The effect of concurrent training on physical fitness factors related to health and the serum level of prostate-specific antigen in inactive men

Parastesh Mohammad1, Hamidreza Khalounejad2*

1- Associate Professor, Department of Exercise Physiology, Faculty of Sport Science, Arak University, Arak, Iran. 

    2- M.S student in Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Science, Arak University, Arak, Iran.[1]


    Background & Aim:  The purpose of this study was to investigate the effect of 12 concurrent training on prostate specific antigen (PSA), cardiopulmonary endurance, muscular strength and body composition in men over 50 years.

    Materials and Methods: In this quasi-experimental study, the statistical sample consisted of 29 men with average weight of 81.1±‏6.7 kg and body mass index of 26.4‏±‏1.4 kg‏/m2, randomly divided into two control untrained group (N=12) and training group (N=17). The concurrent training group performed concurrent training (endurance-resistance) training for 12 weeks. Serum PSA levels, cardiopulmonary endurance (VO2max), muscle strength, and body compositions were measured before and after training. Data were analyzed using covariance analysis (ANCOVA) (P <0.05).

    Results: Concurrent training in the training group significantly reduced PSA compared to the control untrained  group (P=0.001). As well as training significantly decreased fat mass (P=0.046) and the ratio of waist to hip circumference (P=0.024) also significantly increased cardiorespiratory endurance (VO2max) (P=0.001), mean relative muscle strength (P=0.001) and lean body mass (P=0.001) in the training group compared to the control untrained  group.

    Conclusion: Overall, our findings showed that concurrent training (endurance-resistance) with increased cardiorespiratory endurance, mean muscle strength, and improved body composition decreased serum prostate-specific antigen (PSA) levels in Men over 50 years old.

    Key words: Concurrent training; PSA; VO2max; Body fat; over 50 years old

    * Corresponding Author: M.S student in Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Arak University, Arak, Iran. Postal code: 38156-8-8349, Tel:09182400881

     E-mail: ORCID ID: 0000-0003-2298-4429


    Prostate cancer is currently one of the most important health concerns in the world. In the world, it is estimated to be the second and most common malignancy and the fifth cause of cancer death for men (1). The prevalence of this disease is various in different regions, so western countries have a lower rate than eastern countries (2). According to global disease responsibility studies, 1 million and 400 thousand new cases of prostate cancer were registered in 2016 and it is known as the most common cancer in men. Also, 381 thousand of deaths from this disease have been reported this year. It is predicted that new cases of prostate cancer will reach 1.7 million and the death rate will reach 499,000 by 2030 worldwide (3). In general, 1 out of every 6 men will be diagnosed with prostate cancer during their lifetime, and the probability of getting it increases with age (4). Prostate-specific antigen (PSA) is a tumor marker for the diagnosis of prostate cancer, which is currently the best marker available for the early detection of prostate cancer (5). PSA is the most useful tumor marker available for the diagnosis and prevention of prostate cancer. The rate of prostate cancer diagnosis using PSA serum levels has increased over the last two decades and the resulting death has decreased (6). Prostate cancer usually occurs in old men and usually people over 50 years old (7). In the study of De Lima and colleagues (2018), they observed that there is a significant and positive relationship between PSA serum level and increasing age (8). In confirmation of this matter, in a longitudinal cohort study, Vickers and colleagues (2014) observed a high and significant relationship between PSA serum level, age, and prostate cancer (9). The high cancer survival rate is probably related to advances in early detection such as prostate-specific antigen (PSA) screening and treatment methods such as surgery, androgen deprivation therapy (ADT), and radiation therapy (10). Since PSA measurement plays an important role in prostate cancer management and prognosis, any urological intervention that may cause PSA changes should be identified (5). One of the useful and low-cost solutions to improve body composition and subsequent improvement of PSA can be regular and planned physical activity in people with prostate cancer (10). On the other hand, aging is associated with a gradual decrease in aerobic fitness, strength, and muscle mass. These reductions have been associated with an increase in the incidence of obesity, type 2 diabetes, cardiovascular diseases, and prostate cancer (11). In this regard, the combination of resistance training (RT) and endurance training (ET) is highly recommended due to its positive effects on maintaining or simultaneously increasing the volume, strength of skeletal muscles, and aerobic fitness. The current guidelines of the American College of Sports Medicine (2018) express that endurance exercise (ET) should be less than 60% of maximum oxygen consumption (VO2max%60) and resistance training (RT) should be less than 60%. A maximum repetition (1RM%≥60) should be performed in order to improve the performance of the cardiovascular and neuromuscular systems of the elderly (12). Also, some sports activities can interfere with PSA serum levels, so in the study of Mejak et al. (2013) they observed that cycling for a distance of 50 to 160 km in men aged 50 to 71 years increased the level of PSA. It becomes their PSA serum (13).

    In general, there is a lot of contradiction regarding the results of training methods, and on the other hand, the mechanism of the beneficial effect of these training methods on the subject of the present study is not clear. Therefore, this study aims to investigate the effect of combined training (endurance-resistance) on the serum level of Prostate Specific Antigen (PSA) and body composition in men over 50 years of age, to use the method of sports activity in preventing and improving the complications of aging with To evaluate the control of serum level (PSA) and body composition.

    Material and methods

    The current research is semi-experimental in the form of two groups with a pre-test-post-test plan, 33 of the male employees of Arak Petrochemical over 50 years of age volunteered to participate in this research. 50 to 59 years old, no history of cardiovascular disease, no history of diabetes, no participation in regular physical activity in the last six months, no blood pressure higher than 160/95 mmHg, no smoking, no supplement use, Not taking blood sugar-lowering drugs, controlling blood pressure and blood fat in the last two months, 29 eligible subjects were selected and randomly assigned to two control groups (12 people) and concurrent training exercise (endurance-resistance) (17 people). they got. 2 subjects were excluded from the research due to not regularly participating in the training group in the training group and 2 subjects were excluded from the control group due to not participating in the post-test tests in the final stage, and finally this research was conducted with 29 subjects. . The sample size was based on previous studies in this field and then based on the estimation of G Power software that the effect size value was 0.5 and the type 1 error value (alpha 0.5) and the type 2 error value (beta 1) /0) was considered. One week before the start of the exercise program, all the subjects completed the consent form to participate in the research and a 3-day dietary questionnaire, including one day off, and then, if necessary, the nutrition expert provided the necessary dietary recommendations for the eight-week exercise protocol. became. Then the subjects came to the laboratory at 8:00 AM before breakfast and the first blood sample was taken from the brachial vein. The second stage of blood sampling was also taken from the subjects 48 hours after the last training session at the same time. Subjects’ weight was calculated with a Beurer digital scale made by a German company with an accuracy of 0.1 kg, their height was calculated with a Yagami model made in Japan, and body mass index was calculated by dividing the weight in kilograms by the square of the height in meters. The skinfold thickness of the subjects was measured with a Sihan caliper made in South Korea and the percentage of fat by measuring the skinfold at 7 points (thigh, chest, armpit, under the shoulder, supraclavicular, triceps and abdomen) and calculating body density (formula Siri) and placing it in the Jackson and Pollock (1976) formula was determined. Also, to calculate the ratio of abdominal circumference to pelvic circumference (WHR), the division of abdominal circumference (cm) by pelvic circumference (cm) was used (12).

    Biochemical measurements

     At each stage of blood collection, about 5 milliliters of blood was taken from the subject’s forearm vein. 2 ml of it was transferred in tubes without anticoagulant. The final blood sample was taken from the subjects 48 hours after the last training session. The samples were immediately transferred to the laboratory and in the laboratory, the blood serum was separated by a centrifuge (for 5 minutes with 3000 revolutions per minute) and collected in microtubes and kept at a negative temperature of 20 degrees Celsius until the time of analysis. it froze Serum prostate-specific antigen (PSA) using the Cobas E411 device, using the new electrochemiluminescence (ECL) technology made by Roche, Germany, and using a special kit for the device, with an accuracy of 0.1-12 ng/mL. was taken.

    Concurrent training program (endurance-resistance)

    The participants performed the program of concurrent training exercises (endurance-resistance) three times a week for 12 weeks. Resistance exercises included chest press with machine, cable puller, shoulder press with dumbbell, back of arm with two-handed dumbbell, leg with machine, back of thigh with machine and leg press with machine, fillet and stomach with machine. The sessions started and ended with general flexibility exercises. The resistance training program was designed increasingly from 15 to 12 maximum repetitions and with an intensity of 40-60% of 1 repetition maximum (1-RM) for 2 to 4 sets per movement. The endurance part of the training program consisted of 15 to 20 minutes of aerobic exercise (fast walking or running) at 65 to 80% of the maximum heart rate (Sen-220) of the heart and with a pressure perception scale of 11 to 13 (based on the Borg scale of 20 to 6). Sessions were held in small groups of 2 to 4 participants under the direct supervision of a sports physiologist (researcher) (12). To measure the heart rate during exercise and estimate the maximum oxygen consumption (VO2 max), the Polar H6 heart rate monitor made in Finland was used. The method of calculating one repetition of maximums in movements with weight through maximum strength was used based on the subject’s maximum resistance manual (12):

    One-repetition maximum (Kg)= lifted weight ÷ (1.0278 repetition to failure – (0.0278× Repetition to failure) 

    Also, to estimate the maximum oxygen consumption (aerobic capacity), a one-mile running test was used at a constant speed using the formula of George et al. (1993) (14):

    maximum oxygen consumption (VO2max) (ml/kg/min) =

    108.844 – 0.1636 (Weight (kg)) – 0.1636 (time (min)) – 0.1636 (Heart rate at the end of 1 mile per minute)

    Statistical Analysis

    The results were expressed as mean and standard deviation for the samples in each group. For The results were expressed as mean and standard deviation for the samples in each group. For statistical analysis, after ensuring the normality of the data, the Shapiro-Willick normality estimation test was used. To compare the average of the data in the variables whose pre-test did not have a significant difference in the research groups, to compare their post-test using independent t-test; And in the variables whose pre-test had a significant difference in the research groups, to compare their post-test, analysis of covariance (ANCOVA) was used, where the pre-test values ​​were used as covariance variables at a significance level of P≤0.05. All statistical calculations were done using statistical software SPSS version 22 and Graph pad Prism version 8.


    The average age and height of subjects in the untrained control group and the combined exercise group were 53.4±2.15 years, 173.4±7.46 cm, and 52.7±2.2 years, respectively. , was 174.4 ± 0.04 cm per year. All the variables of this study had a normal distribution. The results of the independent t-test showed that there was a significant difference between weight (F=0.788, P=2.21) and body mass index (BMI) (F=0.361, P=0.835) in There is no significant difference in the post-test in the studied groups. But the results of the independent t-test showed that between fat-free mass (F=0.048, P=4.193), waist-to-hip ratio (WHR) (P=0.02, P/323 Fat mass percentage (F = 0.046, P = 0.185) and maximum oxygen consumption (F = 0.001, P = 0.028) in the post-test There is a significant difference in the studied groups (Table1).

    Table 1. Examination of VO2max and body composition indices in the studied groups.

    P-valueConcurrent TrainingControl                                              Stages
    Mean ± SDMean ± SD
    0.799 0.87379.5±9.96 80.6±01.0680.7±6.96 80.10±5.63Pre-test Post-testWeight (Kg)
    0.859 0.046*29.3±01.06 28.2±3.929.2±8.86 30.3±4.47Pre-test Post-testBody Fat Mass (%)
    0.607 0.048*55.3±6.36 58.35±1.956.4± 4.71 55.3±6.38Pre-test Post-testLean Body Mass (Kg)
    0.361 0.58026.1±2.63 26.1±2.6326.1±7.12 26.1±6.9Pre-test Post-testBody Mass Index (Kg/m2)
    0.350 0.02*1.0±0.04 0.97±0.031.0±01.03 1.0±01.05Pre-test Post-testWaist–Hip Ratio (WHR)
    0.081 0.001*45.3±99.06 48.2±33.4144.2±11.48 44.2±20.35Pre-test Post-testVO2max  (Ml/Kg/Min)

    Comparison between groups by independent t-test at significance level P≤0.05.

    The results of analysis of covariance (ANCOVA) showed that there is a significant difference between the machine chest press (P = 0.001, F = 216.1), lat pulldown (P = 0.001, F = 507.5) = F), dumbbell shoulder press (P = 0.001, F = 41.7), back of arm with dumbbells (F = 0.001, P = 10.3), machine calf raise (P=0/0, F=8/481), machine leg extension (P=0/001, F=16/9), machine leg curl (P=0.001 F=44.1), machine back extension (p=0.001, f=23.1), machine crunch (P=0.001, F=250.1) the mean average power (F=0.001, P=253.7) in the post-test of the studied groups (Table 2). Also, the results of analysis of covariance (ANCOVA) showed that there was a significant difference between the serum level of prostate-specific antigen (PSA) (P = 0.005, F = 9.17) in the post-test of the studied groups. (Chart 1).

    Table 2. Examination of 1RM in various muscle groups and average relative strength in the studied groups

    P-valueConcurrent TrainingControl                                              Stages
    Mean ± SDMean ± SD
    0.004 0.00115.54±7.5 25.37±4.710.07±0.5 10.06±0.4Pre-test Post-testMachine bench press (lb)
    0.022 0.00112.99±2.62 22.62±2.2310.12±0.50 10.15±0.16Pre-test Post-testLat pulldown (Kg)
    0.022 0.00110.11±1.96 18.12±1.968.75± 1.68 8.9±1.71Pre-test Post-testDumbbell shoulder press (Kg)
    0.009 0.00112.76±2.29 15.11±2.111.87±6.68 11.87±6.68Pre-test Post-testDumbbell triceps extension  (Kg)
    0.026 0.00125.52±2.93 36.43±1.9120.88±6.45 20.88±6.45Pre-test Post-testMachine calf raise (Kg)
    0.001 0.00113.12±1.69 24.12±1.1211.60±9.37 12.11±8.21Pre-test Post-testLeg extension  (Kg)
    0.024 0.00113.66±1.60 24.16±2.1710.19±1.69 11.1±1.51Pre-test Post-testMachine leg curl (Kg)
    0.001 0.00146.17±5.91 27.11±4.8043.60±2.75 44.12±2.11Pre-test Post-testMachine back extension (Kg)
    0.001 0.001  45.13±4.85 56.1±2.9542.51±2.78 43.12±3.12Pre-test Post-testMachine crunch (Kg)
    0.001 0.001  0.273±0.057 0.452±0.0470.242±0.016 0.256±0.023Pre-test Post-testAverage relative strength (kg/body Weight)

    Comparison between groups in the post-test due to the significant difference in the pre-test by analysis of covariance (ANCOVA), the pre-test values were considered as covariance variables at a significance level of P≤0.05.

    chart 1 . Examining the serum level of prostate specific antigen (PSA) in the studied groups, C per = pre-test of the untrained control group, C post = post-test of the untrained control group, T per = pre-test of the exercise group Combined, T post = post-test of the combined exercise group. *: presence of significant difference, ns: absence of significant difference, comparison between groups by analysis of covariance (ANCOVA) and post hoc Bonferroni test at the significance level of P≤0.05. Values are expressed as mean ± standard deviation.


    The purpose of this study was to investigate the effect of twelve combined exercises prostate-specific antigen, cardio-respiratory endurance, muscle strength, and body composition of men over 50 years old. The results of the present study showed that the regular implementation of twelve weeks of concurrent training exercise caused a significant increase in maximum oxygen consumption (VO2max), muscle strength and a decrease in the serum level prostate-specific antigen (PSA) following the improvement of body composition indicators (especially fat percentage) in high men. 50 years compared to the control group.

    One of the results of the present study was the increase in VO2max of the training group compared to the control group after 12 weeks of concurrent training training (endurance-resistance). The combined effects of concurrent training training led to a significant improvement in the performance of 1 mile walking or slow running in the training group compared to the control group. Consistent with the results of the current study by Pinillos et al. (2019) that three months of high-intensity combined training increased aerobic performance, muscle strength, and balance in men over 65 years old (15). Also, in the study of Rakabdarkolaee et al. (2018), who investigated the effect of eight weeks of combined training on aerobic capacity and serum levels of tumor suppressor protein P53 in patients with prostate cancer, they observed that this training course improved the peak oxygen consumption (VO2peak). and the physical composition of these patients (16). Prostate-specific antigen (PSA) is a glycoprotein that is naturally secreted by the epithelial cells of the prostate gland. PSA is responsible for turning semen into a jelly-like liquid in ejaculation. The serum PSA test and digital rectal examination (DRE) are a combination of tests used in prostate cancer screening, although guidelines for prostate cancer screening vary greatly between countries and different medical organizations. But normally, screening is usually recommended from the age of 50 onwards (17). Anyway, in the present study, we found that 12 weeks of combined training (endurance-resistance) decreases the serum level of PSA in the training group compared to the control group without training. Contrary to the present study, Galvao et al. (2010) reported that performing a combined aerobic and resistance training program twice a week for 12 weeks in men with prostate cancer had no effect on serum PSA levels (18). It seems that the reason for the contradiction of the results can be attributed to the difference in the training protocol and also the lack of change in the improvement of body composition in this study. It is also contrary to the results of the present study in the study of Mejak et al. (2013) who observed on 129 men with an age range of 50 to 71 years (average 55.5 years) that cycling for a distance of 50 to 160 km in men significantly increased the level of their serum PSA becomes (13), the reasons for the contradiction between the results of this study and the present study can be attributed to the difference in the short-term training period and the nature of cycling training and combined (endurance-resistance) training.

    In addition, it has been reported that testosterone stimulates the growth and development of prostate tumors, and on the other hand, muscle hypertrophy and the development of muscle strength and fitness level are associated with the increase in testosterone hormone levels (19). But it seems that one of the possible mechanisms in the current study, in addition to increasing strength and improving muscle endurance, the decreased serum PSA level can be the reduction of testosterone serum level, so in confirmation of this information in the study of Cadore et al. (2010) who investigated a combined training course (endurance-resistance) was performed in men with an average age of 65 for 12 weeks and found that in addition to improving muscle mass and muscle strength, no changes were observed in their serum testosterone levels (20). Also, our results showed that in addition to no significant change in weight and body mass index (BMI), the percentage of body fat mass and waist-to-hip ratio (WHR) decreased in the combined training group (endurance-resistance) compared to the control group. found significance. The lack of weight loss and reduction in body mass index following combined exercise in the findings of this study is consistent with other studies because this issue can be due to the nature of resistance exercises, which in addition to reducing body fat percentage, these exercises can increase body mass. also increase (21) which can be the cause of constant weight and body mass index.

    Our study has several limitations and strengths that can be interpreted. The short-term nature of the exercise program may have limited our ability to observe participants’ metabolic changes or maximal achievable gains in various primary and secondary outcomes. Also, in the present study, an attempt was made to control people’s diet, but it seems that there were limitations such as monitoring the diet in the entire implementation of the exercise protocol, and there was no complete control over other daily physical activities of the people. Also, other limitations of the current research include the shortness of the intervention process and the limitation of the sample to men in the age range of 50 to 60 years. However, based on the recommendation from the American College of Sports Medicine (22) to combine both resistance and aerobic training methods in order to increase cardiovascular and muscular performance in healthy elderly people, this study seems to be a limited part of the studies that this protocol in order to investigate the effect of combined training (endurance-resistance) on the serum level of prostate-specific antigen (PSA), cardio-respiratory endurance, muscle strength and body composition of men over 50 years old.

    One of the limitations of this research, in addition to being cross-sectional and the minimum number of samples (despite the sufficient number of samples to test the main hypothesis), is the lack of recording of the calories consumed and the daily activity level of the subjects, and probably if they were controlled or recorded, we could have to Get more accurate results.


    According to the results of this research, it can be stated that carrying out a period of concurrent training training (endurance-resistance) in men over 50 years of age creates favorable adaptations in increasing cardio-respiratory function, muscle strength, and body composition, which results in this improvement. The serum level of prostate-specific antigen (PSA) decreases. Therefore, concurrent exercise training (endurance-resistance) in men over 50 years of age can probably increase muscle mass, maximum oxygen consumption, and decrease the fat mass of these people, a solution to increase physical fitness and protect against a possible increase in the serum level of a prostate-specific antigen. (PSA) as a result of increasing age and decreasing physical strength.


    This project was carried out in the form of a research project with the credits of Arak University (approved by the Faculty of Sports Sciences, No. 98/98 p.c). The code of ethics has also been obtained as described (IR.Arakmu.rec.1398.145) in the ethics committee of research projects of Arak University of Medical Sciences. Hereby, we are grateful for the sincere cooperation of all the dear ones who helped us in conducting this study in Arak Faculty of Sports Sciences and Arak University of Medical Sciences.


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