients who experience a physiotherapist talk supplemented with a patient talk will self-report a greater increase in PA 3 months following the seminar, compared with those who experienced a physiotherapist talk only; and (2) patients who experience a physiotherapist talk supplemented with a patient talk will be more likely to receive a consultation with a specialist cancer exercise physiotherapist in the following 3 months, compared with those who experienced a physiotherapist talk only. Self-reported quality of life, and exercise ‘behavioural regulations’, will be measured as secondary outcomes.
