The feasibility and impact of a pre-surgical exercise intervention program (prehabilitation) for patients undergoing cystectomy for bladder cancer.

ABSTRACT Objective To assess the feasibility of a prehabilitation program for cystectomy patients and to determine the effectiveness of the program in improving strength and functional capacity in the peri-operative period. Materials and Methods This phase I/II study accrued patients ≥60 years old from 01/2013-10/2017 with biopsy-proven bladder cancer, Karnofsky performance score ≥70 and a sedentary baseline lifestyle to participate in a 4-week supervised pre-operative exercise training program. Primary outcomes were feasibility and safety; secondary outcomes included changes in fitness, patient-reported QOL, peri-operative complications and readmissions. Student's t-tests and Wilcoxon signed-rank test were performed. Results Fifty-four patients enrolled in the program. Successful completion, defined as patients who began the program and adhered to >70% of the sessions, was attained by 41 of 51 patients (80.4%, 90% CI [71% - 90%]. There were no adverse events. Fitness and patient-reported QOL improved post-intervention, with sustained improvements in general and mental health 90-days post-surgery. The primary limitation is no control group. Conclusion Prehabilitation prior to cystectomy is feasible, safe, and results in improvements in patient strength, endurance and sustained improvements in patient-reported QOL from baseline. Efforts to further evaluate the impact of prehabilitation in this population in an expanded and randomized fashion are warranted.