Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial

Jensen, Bente Thoft; Laustsen, Sussie; Jensen, Jørgen Bjerggaard; Borre, Michael; Petersen, Annemette Krintel

doi:10.1007/s00520-016-3140-3

Cited by 72 publications

(68 citation statements)

References 27 publications

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“…According to results of the review, prehabilitation appears to be acceptable to patients and feasible to implement with good levels of adherence supported by studies within the review [15,18,29]. This finding is further supported by the wider research literature [37]. Even an intensive prehabilitation exercise programme compared to home-based exercise was found to have good levels of adherence [38], as long as prehabilitation did not interfere with receipt of cancer treatment [12].…”

Section: Discussionmentioning

confidence: 65%

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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Purpose The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study. Results Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = − 0.96, 95% CI = − 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that presurgical exercise significantly reduced length of hospital stay (MD = − 4.18, 95% CI = − 5.43-− 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical wellbeing and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies. Conclusions Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered. Implications for cancer survivors Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

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Section: Discussionmentioning

confidence: 65%

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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“…Although less objective measures of functional fitness (e.g. improved 6-min walk test (6-MWT) and increased muscle leg power) have been shown to improve within a 31-day timeframe in patients with cancer [35,36], it has previously proved difficult to improve VO AT, (as measured by CPET) by the MCID (1.5-2.0 ml/kg/min) for all comers in major benign [37] and malignant intra-abdominal surgery [11,31,38] using supervised exercise regimes. In addition, until recently, prehabilitation studies in urological patients have largely been aimed at reducing specific urological complications (e.g.…”

Section: Discussionmentioning

confidence: 99%

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

Blackwell

Doleman

Boereboom

et al. 2020

Prostate Cancer Prostatic Dis

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Objectives To assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks. Subjects/patients and methods A randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO 2AT) following HIIT vs. standard care. Results Forty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO 2AT ; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25-3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: −8.2 mmHg (95% CI −16.09 to −0.29) and DBP: −6.47 mmHg (95% CI −12.56 to −0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%. Conclusions HIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable preoperative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socioeconomic impact and long-term survival.

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“…Jensen et al [20] showed that a 2-week home-based program of pre-operative muscle strengthening exercises and endurance training was feasible and resulted in improvements in muscle power in bladder cancer patients prior to RC. However, because of the short time-window between decision for surgery and RC, there is a need to optimise the exercise stimulus for cardiopulmonary adaptations and the potential advantages of vigorous intensity interval exercise in this respect, were recently highlighted [21].…”

Section: Introductionmentioning

confidence: 99%

Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial

Banerjee

Manley

Shaw

et al. 2017

Support Care Cancer

138

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Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial

Abstract: In patients awaiting RC, a short-term exercise-based pre-habilitation intervention is feasible and effective and should be considered in future survivorship strategies.

Cited by 72 publications

References 27 publications

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial

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