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Supportive Care in Cancer

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01-08-2016 | Original Article

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

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

Published in: Supportive Care in Cancer | Issue 8/2016

Abstract

Background

Physical exercises offer a variety of health benefits to cancer survivors during and post-treatment. However, exercise-based pre-habilitation is not well reported in major uro-oncology surgery. The aim of this study was to investigate the feasibility, the adherence, and the efficacy of a short-term physical pre-habilitation program to patients with invasive bladder cancer awaiting radical cystectomy (RC).

Methods

A parent prospective randomized controlled clinical trial investigated efficacy of a multidisciplinary rehabilitation program on length of stay following RC. A total of 107 patients were included in the intension-to-treat population revealing 50 patients in the intervention group and 57 patients in the standard group. Pre-operatively, the intervention group was instructed to a standardized exercise program consisting of both muscle strength exercises and endurance training. The number of training sessions and exercise repetitions was patient-reported. Feasibility was expressed as adherence to the program and efficacy as the differences in muscle power within and between treatment groups at time for surgery.

Results

A total of 66 % (95 % confidence interval (CI) 51; 78) adhered more than 75 % of the recommended progressive standardized exercise program. In the intervention group, a significant improvement in muscle power of 18 % (p < 0.002) was found at time for surgery. Moreover, muscle power was significantly improved compared to that in the standard group with 0.3 W/kg (95 % CI 0.08; 0.5 %) (p < 0.006). Adherence was not associated with pre-operative BMI, nutritional risk, comorbidity, pain, gender, or age.

Conclusion

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

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Witjes JA, Comperat E, Cowan NC, et al (2013) Guidelines on Muscle-Invasive and Metastatic Bladder Cancer Available at: http://www.uroweb.org/gls/pdf/07_Bladder%20Cancer_LRV2.pdf. Accessed Aug 2013

Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–176CrossRefPubMed

Hautmann RE, de Petriconi RC, Volkmer BG (2011) 25 years of experience with 1,000 neobladders: long-term complications. J Urol 185(6):2207–2212CrossRefPubMed

Kehlet H (2008) Fast-track colorectal surgery. Lancet 371(9615):791–793CrossRefPubMed

Wilson RJ, Davies S, Yates D, Redman J, Stone M (2010) Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 105(3):297–303CrossRefPubMed

Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–947CrossRefPubMed

Kehlet H (2009) Multimodal approach to postoperative recovery. Curr Opin Crit Care 15(4):355–358CrossRefPubMed

Singh F, Newton RU, Galvao DA, Spry N, Baker MK (2013) A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol 22(2):92–104CrossRefPubMed

Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. (2010) American College Of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426CrossRefPubMed

10.

Carli F, Awasthi R, Gillis C, Kassouf W (2014) Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program. Can Urol Assoc J 8(11–12):E884–E887PubMedPubMedCentral

11.

Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M (2015) Efficacy of a multiprofessional rehabilitation programme In radical cystectomy pathways; A prospective randomised controlled trial. Scand J Urol 49(2):133–41. doi:10.3109/21681805.2014.967810

12.

Norman K, Pirlich M, Sorensen J, Christensen P, Kemps M, Schutz T, et al. (2009) Bioimpedance vector analysis as a measure of muscle function. Clin Nutr 28(1):78–82CrossRefPubMed

13.

Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM, et al. (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250(3):449–455PubMed

14.

Kehlet H (2011) Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg 396(5):585–90. doi:10.1007/s00423-011-0790-y

15.

Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. (2013) Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr 32(6):879–887CrossRefPubMed

16.

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z (2003) Ad Hoc ESPEN Working Group. nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 22(3):321–336CrossRefPubMed

17.

Reid KF, Fielding RA (2012) Skeletal muscle power: a critical determinant of physical functioning in older adults. Exerc Sport Sci Rev 40(1):4–12CrossRefPubMedPubMedCentral

18.

Foldvari M, Clark M, Laviolette LC, Bernstein MA, Kaliton D, Castaneda C, et al. (2000) Association of muscle power with functional status in community-dwelling elderly women. J Gerontol A Biol Sci Med Sci 55(4):M192–M199CrossRefPubMed

19.

Bean JF, Kiely DK, LaRose S, Goldstein R, Frontera WR, Leveille SG (2010) Are changes in leg power responsible for clinically meaningful improvements in mobility in older adults? J Am Geriatr Soc 58(12):2363–2368CrossRefPubMedPubMedCentral

20.

Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25(2):99–111CrossRefPubMed

21.

Carli FZG (2005) Optimizing functional exercise capacity in the elderly surgical. Population 8:23–32

22.

Mayo NE, Feldman L, Scott S, Zavorsky G, Kim DJ, Charlebois P, et al. (2011) Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery 150(3):505–514CrossRefPubMed

23.

Tolchard S, Angell J, Pyke M, Lewis S, Dodds N, Darweish A, White P, Gillatt D (2015) Cardiopulmonary reserve as determined by cardiopulmonary exercise testing correlates with length of stay and predicts complications after radical cystectomy. BJU Int 115(4):554–61. doi:10.1111/bju.12895

24.

Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, et al. (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–1082CrossRefPubMed

25.

Jensen BT, Jensen JB, Laustsen S, Petersen AK, Sondergaard I, Borre M (2014) Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial. J Multidiscip Healthc 7:301–311CrossRefPubMedPubMedCentral

26.

Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4(2):87–100CrossRefPubMed

Title: Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial
Authors: Bente Thoft Jensen
Sussie Laustsen
Jørgen Bjerggaard Jensen
Michael Borre
Annemette Krintel Petersen
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 8/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3140-3

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