Shaping Up for Surgery: Study Shows Muscle Power Pays Off

Kate Johnson

March 21, 2016

MUNICH — Completing a light, 30-minute home-exercise program daily for 10 days before undergoing a radical cystectomy can significantly improve patients' muscle strength, according to an analysis of data from a randomized clinical trial.

"We have shown that it is actually possible to improve physical capacity, even in a short-term program, which is the reality in clinical practice," said lead investigator Bente Thoft Jensen, PhD, MPH, RN, from Aarhus University Hospital in Denmark.

Dr Jensen presented these latest results here at European Association of Urology 2016 Congress. They were simultaneously published online March 10 in Supportive Care in Cancer.

The prospective study was conducted in 107 patients (age range, 46 - 91 years) with invasive bladder cancer who were awaiting radical cystectomy. They were randomized to the exercise intervention (n = 50) or to standard care (n = 57).

The exercise program, prescribed by a physiotherapist, had endurance, strength, and cardio components, and targeted muscles involved in mobilization, such as getting in and out of bed or a chair, climbing stairs, and walking.

All patients were assessed at baseline (2 weeks before the scheduled surgery) and the day before surgery. Patients in the intervention group had an increase of 18% in muscle capacity compared with baseline (P < .002), and had significantly more muscle capacity (0.3 watt/kg) than those in the control group (P < .006).

Although this analysis did not measure postsurgical outcomes, Dr Jensen said previous work by her group showed that the increased muscle is associated with benefits. Her team has previously published results from this same study of 107 patients which looked at postsurgery recovery.

Dr Jensen told Medscape Medical News that "according to the Katz Index of Independence in Activities of Daily Living Scale, the intervention group was fully mobilized at 3 days postsurgery compared with 4 days in the standard group (P < .05)" (Scand J Urol. 2015;49:133-141).

Although this earlier mobilization did not translate to decreased hospital stay, there were other advantages in terms of health-related quality-of-life scores in dyspnea (P ≤ .05), constipation (P < .02), and abdominal flatulence (P ≤ .05) (J Multidiscip Healthc. 2014;7:301-311).

The lack of reduction in hospital stay may have been due to lack of power, commented Jonas Hugosson, MD, from the University of Gothenburg in Sweden, who chaired the session.

"I think they are on the right track and I hope they continue," he told Medscape Medical News. "I think complications are mainly driven by other risk factors, such as age, comorbidity, and things that happen during surgery, but if you have a complication, I think you're much better if you're fit."

Dr Jensen added that she believes length of hospital stay "is not a good outcome parameter unless there are defined discharge criteria. Length of stay can be biased for many reasons (home care problems, social problems, etc.) and is not exact. We should focus more on other outcomes concerning recovery and rehab."

Dr Jensen and Dr Hugosson have disclosed no relevant financial relationships..

European Association of Urology (EAU) 2016 Congress: Abstract 332. Presented March 13, 2016.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.