Below the Belt Award

Bladder removal surgery as a treatment for bladder cancer is associated with high complication and hospital re-admission rates, as well as significant risk of morbidity and mortality. This risk is increased for patients with poor physical fitness or overall function. This study will test the benefits of a supervised four-week pre-surgery strength and aerobic exercise program in improving post-surgery outcomes and quality of life. It is the first Australian study to test the feasibility and preliminary effectiveness of pre-surgical exercise with opportunities to then proceed to a larger multicentre Phase III trial. Bladder cancer has a poor 5-year survival rate of 53% compared to other common cancers such as prostate and breast cancer (AIHW, 2017). For those with muscle-invasive bladder cancer the primary treatment is radical cystectomy (RC) which involves the surgical removal of the bladder with lymph node dissection and urinary diversion, and a hospital stay of 1-2 weeks. However, RC is a complex, technically demanding and high-risk surgical procedure which is associated with significant morbidity, readmission rates, and mortality (Smith et al., J Urol 2014). Patients with poor pre-operative cardiopulmonary capacity have a higher risk of complications post-surgery and increased hospital length of stay (Prentis et al., BJU Int 2013). Moreover, given the age of the patients (median age at diagnosis is 76 years) as well as the fact that smoking is a major risk factor, patients may have associated pulmonary and cardiovascular diseases which contribute to poorer overall function and quality of life. As a result, enhancing functional capacity prior to RC may reduce the stress of surgery and attenuate the general deconditioning process in the immediate post-surgical period which may reduce the length of hospital stay, complications, and time to return to usual activities. However, little information is available regarding the feasibility of pre-surgical exercise or the potential beneficial effect that exercise may have prior to surgery in this patient group. Therefore, we propose to undertake a short-term (up to 4 weeks in duration) feasibility and preliminary efficacy exercise trial in men and women scheduled to undergo RC and follow them for 3 months post-surgery. The exercise program will be supervised and consist of resistance and aerobic training undertaken three times per week.