Muscle mass is important for metastatic prostate cancer survival and quality of life (QoL). The backbone of treatment for men with metastatic castration sensitive prostate cancer (mCSPC) is androgen ...deprivation therapy (ADT) with an androgen signaling inhibitor. ADT is an effective cancer treatment, but it facilitates significant declines in muscle mass and adverse health outcomes important to mCSPC survivors, such as fatigue, and reductions in physical function, independence, insulin sensitivity, and QoL. In non-metastatic CSPC survivors, resistance training (RT) preserves muscle mass and improves these related health outcomes, but the biggest barrier to RT in CSPC survivors of all stages is fatigue. Creatine monohydrate supplementation coupled with RT (Cr + RT) may address this barrier since creatine plays a critical role in energy metabolism. Cr + RT in cancer-free older adults and other clinical populations improves muscle mass and related health outcomes. Evidence also suggests that creatine supplementation can complement cancer treatment. Thus, Cr + RT is a strategy that addresses gaps in survivorship needs of people with mCSPC. The purpose of this parallel, double-blind randomized controlled trial is to test the effects of 52-weeks of Cr + RT compared with placebo (PLA) and RT (PLA + RT) on muscle mass, other related health outcomes, and markers of cancer progression.
We will carry out this trial with our team's established, effective, home-based, telehealth RT program in 200 mCSPC survivors receiving ADT, and evaluate outcomes at baseline, 24-, and 52-weeks. RT will occur twice weekly with elastic resistance bands, and an established creatine supplementation protocol will be used for supplementation delivery. Our approach addresses a major facilitator to RT in mCSPC survivors, a home-based RT program, while utilizing a supervised model for safety.
Findings will improve delivery of comprehensive survivorship care by providing a multicomponent, patient-centered lifestyle strategy to preserve muscle mass, improve health outcomes, and complement cancer treatment (NCT06112990).
Ecological economics and systems theory have a long-standing history. As a foregrounding metatheoretical framework, systems thinking deepens socio-ecological acuity through comprehensive models of ...complex relationships between social and biophysical systems. However, critical and soft systems are often overlooked, necessitating a framework for “critical pluralism,” similar to that used by systems theorists themselves. To do this, we argue that ecological economics needs to include paradigm analysis as an integral part of the ecological economic discourse to situate work within sociological paradigms – not just biophysical limits to growth. To help establish a critical pluralism approach, we trained a group of emerging ecological economics scholars to integrate systems thinking more firmly in research approaches. We integrate soft systems methodology and critical systems heuristics to establish foundations for critical soft systems methodology. We then trained emerging scholars on this new methodology. Emergent from the results of this training is a new paradigm of thought, centred on regenerative features, for the future of ecological economics – which is best navigated with critical pluralistic approaches. The results of this training also present lessons for the discipline of ecological economics that help chart out the discipline's tensions.
