MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, UK.
Department of Surgery & Anaesthetics, Royal Derby Hospital, Derby, UK.
Prostate Cancer Prostatic Dis. 2024 Dec;27(4):749-755. doi: 10.1038/s41391-023-00774-z. Epub 2023 Dec 18.
Surgery for urological cancers is associated with high complication rates and survivors commonly experience fatigue, reduced physical ability and quality of life. High-intensity interval training (HIIT) as surgical prehabilitation has been proven effective for improving the cardiorespiratory fitness (CRF) of urological cancer patients, however the mechanistic basis of this favourable adaptation is undefined. Thus, we aimed to assess the mechanisms of physiological responses to HIIT as surgical prehabilitation for urological cancer.
Nineteen male patients scheduled for major urological surgery were randomised to complete 4-weeks HIIT prehabilitation (71.6 ± 0.75 years, BMI: 27.7 ± 0.9 kg·m) or a no-intervention control (71.8 ± 1.1 years, BMI: 26.9 ± 1.3 kg·m). Before and after the intervention period, patients underwent m. vastus lateralis biopsies to quantify the impact of HIIT on mitochondrial oxidative phosphorylation (OXPHOS) capacity, cumulative myofibrillar muscle protein synthesis (MPS) and anabolic, catabolic and insulin-related signalling.
OXPHOS capacity increased with HIIT, with increased expression of electron transport chain protein complexes (C)-II (p = 0.010) and III (p = 0.045); and a significant correlation between changes in C-I (r = 0.80, p = 0.003), C-IV (r = 0.75, p = 0.008) and C-V (r = 0.61, p = 0.046) and changes in CRF. Neither MPS (1.81 ± 0.12 to 2.04 ± 0.14%·day, p = 0.39) nor anabolic or catabolic proteins were upregulated by HIIT (p > 0.05). There was, however, an increase in phosphorylation of AS160 (p = 0.046) post-HIIT.
A HIIT surgical prehabilitation regime, which improved the CRF of urological cancer patients, enhanced capacity for skeletal muscle OXPHOS; offering potential mechanistic explanation for this favourable adaptation. HIIT did not stimulate MPS, synonymous with the observed lack of hypertrophy. Larger trials pairing patient-centred and clinical endpoints with mechanistic investigations are required to determine the broader impacts of HIIT prehabilitation in this cohort, and to inform on future optimisation (i.e., to increase muscle mass).
泌尿外科癌症手术相关并发症发生率高，幸存者常经历疲劳、身体活动能力和生活质量下降。高强度间歇训练（HIIT）作为外科术前康复已被证明可有效提高泌尿外科癌症患者的心肺适能（CRF），但其有利适应的机制基础尚不清楚。因此，我们旨在评估 HIIT 作为泌尿外科癌症手术术前康复的生理反应机制。
19 名计划接受主要泌尿外科手术的男性患者被随机分为完成 4 周 HIIT 术前康复组（71.6±0.75 岁，BMI：27.7±0.9kg·m）或无干预对照组（71.8±1.1 岁，BMI：26.9±1.3kg·m）。干预前后，患者接受股外侧肌活检，以量化 HIIT 对线粒体氧化磷酸化（OXPHOS）能力、累积肌纤维蛋白合成（MPS）和合成代谢、分解代谢和胰岛素相关信号的影响。
HIIT 可增加 OXPHOS 能力，电子传递链蛋白复合物（C）-II（p=0.010）和 III（p=0.045）表达增加；CRF 变化与 C-I（r=0.80，p=0.003）、C-IV（r=0.75，p=0.008）和 C-V（r=0.61，p=0.046）的变化之间存在显著相关性。HIIT 既不增加 MPS（1.81±0.12 至 2.04±0.14%·天，p=0.39），也不增加合成代谢或分解代谢蛋白（p>0.05）。然而，AS160 的磷酸化在 HIIT 后增加（p=0.046）。
HIIT 术前康复方案可改善泌尿外科癌症患者的 CRF，增强骨骼肌 OXPHOS 能力；为这种有利适应提供潜在的机制解释。HIIT 并未刺激 MPS，与观察到的无肥大一致。需要更大规模的试验将以患者为中心的和临床终点与机制研究相结合，以确定 HIIT 术前康复在该队列中的更广泛影响，并为未来的优化（即增加肌肉质量）提供信息。
