Efficacy and feasibility of pre-surgical exercise in bladder cancer patients scheduled for open radical cystectomy

Purpose: To examine the feasibility and potential efficacy of pre-surgical exercise in patients with bladder cancer scheduled for open radical cystectomy with follow-up post-surgery. Methods: Prospective single-group design with assessments at baseline, pre-surgery and 3 months post-surgery. Multimodal supervised resistance and aerobic exercise was undertaken 2-3 days/week at moderate intensity for a median of 3.5 (IQR 1.3-5.6) weeks. Feasibility was assessed by recruitment and completion rates, patient safety, program tolerance, adherence, and compliance. Lean and fat mass were assessed by dual-energy X-ray absorptiometry, physical function by a battery of tests [chest press and leg press strength, 6-minute walk test (6MWT), timed up-and-go (TUG), repeated chair rise], and quality of life (QoL), psychological distress and body image by questionnaire. Hospital length of stay (LOS) and complications were assessed by medical records. Results: Thirty-seven patients were referred with 20 recruited (67.3 ± 12.2 years) and a pre-surgery intervention completion rate of 80% (16 of 20). The individual median program adherence was 100.0% (IQR 89.4-100.0) with compliance of 100.0% (IQR 90.5-100.0) for resistance exercise and 81.8% (IQR 55.0-99.5) for aerobic exercise. There were no exercise-related adverse events. Body composition did not change pre-surgery, however, there were improvements (p \u3c 0.05) in leg press strength (16%), 6MWT distance (8%), TUG (12%), chair rise (10%), and multiple QoL domains including mental health. Median LOS was 8.0 (IQR 7.0, 15.0) days. Post-surgery there were declines in components of QoL and apparent body image dissatisfaction. Conclusions: A pre-radical cystectomy exercise program is feasible, safe, and well-tolerated with improvements in physical function and QoL. Supervised multimodal exercise in bladder cancer patients prior to cystectomy can enhance physical and mental health potentially buffering the effects of surgery