Modifying Metabolic Syndrome and Cardiovascular Risk for Prostate Cancer Patients on ADT Using a Risk Factor Modification Program and Continuous Fitbit Monitoring

Inclusion Criteria:

* Willing and able to provide written informed consent
* Histologically or cytologically confirmed adenocarcinoma of the prostate
* Presence of metastatic disease documented on imaging studies (bone scan, computed tomography \[CT\] and/or magnetic resonance imaging \[MRI\]) or biochemical recurrence/refractoriness following local therapy (prostatectomy or radiation)
* Stable or improving disease activity as demonstrated by stable or improving PSA over at least 2 months
* On gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist or status post-surgical castration for at least 3 months
* Combination ADT with abiraterone or enzalutamide is permitted
* Anticipation to remain hypogonadal for at least 6 months subsequently
* Asymptomatic bone metastasis is permissible (exercise will be modified and patients monitored)
* Eastern Cooperative Oncology Group (ECOG) performance status of =\< 2
* Patients must be able to finish a maximal exercise stress test which will be assessed by cardiopulmonary exercise testing using a standardized protocol \^70 supervised by a cardiologist
* Hemoglobin \>= 9.0 g/dL independent of transfusion and/or growth factors within 3 months prior to enrollment
* Platelet count \>=75,000/uL independent of transfusion and/or growth factors within 3 months prior to enrollment
* Access to a smart phone with android or iPhone OS (iOS) operating systems
* Able to speak and comprehend English

Exclusion Criteria:

* Current use of any other systemic therapy for prostate cancer with the exception of gonadotrophin releasing hormone (GnRH) agonists/antagonists, abiraterone, enzalutamide, bisphosphonates or RANK-ligand inhibitors (for bone metastases) which are allowed
* Any underlying comorbid medical or psychiatric condition, which in the opinion of the Investigator, will make participation in our exercise intervention hazardous or obscure the interpretation of adverse events
* Inability to walk 400 meters or undertake upper and lower limb exercise, and resistance training in the previous 3 months
* Chemotherapy treatment within 28 days of study enrollment
* Symptomatic bone metastasis
* Any investigational pharmaceutical products
* Radiation therapy or surgical intervention for prior bone metastasis
* Clinically significant active malignancy other than prostate cancer
* Prolonged corrected QT (QTc) interval on pre-entry electrocardiogram (\>= 450 m/sec)
* Clinically significant heart disease that may impact safety of independent or supervised exercise including preexisting coronary artery disease, myocardial infarction or arterial thrombotic events in the past 6 months, severe or unstable angina, history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsade de pointes), New York Heart Association Class III-IV heart disease or cardiac ejection fraction measurement of \< 40% at baseline
* Untreated symptomatic spinal cord compressions
* Prisoners or subjects who are involuntarily incarcerated
* Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g. infectious disease) illness