Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.
Med Sci Sports Exerc. 2023 Jul 1;55(7):1123-1132. doi: 10.1249/MSS.0000000000003137. Epub 2023 Feb 1.
This study aimed to examine the feasibility and potential efficacy of presurgical exercise in patients with bladder cancer scheduled for open radical cystectomy with follow-up postsurgery.
Prospective single-group design with assessments at baseline, presurgery, and 3 months postsurgery was used in this study. Multimodal supervised resistance and aerobic exercise was undertaken 2-3 d·wk -1 at moderate intensity for a median of 3.5 wk (interquartile range [IQR] = 1.3-5.6). 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-min walk test [6MWT], timed up-and-go, 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.
Thirty-seven patients were referred with 20 recruited (67.3 ± 12.2 yr) and a presurgery 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 presurgery; however, there were improvements ( P < 0.05) in leg press strength (16%), 6MWT distance (8%), timed up-and-go (12%), chair rise (10%), and multiple QoL domains including mental health. Median LOS was 8.0 d (IQR = 7.0, 15.0). Postsurgery, there were declines in components of QoL and apparent body image dissatisfaction.
A preradical cystectomy exercise program is feasible, safe, and well tolerated with improvements in physical function and QoL. Supervised multimodal exercise in bladder cancer patients before cystectomy can enhance physical and mental health potentially buffering the effects of surgery.
本研究旨在探讨膀胱癌患者术前进行运动的可行性和潜在疗效，这些患者计划接受开放性根治性膀胱切除术，并在术后进行随访。
本研究采用前瞻性单组设计，在基线、术前和术后 3 个月进行评估。采用多模式监督的抗阻和有氧运动，每周 2-3 次，中等强度，中位时间为 3.5 周（四分位距 [IQR]=1.3-5.6）。通过招募和完成率、患者安全性、方案耐受性、依从性和顺应性来评估可行性。通过双能 X 射线吸收法评估瘦体重和脂肪量，通过一系列测试（卧推和腿蹬力量、6 分钟步行测试 [6MWT]、起立行走计时测试、重复椅子站立）评估身体功能，通过问卷评估生活质量（QoL）、心理困扰和身体形象。通过病历评估住院时间（LOS）和并发症。
共转介了 37 例患者，其中 20 例（67.3±12.2 岁）被招募，术前干预完成率为 80%（16/20）。个体中位方案依从率为 100.0%（IQR=89.4-100.0），抗阻运动的顺应率为 100.0%（IQR=90.5-100.0），有氧运动的顺应率为 81.8%（IQR=55.0-99.5）。无与运动相关的不良事件。术前身体成分没有变化；然而，腿蹬力量（16%）、6MWT 距离（8%）、起立行走计时测试（12%）、椅子站立（10%）和多个 QoL 领域（包括心理健康）都有改善（P<0.05）。中位 LOS 为 8.0d（IQR=7.0，15.0）。术后，QoL 的各个组成部分和明显的身体形象不满意程度都有所下降。
术前根治性膀胱切除术运动方案是可行的、安全的且耐受良好，可改善身体功能和 QoL。膀胱癌患者在接受膀胱切除术之前进行监督下的多模式运动可以增强身心健康，可能减轻手术的影响。
