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Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial.
Surg Oncol 2018; 27(2):289-298SO

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.

Authors+Show Affiliations

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.Cancer Rehabilitation and Survivorship, University Health Network, Toronto, Ontario, Canada.Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada.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; Division of Urology Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada.Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Urology Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada.Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada.Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, Division of Urology, McGill University, Quebec, Canada.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.

Pub Type(s)

Clinical Trial, Phase II
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

29937184

Citation

Santa Mina, Daniel, et al. "Prehabilitation for Radical Prostatectomy: a Multicentre Randomized Controlled Trial." Surgical Oncology, vol. 27, no. 2, 2018, pp. 289-298.
Santa Mina D, Hilton WJ, Matthew AG, et al. Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial. Surg Oncol. 2018;27(2):289-298.
Santa Mina, D., Hilton, W. J., Matthew, A. G., Awasthi, R., Bousquet-Dion, G., Alibhai, S. M. H., ... Carli, F. (2018). Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial. Surgical Oncology, 27(2), pp. 289-298. doi:10.1016/j.suronc.2018.05.010.
Santa Mina D, et al. Prehabilitation for Radical Prostatectomy: a Multicentre Randomized Controlled Trial. Surg Oncol. 2018;27(2):289-298. PubMed PMID: 29937184.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial. AU - Santa Mina,Daniel, AU - Hilton,William J, AU - Matthew,Andrew G, AU - Awasthi,Rashami, AU - Bousquet-Dion,Guillaume, AU - Alibhai,Shabbir M H, AU - Au,Darren, AU - Fleshner,Neil E, AU - Finelli,Antonio, AU - Clarke,Hance, AU - Aprikian,Armen, AU - Tanguay,Simon, AU - Carli,Franco, Y1 - 2018/05/07/ PY - 2018/03/08/received PY - 2018/04/13/revised PY - 2018/05/03/accepted PY - 2018/6/26/entrez PY - 2018/6/26/pubmed PY - 2018/11/2/medline KW - Exercise KW - Prehabilitation KW - Prostate cancer KW - Radical prostatectomy KW - Surgery SP - 289 EP - 298 JF - Surgical oncology JO - Surg Oncol VL - 27 IS - 2 N2 - 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. SN - 1879-3320 UR - https://www.unboundmedicine.com/medline/citation/29937184/Prehabilitation_for_radical_prostatectomy:_A_multicentre_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0960-7404(18)30098-7 DB - PRIME DP - Unbound Medicine ER -