Abstract
PURPOSE: Operations for urological malignancy are increasing in number and complexity due to the advancing age of patients with multiple comorbidities. Low pre-operative cardiorespiratory fitness (CRF) and muscle mass, are both associated with increased peri-operative morbidity and mortality, as well as poorer post-operative outcomes and delayed return normal activities. High intensity interval training (HIIT) may represent an efficacious training modality to rapidly improve CRF and body composition in the short clinically-dictated time-frame between diagnosis and surgery. METHODS: Forty patients (mean: 71 years, 98% male) were recruited at diagnosis of urological cancer. Patients providing written informed consent were to randomisation to either HIIT prehabilitation ((HIIT): 12 sessions of 5 x 1-min exertions, 3 sessions/week) or usual care (control (CON)). Patients underwent cardiopulmonary exercise testing (CPET), dual-energy X-ray absorptiometry (DXA) scans and muscle architecture assessments using B-mode ultrasonography before and after a 28-day intervention period. Vastus lateralis (VL) muscle biopsies were also taken at both time-points. Statistical analysis, using ANCOVA, compared the effects of HIIT versus CON. RESULTS: HIIT elicited a clinically significant improvement in CPET-derived measures of anaerobic threshold (2.16 ml/kg/min (95% CI: 0.24 to 4.08), VO2PEAK (2.26 ml/kg/min (95% CI: 1.25 to 3.26) and wattage at failure (12.86 W (95% CI: 5.52 to 20.19) vs. CON. Resting blood pressure (BP) decreased (vs. CON) with HIIT (systolic: -8.2 mmHg (95% CI -16.1 to -0.3), diastolic: -6.5 mmHg (95% CI -12 to -0.4)). There were no differences in whole-body composition changes between the groups, despite HIIT eliciting preferential gains in VL muscle thickness 0.22 mm (95% CI 0.02 to 0.41) and pennation angle 2.49 degrees (95% CI 0.42 to 4.55). HIIT was well-tolerated and safely delivered within this cohort. CONCLUSIONS: CRF, BP and muscle architecture parameters can be significantly improved with 4 weeks low-volume HIIT in urological cancer patients awaiting surgery. Mass-spectrometry analysis of muscle biopsies from this patient cohort will help elucidate the relative contribution of changes in mitochondrial and/or myofibrillar muscle protein metabolism in achieving these gains.
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