The effectiveness of community-based football in care for men with prostate cancer

Sport can be an enjoyable and beneficial activity for everyone, including individuals diagnosed with a serious disease, where it can provide respite from their illness and a way to become more physically active and live more consciously. A new study protocol in BMC Cancer explores the use of community based football in Denmark as a way of promoting physical activity in healthcare. Here, author Julie Midtgaard tells us about the study protocol and the role physical activity plays in our lives.

Reasons for physical activity

The evidence for the positive effect of physical activity on the human body is indisputable. Physical activity is a key factor in preserving and restoring health. However, physical activity is more complex than movement of the body. Physical activity is a behavior contingent on motivation influenced by societal structures and cultural values.

Think for one minute why you (if motivated) choose to be physically active. Are you physically active simply to avoid disease and for the prospect of living 6-8 years longer? If you are, you may be characterized as an extremely rational person. However, if you’re like most people in the western world, whose basic needs are fulfilled, your choice to be physically active has to do also with fulfillment of more subtle intrinsic values (i.e. competence, autonomy and relatedness).

If you exercise regularly, you probably choose so for the excitement of achieving a personal goal, to look good, to feel good and/or to be around friends – and movement of your body is merely a means. From engagement in numerous studies of exercise behavior in different patient populations (primarily cancer and arthritis), I will argue, that this is also the case if you’re confronted with a serious disease.

Physical activity for individuals with a serious disease

Individuals who have been diagnosed with a serious disease, and who know that they have an elevated risk of dying, may choose to become more physically active as a consequence of a more conscious way of living and as a way of coping; they ride the crest of the diagnosis as a teachable moment. However, in terms of adoption of physical activity, patients are not that different from the average healthy person. Therefore, simple exercise recommendations, let alone warnings against sedentary behavior, are most likely to be insufficient in the long run.

Patients may experience more barriers towards physical activity (e.g. fatigue, pain, deteriorated body image and lack of self-efficacy); but at the same time strive for normality and distraction from their illness. Therefore, promotion of physical activity in health care including prevention of co-morbidity and development of secondary diseases, requires interventions, that will ensure safety and physiological efficacy without compromising the intrinsic values imperative for sustainment of the behavior. Moreover, the intervention must be easily accessible and possible to implement at low costs.

Community based football

One such novel intervention could be community-based football (soccer), which is currently being examined in the context of prostate cancer survivorship care in Denmark. The FC Prostate Community trial is an ongoing randomized multicenter study aiming to examine the effectiveness of community-based football in men with prostate cancer – regardless of treatment status and potential previous experience with football.

The study protocol recently published in BMC Cancer describes how the study as well as the intervention is pragmatically designed to improve generalization and implementation. Changes in bone health and body composition are secondary to changes in quality of life based on the idea that sustainment of the football training (and thus the expected health effects) is associated with a subjective improvement in quality of life.

In Denmark, as in many other countries around the world, football is the sport that arouses the most passion. Our previous qualitative research suggests that prostate cancer survivors’ perception of football is pivotal for their enrolment and sustainment. Football connotes male values, and is therefore especially attractive for men whose masculinity has be threatened by the prostate cancer diagnosis and anti-hormone treatment. In the context of community-based football, men with prostate cancer can exchange their worries and express mutual understanding without taking on the role as patients. As participants in the FC Prostate Community trial, they can feel safe knowing that their coach has undergone special training and employs an evidence-based training manual intended to prevent injuries.

While men with prostate cancer may be motivated to enrol in community-based football because they wish to achieve or maintain their physical health, they stay motivated because of the positive relations to peers and because of the excitement of scoring a goal; they stay motivated because of what the activity enables them to feel and become. As such, their continued motivation towards physical activity may not be that different from yours or mine – although I doubt that I personally will ever feel competent playing football. Football will not be for everyone, but everyone deserves to be engaged in physical activity for other reasons than mere protection from disease.

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