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Supportive Care in Cancer

, Volume 26, Issue 5, pp 1515–1523 | Cite as

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

  • Srijit Banerjee
  • Kate Manley
  • Barnabas Shaw
  • Liane Lewis
  • Gabriel Cucato
  • Robert Mills
  • Mark Rochester
  • Allan Clark
  • John M. Saxton
Original Article

Abstract

Purpose

Strategies to improve pre-operative cardiopulmonary fitness could positively impact recovery after surgery. This study investigated the feasibility of vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy (RC).

Methods

A total of 60 patients were randomised (1:1) to exercise or control following a cardiopulmonary exercise test (CPET). The exercise group was offered twice-weekly pre-operative supervised vigorous intensity aerobic interval exercise in addition to standard treatment. The controls received standard treatment only. A repeat CPET was undertaken before surgery and post-operative recovery outcomes were recorded.

Results

Over half of the 112 eligible patients approached in the clinic were recruited to the study (53.5%), with recruited patients attending a median of 8 (range 1–10) exercise sessions over a pre-operative period of 3–6 weeks. Improvements in peak values of oxygen pulse (P = 0.001), minute ventilation (P = 0.002) and power output (P < 0.001) were observed at the follow-up CPET in the exercise group versus controls and there were no adverse events. Although this feasibility study was not powered to detect changes in post-operative recovery outcomes, there were marginal (non-significant) differences in favour of the exercise group in post-operative Clavien-Dindo score and need for high dependency unit inotropic support.

Conclusions

Bladder cancer patients respond well to pre-surgical aerobic interval exercise, and the improvements in cardiopulmonary fitness variables could have important implications for post-operative recuperation after RC. These findings provide a strong foundation for an adequately powered randomised controlled trial.

Keywords

Pre-operative care Exercise Urinary bladder neoplasms 

Abbreviations

ANCOVA

analysis of covariance

AT

anaerobic threshold

BMI

body mass index

CPET

cardiopulmonary exercise test

HDU

high dependency unit

LoS

length of stay

NHS

National Health Service

RC

radical cystectomy

RPE

ratings of perceived exertion

\( \dot{V}E \)

minute ventilation

\( \dot{V} \)O2

oxygen consumption per minute

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Older P, Hall A, Hader R (1999) Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest 116(2):355–362.  https://doi.org/10.1378/chest.116.2.355 CrossRefPubMedGoogle Scholar
  2. 2.
    Prentis JM, Trenell MI, Vasdev N, French R, Dines G, Thorpe A, Snowden CP (2013) Impaired cardiopulmonary reserve in an elderly population is related to postoperative morbidity and length of hospital stay after radical cystectomy. BJU Int 112(2):E13–E19.  https://doi.org/10.1111/bju.12219 CrossRefPubMedGoogle Scholar
  3. 3.
    Stringer W, Casaburi R, Older P (2012) Cardiopulmonary exercise testing: does it improve perioperative care and outcome? Curr Opin Anaesthesiol 25(2):178–184.  https://doi.org/10.1097/ACO.0b013e32834f6c32 CrossRefPubMedGoogle Scholar
  4. 4.
    Carli FG, Scheede-Bergdahl C (2017) Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncologica; published online: 09 Jan 2017 56(2):128–133.  https://doi.org/10.1080/0284186X.2016.1266081 CrossRefPubMedGoogle Scholar
  5. 5.
    Jack S, West M, Grocott MP (2011) Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 25(3):461–472.  https://doi.org/10.1016/j.bpa.2011.07.003 CrossRefPubMedGoogle Scholar
  6. 6.
    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):92–104.  https://doi.org/10.1016/j.suronc.2013.01.004 CrossRefPubMedGoogle Scholar
  7. 7.
    Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, Trachtenberg J, Alibhai SMH (2014) Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 100(3):196–207.  https://doi.org/10.1016/j.physio.2013.08.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, Joy AA, Kumar V, Winton TW, Reiman T (2007) Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 110(3):590–598.  https://doi.org/10.1002/cncr.22830 CrossRefPubMedGoogle Scholar
  9. 9.
    Stefanelli F, Meoli I, Cobuccio R, Curcio C, Amore D, Casazza D, Tracey M, Rocco G (2013) High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg 44(4):e260–e265.  https://doi.org/10.1093/ejcts/ezt375 CrossRefPubMedGoogle Scholar
  10. 10.
    Peddle CJ, Jones LW, Eves ND, Reiman T, Sellar CM, Winton T, Courneya KS (2009) Effects of presurgical exercise training on quality of life in patients undergoing lung resection for suspected malignancy: a pilot study. Cancer Nurs 32(2):158–165.  https://doi.org/10.1097/NCC.0b013e3181982ca1 CrossRefPubMedGoogle Scholar
  11. 11.
    Cheville AL, Alberts SR, Rummans TA, Basford JR, Lapid MI, Sloan JA, Satele DV, Clark MM (2015) Improving adherence to cancer treatment by addressing quality of life in patients with advanced gastrointestinal cancers. J Pain Symptom Manag 50(3):321–327.  https://doi.org/10.1016/j.jpainsymman.2015.03.005 CrossRefGoogle Scholar
  12. 12.
    Sekine Y, Chiyo M, Iwata T, Yasufuku K, Furukawa S, Amada Y, Iyoda A, Shibuya K, Iizasa T, Fujisawa T (2005) Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg 53(5):237–243.  https://doi.org/10.1007/s11748-005-0032-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Sueppel C, Kreder K, See W (2001) Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Urol Nurs 21(3):201–210PubMedGoogle Scholar
  14. 14.
    Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, Bueschen A, Redden DT (2006) Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol 175(1):196–201.  https://doi.org/10.1016/S0022-5347(05)00047-9 CrossRefPubMedGoogle Scholar
  15. 15.
    Centemero A, Rigatti L, Giraudo D, Lazzeri M, Lughezzani G, Zugna D, Montorsi F, Rigatti P, Guazzoni G (2010) Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol 57(6):1039–1043.  https://doi.org/10.1016/j.eururo.2010.02.028 CrossRefPubMedGoogle Scholar
  16. 16.
    Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Wongyingsinn M, Gamsa A, Kim DJ, Vassiliou MC, Feldman LS (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–1082.  https://doi.org/10.1007/s00464-012-2560-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–947.  https://doi.org/10.1097/ALN.0000000000000393 CrossRefPubMedGoogle Scholar
  18. 18.
    Jensen BT, Jensen JB, Laustsen S, Petersen AK, Sondergaard I et al (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 7:301–311.  https://doi.org/10.2147/JMDH.S62172 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M (2015) Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol 49(2):133–141.  https://doi.org/10.3109/21681805.2014.967810 CrossRefPubMedGoogle Scholar
  20. 20.
    Jensen BE, Laustsen S, Jensen JB, Borre M, Petersen AK (2016) Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial. Support Care Cancer 24(8):3325–3331.  https://doi.org/10.1007/s00520-016-3140-3 CrossRefPubMedGoogle Scholar
  21. 21.
    Weston M, Weston KL, Prentis JM, Snowden CP (2016) High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioper Med (Lond) 5(1):2.  https://doi.org/10.1186/s13741-015-0026-8 CrossRefGoogle Scholar
  22. 22.
    Lancaster GA, Dodd S, Williamson PR (2004) Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 10(2):307–312.  https://doi.org/10.1111/j..2002.384.doc.x CrossRefPubMedGoogle Scholar
  23. 23.
    Browne RH (1995) On the use of a pilot sample for sample size determination. Stat Med 14(17):1933–1940.  https://doi.org/10.1002/sim.4780141709 CrossRefPubMedGoogle Scholar
  24. 24.
    UK Department of Health, Physical Activity, Health Improvement and Protection (2011) Start active, Stay Active: a report on physical activity for health from the four home countries’ Chief Medical OfficersGoogle Scholar
  25. 25.
    Borg GA (1970) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381Google Scholar
  26. 26.
    Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE et al (2012) Principles of exercise testing and interpretation: including pathophysiology and clinical applications, 5th edn. Lippincott, Williams & Wilkins, BaltimoreGoogle Scholar
  27. 27.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196.  https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
  28. 28.
    Yoon PD, Chalasani V, Woo HH (2013) Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol 190(4):1271–1274.  https://doi.org/10.1016/j.juro.2013.04.025 CrossRefPubMedGoogle Scholar
  29. 29.
    Vickers AJ, Altman DG (2001) Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ 323(7321):1123–1124.  https://doi.org/10.1136/bmj.323.7321.1123 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    US Department of Health and Human Services (1996) Physical Activity and Health: A Report of the Surgeon General. In. Atlanta: Centers for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion; 33Google Scholar
  31. 31.
    Huang G, Wang R, Chen P, Huang SC, Donnelly JE, Mehlferber JP (2016) Dose-response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol 23(5):518–529.  https://doi.org/10.1177/2047487315582322 CrossRefPubMedGoogle Scholar
  32. 32.
    Bassett DR Jr, Howley ET (2000) Limiting factors for maxium oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 32:70–84CrossRefPubMedGoogle Scholar
  33. 33.
    West MAL, Lythgoe D, Barben CP, Adams VL, Bimson WE et al (2014) The effect of neoadjuvant chemoradiotherapy on whole-body physical fitness and skeletal muscle mitochondrial oxidative phosphorylation in vivo in locally advanced rectal cancer patients—an observational pilot study. PLoS One 9(12):e111526.  https://doi.org/10.1371/journal.pone.0111526 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hojman PF, Zerahn B, Christensen JF, Dethlefsen C, Lonkvist CK et al (2014) Voluntary exercise prevents cisplatin-induced muscle wasting during chemotherapy in mice. PLoS One 9(9):e109030.  https://doi.org/10.1371/journal.pone.0109030 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    West MAL, Lythgoe D, Barben CP, Sripadam R, Kemp GJ et al (2015) Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth 114(2):244–251.  https://doi.org/10.1093/bja/aeu318 CrossRefPubMedGoogle Scholar
  36. 36.
    Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E et al (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25(2):99–111.  https://doi.org/10.1177/0269215510380830 CrossRefPubMedGoogle Scholar
  37. 37.
    Lemanu DP, Singh PP, MacCormick AD, Arroll B, Hill AG (2013) Effect of preoperative exercise on cardiorespiratory function and recovery after surgery: a systematic review. World J Surg 37(4):711–720.  https://doi.org/10.1007/s00268-012-1886-4 CrossRefPubMedGoogle Scholar
  38. 38.
    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):554–561.  https://doi.org/10.1111/bju.12895 CrossRefPubMedGoogle Scholar
  39. 39.
    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):297–303.  https://doi.org/10.1093/bja/aeq128 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Srijit Banerjee
    • 1
  • Kate Manley
    • 1
  • Barnabas Shaw
    • 2
  • Liane Lewis
    • 3
  • Gabriel Cucato
    • 4
  • Robert Mills
    • 1
  • Mark Rochester
    • 1
  • Allan Clark
    • 5
  • John M. Saxton
    • 6
  1. 1.Department of UrologyNorfolk and Norwich University HospitalNorwichUK
  2. 2.School of Health Sciences, Faculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
  3. 3.Department of Computer and Information SciencesUniversity of StrathclydeGlasgowUK
  4. 4.School of Physical Education and SportUniversity of Sao PauloSao PauloBrazil
  5. 5.Norwich Medical School, Faculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
  6. 6.Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK

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