Daniel Santa Mina1, William J Hilton2, Andrew G Matthew3, Rashami Awasthi4, Guillaume Bousquet-Dion4, Shabbir M H Alibhai5, Darren Au6, Neil E Fleshner7, Antonio Finelli7, Hance Clarke8, Armen Aprikian9, Simon Tanguay10, Franco Carli11. 1. Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Cancer Rehabilitation and Survivorship, University Health Network, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: daniel.santamina@utoronto.ca. 2. Cancer Rehabilitation and Survivorship, University Health Network, Toronto, Ontario, Canada. 3. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada. 5. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada. 6. Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Cancer Rehabilitation and Survivorship, University Health Network, Toronto, Ontario, Canada. 7. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Urology Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada. 8. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada. 9. Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada. 10. Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, Division of Urology, McGill University, Quebec, Canada. 11. Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, Division of Urology, McGill University, Quebec, Canada; Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Abstract
INTRODUCTION: Preoperative exercise and fitness are predictors of surgical recovery; however, little is known of the effect of preoperative exercise-based conditioning, known as prehabilitation, in this for men undergoing radical prostatectomy. Our study examined the feasibility and effects of prehabilitation on perioperative and postoperative outcomes in men undergoing radical prostatectomy. METHODS: This feasibility RCT compared prehabilitation (PREHAB) versus a control condition (CON) in 86 men undergoing radical prostatectomy. PREHAB consisted of home-based, moderate-intensity exercise prior to surgery. Both groups received a preoperative pelvic floor training regimen. Feasibility was assessed via rates of recruitment, attrition, intervention duration and adherence, and adverse events. Clinical outcomes included surgical complications, and length of stay. The following outcomes were assessed at baseline, prior to surgery, and 4, 12, and 26-weeks postoperatively: 6-min walk test (6MWT), upper-extremity strength, quality of life, psychosocial wellbeing, urologic symptoms, and physical activity volume. RESULTS: The recruitment rate was 47% and attrition rates were 25% and 33% for PREHAB and CON, respectively. Adherence to PREHAB was 69% with no serious intervention-related adverse events. After the intervention and prior to surgery, PREHAB participants demonstrated less anxiety (P = 0.035) and decreased body fat percentage (P = 0.001) compared to CON. Four-weeks postoperatively, PREHAB participants had greater 6MWT scores of clinical significance compared to CON (P = 0.006). Finally, compared to CON, grip strength and anxiety were also greater in the PREHAB at 26-weeks (P = 0.022) and (P = 0.025), respectively. CONCLUSION: While feasible and safe, prehabilitation has promising benefits to physical and psychological wellbeing at salient timepoints relative to radical prostatectomy.
RCT Entities:
INTRODUCTION: Preoperative exercise and fitness are predictors of surgical recovery; however, little is known of the effect of preoperative exercise-based conditioning, known as prehabilitation, in this for men undergoing radical prostatectomy. Our study examined the feasibility and effects of prehabilitation on perioperative and postoperative outcomes in men undergoing radical prostatectomy. METHODS: This feasibility RCT compared prehabilitation (PREHAB) versus a control condition (CON) in 86 men undergoing radical prostatectomy. PREHAB consisted of home-based, moderate-intensity exercise prior to surgery. Both groups received a preoperative pelvic floor training regimen. Feasibility was assessed via rates of recruitment, attrition, intervention duration and adherence, and adverse events. Clinical outcomes included surgical complications, and length of stay. The following outcomes were assessed at baseline, prior to surgery, and 4, 12, and 26-weeks postoperatively: 6-min walk test (6MWT), upper-extremity strength, quality of life, psychosocial wellbeing, urologic symptoms, and physical activity volume. RESULTS: The recruitment rate was 47% and attrition rates were 25% and 33% for PREHAB and CON, respectively. Adherence to PREHAB was 69% with no serious intervention-related adverse events. After the intervention and prior to surgery, PREHAB participants demonstrated less anxiety (P = 0.035) and decreased body fat percentage (P = 0.001) compared to CON. Four-weeks postoperatively, PREHAB participants had greater 6MWT scores of clinical significance compared to CON (P = 0.006). Finally, compared to CON, grip strength and anxiety were also greater in the PREHAB at 26-weeks (P = 0.022) and (P = 0.025), respectively. CONCLUSION: While feasible and safe, prehabilitation has promising benefits to physical and psychological wellbeing at salient timepoints relative to radical prostatectomy.
Authors: Clarice Y Tang; Monica Turczyniak; Alesha Sayner; Kimberley Haines; Sally Butzkueven; Helen E O'Connell Journal: Support Care Cancer Date: 2020-02-18 Impact factor: 3.603
Authors: Sean F Mungovan; Sigrid V Carlsson; Gregory C Gass; Petra L Graham; Jaspreet S Sandhu; Oguz Akin; Peter T Scardino; James A Eastham; Manish I Patel Journal: Nat Rev Urol Date: 2021-04-08 Impact factor: 14.432
Authors: J E M Blackwell; B Doleman; C L Boereboom; A Morton; S Williams; P Atherton; K Smith; J P Williams; B E Phillips; J N Lund Journal: Prostate Cancer Prostatic Dis Date: 2020-03-10 Impact factor: 5.554