Abstract
ObjectivesTo assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks.Subjects/patients and methodsA randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO2AT) following HIIT vs. standard care.ResultsForty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO2AT; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25–3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: −8.2 mmHg (95% CI −16.09 to −0.29) and DBP: −6.47 mmHg (95% CI −12.56 to −0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%.ConclusionsHIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable pre-operative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socio-economic impact and long-term survival.
Highlights
Urological malignancy is common, with over 69,000 new diagnoses for prostate, kidney and bladder cancer in 2015 in the United Kingdom (UK) alone [1]
Based on all study participants who completed both pre and post intervention Cardiopulmonary exercise testing (CPET), there was a significant improvement in VO2AT (mean difference (MD) 2.26 ml/kg/min) and VO2PEAK (MD 2.16 ml/kg/min) following high-intensity interval training (HIIT) (Fig. 2)
There was a statistically significant reduction in resting blood pressure (BP) parameters following: HIIT (systolic blood pressure (SBP): −8.2 mmHg, diastolic blood pressure (DBP): −6.47 mmHg) with no change in either parameter in the control group (CON) group (Fig. 3))
Summary
Urological malignancy is common, with over 69,000 new diagnoses for prostate, kidney and bladder cancer in 2015 in the United Kingdom (UK) alone [1]. Surgery for these cancers is associated with high complication rates (cystectomy 56%, nephrectomy 21%, prostatectomy 19%) [2] and survivors commonly experience fatigue, reduced physical ability and reduced quality of life [3]. Only 30% of survivors have returned to baseline levels of physical function at 3 months after radical prostatectomy. Recent work has suggested that measures of surgical success should include return to pre-operative levels of quality of life and physical function [8]
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