Prehabilitative Versus Rehabilitative Exercise in Prostate Cancer Patients Undergoing Prostatectomy

Abstract

Abstract PURPOSE: The study compared the efficacy of commencing supervised exercise in men with prostate cancer before (Prehab) and after (Rehab) prostatectomy on objective and patient-reported outcomes, hospital length of stay (LOS), and urinary incontinence (UI). METHODS: Forty-one men were randomised to a 6-week Prehab or Rehab exercise programme. Prehabinvolved resistance and aerobic exercise thrice weekly pre-surgery, while Rehabcomprised the same commencing 6-weeks post-surgery. Assessments included strength (1RM), function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition (DXA), fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with UI (24-hr pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. RESULTS: Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, Prehab improved muscle strength (leg press: 17.2kg; chest press: 2.9kg; p≤0.001), 400-m, chair rise, 6-m fast and backward walk tests (p<0.001–0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehab showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6kg, p<0.001; chest press: 6.8kg, p<0.001; 400-m walk: -12.0sec, p=0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital LOS or UI. CONCLUSION: Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. Trial registration: ACTRN12617001115325. Registered 31 July 2017.