This is a single-center pilot randomized controlled trial among 68 physically "inactive" older men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (LUTS/BPH) assessing a 12-week remote exercise intervention versus health education control.

This study will provide valuable insights into the feasibility of an individualized, remotely-monitored, and home-based exercise intervention as well as the effect of this intervention on lower urinary tract symptom (LUTS) severity and mechanistic measures (physical function, lower urinary tract function, frailty-related mechanistic biomarkers) in a diverse group of older men with LUTS attributed to benign prostatic hyperplasia (BPH). The potential public health benefit to society in this study could be large, as the investigators are targeting a common condition in older men (one in three older men develop LUTS in their lifetime).

Inclusion Criteria:

1. Age 60 years or older.
2. Male sex at birth.
3. Moderate-to-severe LUTS over the past month (defined as International Prostate Symptom Score [IPSS] >=12).
4. A clinical diagnosis of LUTS/BPH as demonstrated by a current or prior BPH medication prescription (alpha-blocker, 5alpha-reductase inhibitor, daily phosphodiesterase type 5 inhibitor) OR untreated LUTS/BPH and a maximum urinary flow rate <=12 ml/sec.
5. Physically inactive as defined in the Molecular Transducers of Physical Activity Consortium (MoTrPAC): no more than 1 day per week, lasting no more than 60 minutes, of regular endurance/aerobic exercise [e.g., brisk walking, jogging, running, cycling, elliptical, or swimming activity that results in feelings of increased heart rate (HR), rapid breathing, and/or sweating] or resistance exercise [resulting in muscular fatigue] in the past year). Leisure walkers are eligible unless they meet the HR, breathing, and sweating criteria.
6. Able to walk 400m without sitting, leaning, or the help of another person (observed during exercise testing) to ensure safety while exercising with remote monitoring. Use of a straight cane is allowed.
7. Able to speak and complete questionnaires in English.
8. Have an iOS or Android smartphone capable of installing the Polar Beat app.

Exclusion Criteria:

1. Prescribed overactive bladder medications (e.g., anti-muscarinics, beta-3-adrenergic agonists) <3 months before screening.
2. Initiation, dose escalation, or weaning of BPH medications <1 month before screening (<6 months for 5-alpha-reductase inhibitors). Participants' must also be willing to not start, stop, or change their BPH medications for the subsequent 7 months (the entire study period).
3. Initiation, dose escalation, or weaning of other pharmacologic agents or dietary supplements that might affect LUTS (e.g., saw palmetto, testosterone, diuretics, glucose-lowering agents) <1 month before screening. Participants' must also be willing to not start, stop, or change these medications for the subsequent 7 months (the entire study period) unless deemed necessary by their clinician.
4. History of BPH procedure or surgery.
5. History of overactive bladder procedure (e.g., intravesical Botox, sacral neuromodulation, posterior tibial nerve stimulation).
6. History of prostate cancer (treated with surgery or radiation), bladder cancer, other lower urinary tract cancer, pelvic radiation, or active non-urologic cancer treatments.
7. History of urethral strictures.
8. History of neurogenic bladder or neurologic conditions causing lower urinary tract dysfunction (e.g., Parkinson's disease, multiple sclerosis, other progressive neurological disease).
9. History of recurrent bladder or prostate infections (3 or more infections in the previous 12 months before screening).
10. History of severe or end-stage chronic kidney disease disease, kidney transplant, heart transplant, congenital heart disease, severe heart failure (defined as current New York Heart Association (NYHA) Class III or IV), valvular heart disease, diabetic coma, or the presence of a pacemaker or implantable cardiac defibrillator without clinician clearance.
11. Heart attack or myocardial infarction, heart surgery, cardiac catheterization, stroke, transient ischemic attack, brain hemorrhage, bleeding brain aneurysm, blood clot in leg or lungs, symptomatic hypoglycemia or hyperglycemia, hip fracture, or non-elective hospitalization <6 months before screening. If conditions occurred 6 to <12 months before screening, can participate with clinician clearance.
12. Bladder or prostate infection <1 months before screening. If infection occurred between 1 to <3 months before screening, can participate with clinician clearance.
13. Major surgery <3 months before screening or scheduled in the subsequent 7 months.
14. Terminal illness diagnosis with estimated life expectancy <12 months.
15. Plan to leave the study area for >28 consecutive days during the subsequent 7 months.
16. Participation in formal behavioral LUTS interventions (e.g., pelvic floor physiotherapy) <1 month before screening.
17. Symptoms of possible coronary artery disease, heart failure, arrythmia, stroke, carotid artery stenosis, valvular heart disease, blood clot in lungs, poorly controlled diabetes, peripheral vascular disease, or bladder or prostate infection without clinician clearance.
18. Maximum urinary flow rate <=4 ml/sec OR volume voided during free flow <120ml during screening or the baseline visit.
19. Post-void residual >=450ml measured by ultrasound during screening or the baseline visit.
20. Uncontrolled hypertension (systolic blood pressure >180mmHg or diastolic blood pressure >110mmHg) or hypotension (systolic blood pressure<100mmHg) measured during baseline visit anthropometric assessments.
21. Severe abnormalities on standard clinical labs measured prior to the baseline visit, without clinician clearance, including hemoglobin A1c (>10%) and urinary albumin: creatinine ratio (>300 mg/g).
22. Other medical, psychiatric, or behavioral factors or participation in other research studies that, based on the judgment of the multiple principal investigators, may interfere with study participation, assessments, or the ability to follow either the exercise intervention or the health education control.
23. Use of a permanent or temporary urinary catheter.

As required by NIH rules, data collected as part of the proposed research will be made available to outside investigators, but within the limitations of preserving the anonymity and privacy of individuals. To maintain compliance with HIPAA regulations, our preferred method will be to execute a data sharing agreement with the requestor for a limited use dataset as defined by the US Department of Health and Human Services (DHHS). Although the investigators will require w data, the investigators propose a mechanism for sharing anonymized study data with investigators who do not choose to collaborate with the study.

After study completion

Investigators will have to execute a data use agreement before documents with data from the study are sent.

This will be a 2-arm, partially-blinded, attention-controlled RCT. The randomization scheme will be computer-generated by the study statistician without participant contact. Participants will be randomized 1:1 in randomly permuted block sizes (2 or 4) to the exercise intervention or health education control arm stratified by recruitment site and any BPH medication use (yes/no). The randomization scheme is uploaded to University of California San Francisco (UCSF) REDCap and the study coordinator will randomize participants in UCSF REDCap. Assessors (for urinary and physical function testing), data analysts, and investigators will remain blinded to participants' randomization arm.

Primary outcomes will be collected using self-administered questionnaires without risk of unblinding. Intervention status and any variables related to intervention status will be recorded and stored in a separate database by unblinded Clinical Research Coordinator (CRC).