Progressive Resistance Training and Cancer Testis PROTRACT - Efficacy of resistance training on muscle function, morphology and inflammatory profile in testicular cancer patients undergoing chemotherapy: design of a randomized conReport as inadecuate

Progressive Resistance Training and Cancer Testis PROTRACT - Efficacy of resistance training on muscle function, morphology and inflammatory profile in testicular cancer patients undergoing chemotherapy: design of a randomized con - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 11:326

First Online: 01 August 2011Received: 25 July 2011Accepted: 01 August 2011DOI: 10.1186-1471-2407-11-326

Cite this article as: Christensen, J.F., Andersen, J.L., Adamsen, L. et al. BMC Cancer 2011 11: 326. doi:10.1186-1471-2407-11-326


BackgroundStandard treatment for patients with disseminated germ cell tumors is combination chemotherapy with bleomycin, etoposide and cisplatin BEP. This treatment is highly effective, but the majority of patients experience severe adverse effects during treatment and are at risk of developing considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, and pulmonary toxicity. One neglected side effect is the significant muscular fatigue mentioned by many patients with testicular cancer both during and after treatment. Very limited information exists concerning the patho-physiological effects of antineoplastic agents on skeletal muscle. The primary aim of this study is to investigate the effects of BEP-treatment on the skeletal musculature in testicular cancer patients, and to examine whether the expected treatment-induced muscular deterioration can be attenuated or even reversed by high intensity progressive resistance training HIPRT.

Design-MethodsThe PROTRACT study is a randomized controlled trial in 30 testicular cancer patients undergoing three cycles of BEP chemotherapy. Participants will be randomized to either a 9-week HIPRT program STR initiated at the onset of treatment, or to standard care UNT. 15 healthy matched control subjects CON will complete the same HIPRT program. All participants will take part in 3 assessment rounds baseline, 9 wks, 21 wks including muscle biopsies, maximum muscle strength tests, whole body DXA scan and blood samples. Primary outcome: mean fiber area and fiber type composition measured by histochemical analyses, satellite cells and levels of protein and mRNA expression of intracellular mediators of protein turnover. Secondary outcomes: maximum muscle strength and muscle power measured by maximum voluntary contraction and leg-extensor-power tests, body composition assessed by DXA scan, and systemic inflammation analyzed by circulating inflammatory markers, lipid and glucose metabolism in blood samples. Health related Quality of Life QoL will be assessed by validated questionnaires EORTC QLQ-C30, SF-36.

DiscussionThis study investigates the muscular effects of antineoplastic agents in testicular cancer patients, and furthermore evaluates whether HIPRT has a positive influence on side effects related to chemotherapy. A more extensive knowledge of the interaction between cytotoxic-induced physiological impairment and exercise-induced improvement is imperative for the future development of optimal rehabilitation programs for cancer patients.

Trial RegistrationCurrent Controlled Trials ISRCTN32132990.

KeywordsTesticular cancer anti neoplasms resistance exercise muscle morphology AbbreviationsBEPBleomycin, Etopside, Cisplatin

CONhealthy Control group

CRPC-reactive Protein

DXADual-Energy X-ray Absorptiometry


ELISAEnzyme-linked Immunosorbent Assay

EORTC QLQ-C30European Organization for Research and Treatment of Cancer Quality of Life Questionnaire

HDLHigh Density Lipoprotein

HIPRTHigh Intensity Progressive Resistance Training

IGF-1Insulin-like Growth Factor 1


LDLLow Density Lipoprotein

LEPLeg Extensor Power

MOS SF-36Medical Outcomes Study Short Form-36

MVCMaximum Voluntary Contraction

QoLQuality of Life

RMrepetition maximum

ROSreactive oxygen species

RT-PCRReverse Transcription Polymerase Chain Reaction

STRStrength training group

TCTesticular Cancer

TCHOTotal Cholesterol

TNF-alphaTumor Necrosis Factor-alpha

UNTUntrained group.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-11-326 contains supplementary material, which is available to authorized users.

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Author: Jesper F Christensen - Jesper L Andersen - Lis Adamsen - Birgitte Lindegaard - Abigail L Mackey - Rie H Nielsen - Mikael


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