Association between physical function before radical cystectomy for urinary bladder cancer and recovery after discharge from hospital

Authors

  • Simon Torikka Suua Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden https://orcid.org/0009-0009-5527-7860
  • Andrea Porserud Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0001-9144-7905
  • Malin Nygren-Bonnier Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0001-6731-8468
  • Maria Hagströmer Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden https://orcid.org/0000-0002-4607-8677

DOI:

https://doi.org/10.2340/sju.v60.43992

Keywords:

Abdominal surgery, activity monitor, cancer rehabilitation, physiotherapy, recovery

Abstract

Objective

This study aimed to evaluate the association between physical function before surgery and recovery measured as physical activity in daily life after discharge from the hospital.

Material and methods

In total, 105 patients undergoing robot-assisted radical cystectomy were included, based on preoperative and baseline measurements taken before the intervention from a randomised controlled trial. Physical function was assessed the day before surgery using Six-minute Walk test for functional capacity and 30-second chair stand test for lower body strength. Recovery was evaluated during the week after discharge by measuring daily physical activity, including daily steps, brisk walking, sedentary time, and sit-to-stand transitions, using an accelerometer (activPAL3 micro activity monitor). Multiple regression analysis was performed to evaluate the association, adjusting for age, sex, and American Society of Anaesthesiologists score.

Results

Analysis included 73 participants with valid measurements for both physical function and recovery. A significant positive association was observed between functional capacity and daily steps, with a 100-meter increase in walking distance associated with approximately 600 additional steps per day (95% CI: 0.53-11.29). The association between functional capacity and sit-to-stand transitions approached significance (β = 0.05; 95% CI: -0.001-0.09). No significant associations were observed between physical function and brisk walking or sedentary time, nor between lower body strength and any recovery outcomes.

Conclusions

Higher functional capacity is associated with higher recovery levels, as measured by physical activity after hospital discharge using activity monitors. The findings indicate that interventions aimed at improving physical function before robot-assisted radical cystectomy may enhance recovery.

Keywords: Abdominal surgery, activity monitor, cancer rehabilitation, physiotherapy, recovery.

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References

Ullén A, Aljabery F, Dahlman P, et al. Swedish national guidelines on urothelial carcinoma: 2024 update on advanced and metastatic disease. Scand J Urol. 2025;60:76–82. https://doi.org/10.2340/sju.v60.43236 DOI: https://doi.org/10.2340/sju.v60.43236

Venkatramani V, Reis IM, Gonzalgo ML, et al. Comparison of robot-assisted and open radical cystectomy in recovery of patient-reported and performance-related measures of independence: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2022;5(2):e2148329. https://doi.org/10.1001/jamanetworkopen.2021.48329 DOI: https://doi.org/10.1001/jamanetworkopen.2021.48329

Novara G, Catto JW, Wilson T, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67(3):376–401. https://doi.org/10.1016/j.eururo.2014.12.007 DOI: https://doi.org/10.1016/j.eururo.2014.12.007

Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS(®) Society Recommendations: 2018. World J Surg. 2019;43(3):659–695. https://doi.org/10.1007/s00268-018-4844-y DOI: https://doi.org/10.1007/s00268-018-4844-y

Zhou Y, Li R, Liu Z, et al. The effect of the enhanced recovery after surgery program on radical cystectomy: a meta-analysis and systematic review. Front Surg. 2023;10:1101098. https://doi.org/10.3389/fsurg.2023.1101098 DOI: https://doi.org/10.3389/fsurg.2023.1101098

Hendry PO, Hausel J, Nygren J, et al. Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg. 2009;96(2):197–205. https://doi.org/10.1002/bjs.6445 DOI: https://doi.org/10.1002/bjs.6445

Neville A, Lee L, Antonescu I, et al. Systematic review of outcomes used to evaluate enhanced recovery after surgery. Br J Surg. 2014;101(3):159–170. https://doi.org/10.1002/bjs.9324 DOI: https://doi.org/10.1002/bjs.9324

Abeles A, Kwasnicki RM, Pettengell C, et al. The relationship between physical activity and post-operative length of hospital stay: a systematic review. Int J Surg. 2017;44:295–302. DOI: https://doi.org/10.1016/j.ijsu.2017.06.085

Allvin R, Svensson E, Rawal N, et al. The Postoperative Recovery Profile (PRP) – a multidimensional questionnaire for evaluation of recovery profiles. J Eval Clin Pract. 2011;17(2):236–243. https://doi.org/10.1111/j.1365-2753.2010.01428.x DOI: https://doi.org/10.1111/j.1365-2753.2010.01428.x

Makker PGS, Koh CE, Solomon MJ, et al. Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta-analysis. ANZ J Surg. 2022;92(7–8):1658–1667. https://doi.org/10.1111/ans.17577 DOI: https://doi.org/10.1111/ans.17577

Argillander TE, Heil TC, Melis RJF, et al. Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: a systematic review. Eur J Surg Oncol. 2022;48(3):570–581. https://doi.org/10.1016/j.ejso.2021.09.019 DOI: https://doi.org/10.1016/j.ejso.2021.09.019

Porserud A, Karlsson P, Aly M, et al. Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial. BMC Cancer. 2024;24(1):891. https://doi.org/10.1186/s12885-024-12647-2 DOI: https://doi.org/10.1186/s12885-024-12647-2

Porserud A, Karlsson P, Rydwik E, et al. The CanMoRe trial – evaluating the effects of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer: the study protocol of a randomised controlled trial. BMC Cancer. 2020;20(1):805. https://doi.org/10.1186/s12885-020-07140-5 DOI: https://doi.org/10.1186/s12885-020-07140-5

Ryan CG, Grant PM, Tigbe WW, et al. The validity and reliability of a novel activity monitor as a measure of walking. Br J Sports Med. 2006;40(9):779–784. https://doi.org/10.1136/bjsm.2006.027276 DOI: https://doi.org/10.1136/bjsm.2006.027276

Grant PM, Dall PM, Mitchell SL, et al. Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults. J Aging Phys Act. 2008;16(2):201–214. https://doi.org/10.1123/japa.16.2.201 DOI: https://doi.org/10.1123/japa.16.2.201

American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-117. https://doi.org/10.1164/ajrccm.166.1.at1102 DOI: https://doi.org/10.1164/ajrccm.166.1.at1102

Schmidt K, Vogt L, Thiel C, et al. Validity of the six-minute walk test in cancer patients. Int J Sports Med. 2013;34(7):631–636. https://doi.org/10.1055/s-0032-1323746 DOI: https://doi.org/10.1055/s-0032-1323746

Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–119. https://doi.org/10.1080/02701367.1999.10608028 DOI: https://doi.org/10.1080/02701367.1999.10608028

Snowden CP, Prentis J, Jacques B, et al. Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people. Ann Surg. 2013;257(6):999–1004. https://doi.org/10.1097/SLA.0b013e31828dbac2 DOI: https://doi.org/10.1097/SLA.0b013e31828dbac2

Karlsson E, Egenvall M, Farahnak P, et al. Better preoperative physical performance reduces the odds of complication severity and discharge to care facility after abdominal cancer resection in people over the age of 70 – a prospective cohort study. Eur J Surg Oncol. 2018;44(11):1760–1767. DOI: https://doi.org/10.1016/j.ejso.2018.08.011

van der Meij E, van der Ploeg HP, van den Heuvel B, et al. Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study. BMC Surg. 2017;17(1):56. https://doi.org/10.1186/s12893-017-0223-0 DOI: https://doi.org/10.1186/s12893-017-0223-0

Porserud A, Aly M, Nygren-Bonnier M, et al. Objectively measured mobilisation is enhanced by a new behaviour support tool in patients undergoing abdominal cancer surgery. Eur J Surg Oncol. 2019;45(10):1847–1853. https://doi.org/10.1016/j.ejso.2019.04.013 DOI: https://doi.org/10.1016/j.ejso.2019.04.013

Bor P, de Leeuwerk ME, Valkenet K, et al. Physical functioning and physical activity after gastrointestinal or bladder oncological surgery: an observational cohort study. Eur J Cancer Care (Engl). 2022;31(6):e13739. https://doi.org/10.1111/ecc.13739 DOI: https://doi.org/10.1111/ecc.13739

Karlsson P, Nygren-Bonnier M, Torikka S, et al. Patients´ experiences of an exercise intervention in primary care following robot-assisted radical cystectomy due to bladder cancer: a qualitative study. BMC Cancer. 2024;24(1):1306. https://doi.org/10.1186/s12885-024-13059-y DOI: https://doi.org/10.1186/s12885-024-13059-y

Liedberg F, Hagberg O, Aljabery F, et al. Cystectomy for bladder cancer in Sweden – short-term outcomes after centralization. Scand J Urol. 2024;59:84–89. https://doi.org/10.2340/sju.v59.40120 DOI: https://doi.org/10.2340/sju.v59.40120

Cooke R, Jones A. Recruiting adult participants to physical activity intervention studies using sport: a systematic review. BMJ Open Sport Exerc Med. 2017;3(1):e000231. https://doi.org/10.1136/bmjsem-2017-000231 DOI: https://doi.org/10.1136/bmjsem-2017-000231

Karlsson E, Franzén E, Nygren-Bonnier M, et al. Short-term postoperative physical decline and patient-reported recovery in people aged 70 or older undergoing abdominal cancer resection- A prospective cohort study. J Geriatr Oncol. 2019;10(4):610–617. https://doi.org/10.1016/j.jgo.2019.01.004 DOI: https://doi.org/10.1016/j.jgo.2019.01.004

Garcia DO, Thomson CA. Physical activity and cancer survivorship. Nutr Clin Pract. 2014;29(6):768–779. https://doi.org/10.1177/0884533614551969 DOI: https://doi.org/10.1177/0884533614551969

Rammant E, Decaestecker K, Bultijnck R, et al. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil. 2018;32(5):594–606. https://doi.org/10.1177/0269215517746472 DOI: https://doi.org/10.1177/0269215517746472

Jensen BT, Lauridsen SV, Jensen JB. Prehabilitation for major abdominal urologic oncology surgery. Curr Opin Urol. 2018;28(3):243–250. https://doi.org/10.1097/MOU.0000000000000487 DOI: https://doi.org/10.1097/MOU.0000000000000487

Additional Files

Published

2025-07-27

How to Cite

Torikka Suua, S., Porserud, A., Nygren-Bonnier, M., & Hagströmer, M. (2025). Association between physical function before radical cystectomy for urinary bladder cancer and recovery after discharge from hospital. Scandinavian Journal of Urology, 60, 135–140. https://doi.org/10.2340/sju.v60.43992

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