Introduction: Prostate cancer is one of the most common malignancies in men, both in terms of incidence and mortality. Despite the efficacy of medical and surgical treatments, these therapies often lead to complications that impair functionality and quality of life (QoL). Exercise Medicine serves as a non-pharmacological intervention capable of inducing immuno-metabolic adaptations, stimulating the release of myokines, and building a preoperative functional reserve. This paper analyzes recent scientific evidence and proposes an original preoperative rehabilitation protocol. Materials and Methods: A literature review was conducted via PubMed (in February 2026) using the PICO framework and MeSH terms, including randomized controlled trials (RCTs), reviews, and meta-analyses published in English between 2020 and 2025. Following an initial screening (2,155 records) and an assessment of methodological quality (using JBI tools), 23 studies were selected for inclusion. Based on these findings, a 10-week (30-session) preoperative protocol was developed, consisting of two types of intervention: progressive strength training (ST) (at 70% of 1-RM) and polarized high-intensity interval training (HIIT) (prescribed based on peak heart rate and the first lactate threshold, LT1). Defined outcomes included IL-6 levels, PSA, magnetic resonance imaging (MRI) findings, the 6-minute walk test (6MWT), surface electromyography, the International Prostate Symptom Score (IPSS), the EORTC QLQ-PR25 questionnaire, and a voiding diary. Results: The literature indicates that exercise counteracts iatrogenic sarcopenia, improves strength, cardiorespiratory capacity, and quality of life, while also reducing tumor hypoxia and promoting immunomodulation through the release of myokines. Discussion and conclusion: Physical exercise is confirmed as a fundamental integrated intervention in the field of oncology. The development of this protocol provides a robust and safe methodological model for leveraging the preoperative window. Future clinical application will allow for the assessment of its feasibility, tolerability, and efficacy.
Introduzione: Il carcinoma della prostata è tra le principali neoplasie maschili per incidenza e mortalità. Nonostante l’efficacia dei trattamenti medico chirurgici, le terapie comportano complicanze che riducono la funzionalità e la qualità di vita (QoL). L’Exercise Medicine rappresenta un presidio non farmacologico in grado di indurre adattamenti immuno-metabolici, stimolare il rilascio di miochine e creare una riserva funzionale preoperatoria. Il presente lavoro analizza le evidenze scientifiche recenti e propone un protocollo riabilitativo pre-chirurgico originale. Materiali e Metodi: è stata condotta una revisione della letteratura su PubMed (a febbraio 2026) tramite quesito PICO e descrittori MeSh, includendo RCT, revisioni e metanalisi pubblicate in inglese (2020-2025). Dalla selezione iniziale (2155 record) e valutazione della qualità metodologica (JBI Tools), sono stati inclusi 23 studi. Su tali basi è stato progettato ex-novo un protocollo preoperatorio di 10 settimane (30 sedute), strutturato in due tipologie di intervento: Strenght Training (ST) progressivo (70% 1-RM) e HIIT Polarizzato (somministrato in base a HRpeak e LT1). Sono stati definiti gli outcome (IL-6, PSA, risonanza magnetica, 6MWT, elettromiografia di superficie, IPSS, EORTC QLC PR25 e diario minzionale). Risultati: La letteratura evidenzia che l’esercizio contrasta la sarcopenia iatrogena, migliora la forza, la capacità cardiorespiratoria e la qualità della vita, oltre a ridurre l’ipossia tumorale e favorire l’immunomodulazione tramite miochine. Discussione e conclusione: L’esercizio fisico si conferma un intervento integrato fondamentale in ambito oncologico. La formulazione di questo protocollo fornisce un modello metodologico solido e sicuro per valorizzare la finestra preoperatoria. L’applicazione clinica futura permetterà di valutarne fattibilità, tolleranza ed efficacia.
Exercise Medicine: il ruolo della riabilitazione nelle patologie prostatiche oncologiche
RUFFINI, ELENA
2025/2026
Abstract
Introduction: Prostate cancer is one of the most common malignancies in men, both in terms of incidence and mortality. Despite the efficacy of medical and surgical treatments, these therapies often lead to complications that impair functionality and quality of life (QoL). Exercise Medicine serves as a non-pharmacological intervention capable of inducing immuno-metabolic adaptations, stimulating the release of myokines, and building a preoperative functional reserve. This paper analyzes recent scientific evidence and proposes an original preoperative rehabilitation protocol. Materials and Methods: A literature review was conducted via PubMed (in February 2026) using the PICO framework and MeSH terms, including randomized controlled trials (RCTs), reviews, and meta-analyses published in English between 2020 and 2025. Following an initial screening (2,155 records) and an assessment of methodological quality (using JBI tools), 23 studies were selected for inclusion. Based on these findings, a 10-week (30-session) preoperative protocol was developed, consisting of two types of intervention: progressive strength training (ST) (at 70% of 1-RM) and polarized high-intensity interval training (HIIT) (prescribed based on peak heart rate and the first lactate threshold, LT1). Defined outcomes included IL-6 levels, PSA, magnetic resonance imaging (MRI) findings, the 6-minute walk test (6MWT), surface electromyography, the International Prostate Symptom Score (IPSS), the EORTC QLQ-PR25 questionnaire, and a voiding diary. Results: The literature indicates that exercise counteracts iatrogenic sarcopenia, improves strength, cardiorespiratory capacity, and quality of life, while also reducing tumor hypoxia and promoting immunomodulation through the release of myokines. Discussion and conclusion: Physical exercise is confirmed as a fundamental integrated intervention in the field of oncology. The development of this protocol provides a robust and safe methodological model for leveraging the preoperative window. Future clinical application will allow for the assessment of its feasibility, tolerability, and efficacy.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/29933