Feasibility of the Golf Recreational Exercise for Enhanced Survivorship in prostate cancer survivors undergoing hormone therapy.

BACKGROUND: Prostate cancer (PCa) survivors undergoing androgen deprivation therapy (ADT) experience significant physical and psychosocial side effects that negatively impact quality of life. Although exercise is effective in mitigating these effects, adherence to traditional programs remains low. The Golf Recreational Exercise for Enhanced Survivorship (GREENS) program was developed as a novel multimodal recreational activity (MRA) integrating structured exercise with golf to enhance engagement and sustainability.

OBJECTIVE: To evaluate the feasibility of the GREENS program in PCa survivors on hormone therapy, focusing on safety, adherence, enjoyment, and satisfaction, while exploring participant experiences through mixed methods.

METHODS: This single-arm, within-subjects feasibility study included a 5-week delayed-entry control period followed by a 10-week intervention. Fifteen participants were enrolled, with 11 initiating and 10 completing the intervention. Participants attended twice-weekly 90-minute group sessions combining exercise and golf activities. Feasibility outcomes included attendance, within-session adherence, adverse events (CTCAE), Physical Activity Enjoyment Scale (PACES-8), and a 4-item satisfaction scale. Post-intervention exit interviews were analyzed using thematic analysis.

RESULTS: Among completers, attendance was 90% and within-session adherence was 98.9%. No adverse events ≥ Grade 2 were reported, indicating high safety. Mean PACES-8 scores ranged from 52.9 to 54.8, and satisfaction scores ranged from 26.2 to 27.1 across program phases, demonstrating high enjoyment and satisfaction. All participants reported a strong willingness to recommend the program (mean = 7/7), and high likelihood of continued participation (mean = 6.4/7). Qualitative analysis identified four key themes: perceived value and satisfaction, program design and delivery, challenges and barriers, and expectations and reflections. Participants highlighted holistic health benefits, social support, skill development, and program structure as major facilitators of engagement; while scheduling and health-related factors were the primary barriers.

CONCLUSION: The GREENS program is a safe, highly adherent, and well-accepted MRA for PCa survivors on hormone therapy. The integration of exercise with a socially engaging and skill-based activity such as golf may enhance motivation and long-term participation. These findings support further investigation of golf-based and other recreational interventions in exercise oncology.