HIIT rapidly improves fitness in patients awaiting surgery for urological cancer
What’s the issue?
Cancers of the prostate, kidney and bladder are common in the UK, with over 69,000 new diagnoses each year. Surgery carries a high risk of complications. Many patients struggle to get back to their former levels of physical ability, with a knock-on effect on their quality of life.
Clinicians are aware of the importance of prehabilitation to optimise patients’ overall health before surgery. Previous work1 has suggested that improving cardiorespiratory fitness before surgery reduces the risk of complications, increases quality of life after surgery, and improves long-term survival rates.
In the UK, the National Cancer Action Team states that initial treatment should take place within 31 days of the decision to treat. This leaves only a small window in which prehabilitation can take place.
Previous studies2 have found that High Intensity Interval Training (HIIT) can improve the health of patients with certain cancer types over short time periods. However, within urology, most prehabilitation studies have focused on reducing specific complications, such as urinary incontinence, rather than general fitness.
This study aimed to assess whether HIIT could improve cardiorespiratory fitness within four weeks in patients with urological cancers awaiting surgery. The authors examined the effect of HIIT on blood pressure, body composition, and muscle structure. Once the exercise regime was completed, patients were asked whether they enjoyed taking part.
This randomised controlled trial included 34 cancer patients over the age of 65 who were scheduled for major urological surgery. Most patients completed between 10 and 12 HIIT sessions on an exercise bicycle in a university laboratory. Patients completed five bursts of exercise, each of one minute. They all achieved more than 85 per cent of their maximum predicted heart rate during the sessions. They rated the exercise protocol as highly acceptable and enjoyable.
There are over 69,000 new diagnoses of prostate, kidney and bladder cancers in the UK each year
After 31 days, the authors identified a meaningful improvement in cardiorespiratory fitness for the patients taking part in HIIT, versus those undergoing standard care in the control group.
The study reports improvements in:
- the volume of oxygen consumed at the anaerobic threshold (VO2AT)
- the volume of oxygen consumed at the maximal exertion during the test (VO2PEAK )
The authors also found:
- a reduction in blood pressure (systolic blood pressure: -8.2 mmHg; diastolic blood pressure: -6.47 mmHg)
- an increase in the muscle fibre quality and thickness of the vastus lateralis
Why is this important?
Within a month, this HIIT regime improved cardiorespiratory fitness, cardiovascular health, and muscle condition. This makes the protocol a feasible prehabilitation tool in the 31-day target window between cancer diagnosis and treatment.
Further research is required to assess patient outcomes after surgery. But the authors suggest that the reported improvements in physical fitness could help reduce medical problems and deaths related to surgery and speed up patients’ subsequent recovery.
Comparing the results of this study with other prehabilitation exercise research suggests that HIIT could deliver greater improvements in fitness than other approaches such as walking and traditional aerobic exercise.
The HIIT protocol followed here – carried out in a laboratory setting with a doctor present – is unlikely to be delivered in a real-world setting. The authors note that it may be difficult to ensure exercise intensity and compliance in unsupervised training.
The authors hope that larger, randomised trials will provide firmer links between HIIT and improved outcomes after cancer surgery.
Further research is also required to:
- examine the responses of other patient groups – including different age groups, patients who also have other
- conditions (comorbidities), and patients with other cancer types
- establish optimal exercise methods
- work out how best to roll out HIIT to large numbers of patients
- take into account dietary intake and habitual activity levels
The study was part of a larger project, which is analysing muscle biopsy samples. This ongoing research aims to deepen understanding of the biological mechanisms behind the improvements reported here.
You may be interested to read
- The full NIHR Alert and additional expert commentary published on 5 June
- The full paper: Blackwell JEM, and others. Prostate Cancer and Prostatic Diseases 2020 (online ahead of print)
Macmillan Cancer Support:
Conflict of interest
- The authors have declared that no competing interests exist.
- This research was supported by the NIHR Biomedical Research Centre in Nottingham.
Tom Cave, adult therapies oncology and haematology pathway lead and physiotherapist, University Hospitals Bristol and Weston NHS Trust
Prehabilitation is gaining credibility for those undergoing cancer surgery, however evidence for its impact upon outcomes for those with urological cancers remains sparse.
This NIHR Alert adds credence to the use of High Intensity Interval Training (HIIT) sessions to improve aerobic fitness and muscle mass for this cohort of patients, but further studies are necessary to establish specific protocols and empirical evidence.
As a cancer physiotherapist this study poses further questions. We know concordance for exercise interventions outside the supervised environment tends to diminish. How to best develop and deliver HIIT prehabilitation within the current social distancing limitations of our ‘pandemic health service’ remains an unanswered question.
This Alert highlights the benefits for a surgical cohort. However, significant numbers of cancer patients never come under the knife so should we as physiotherapists be taking the opportunity to intervene with all patients regardless of their treatment pathway?
As Sallis (2009) suggested ‘If we had a pill that conferred all the confirmed health benefits of exercise, would we not do everything humanly possible to see to it that everyone had access to this wonder drug?’
Sallis RE. Exercise is medicine and physicians need to prescribe it! British Journal of Sports Medicine. 2009
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