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

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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.

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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

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Authors and Affiliations

  1. Department of Urology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Srijit Banerjee, Kate Manley, Robert Mills & Mark Rochester

  2. School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK

    Barnabas Shaw

  3. Department of Computer and Information Sciences, University of Strathclyde, Glasgow, G1 1XH, UK

    Liane Lewis

  4. School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil

    Gabriel Cucato

  5. Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK

    Allan Clark

  6. Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Room NB259 Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK

    John M. Saxton

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  1. Srijit Banerjee
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Correspondence to John M. Saxton.

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Banerjee, S., Manley, K., Shaw, B. et al. Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial. Support Care Cancer 26, 1515–1523 (2018). https://doi.org/10.1007/s00520-017-3991-2

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  • DOI: https://doi.org/10.1007/s00520-017-3991-2

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