Exercise after a Bladder or Kidney Cancer Diagnosis
Creators: Arthuso, Fernanda Z
Publisher: name: University of Alberta Library
Year: 2024

<p>Bladder and kidney cancer are among the eight most common cancers in Canada. Cancer and its treatments affect patient functioning and quality of life. Exercise interventions help many patients with cancer improve health-related fitness, treatment-related side effects, quality of life, and possibly survival; however, limited research has been conducted in patients with bladder and kidney cancer. The overarching goal of this dissertation is to generate new knowledge in the field of exercise oncology in two common, yet understudied genitourinary cancers - bladder and kidney cancer. <br>
Chapter 1 reviews bladder and kidney cancer statistics, pathophysiology, staging, and treatments. Briefly, bladder cancer is classified as muscle-invasive bladder cancer (MIBC) or non-muscle-invasive bladder cancer (NMIBC). MIBC is managed by chemotherapy in combination with bladder-removal surgery. NMIBC is treated with transurethral resection of the bladder tumor followed by induction adjuvant intravesical therapy. Renal cell carcinoma (RCC) is the most common type of kidney cancer. The primary treatment for localized RCC is kidney-removal surgery.<br>
Study 1 (Chapter 2, Paper 1) retrospectively investigated the associations of pre-surgical body mass index (BMI) with bladder cancer outcomes in 488 patients treated with radical cystectomy. Cox regression were used to estimate the hazard ratio (HR). The HR for overweight during the first 63 months was 0.66 (95% CI 0.49–0.90, p=0.008), whereas it was 1.41 (95% CI 0.89–2.23, p=0.14) after 63 months. Although not statistically significant, a similar pattern was observed for obese patients. These data suggest that the obesity paradox in bladder cancer patients treated with radical cystectomy may be short-lived. <br>
Study 2 (Chapter 3, 4, and 5, Papers 2, 3, and 4) was a randomized controlled trial. The Bladder cancer and exeRcise trAining during or after intraVesical thErapy (BRAVE) trial evaluated the feasibility and safety of high-intensity interval training (HIIT) in NMIBC patients during or after intravesical therapy. Secondary aims were 1) to assess the preliminary efficacy of HIIT on cardiorespiratory fitness and physical functioning, and 2) to explore the motivational outcomes, perceived benefits and harms, and perceived barriers to exercise. Patients scheduled to receive intravesical treatment or on surveillance after intravesical treatment for NMIBC were randomly assigned to usual care (UC, n=8) or HIIT (n=13). The HIIT group performed thrice-weekly, supervised HIIT at 75-95% of peak cardiorespiratory fitness (VO2peak) for 12 weeks. In 24 months, 21 out of 129 eligible participants (16.3%) were randomized. Median exercise attendance was 100%, VO2peak increased from baseline to 12 weeks by 1.2 ml/kg/min in the HIIT group but was not significantly higher than the UC group (p=0.33). Compared to the UC group at 12 weeks, the HIIT group significantly improved six-minute walk distance (p=0.034) and time in the 8-foot up-and-go (p=0.039). The HIIT group reported that the exercise was meaningfully (d≥0.33) more enjoyable, elicited higher confidence, and was less difficult than anticipated. Compared to the UC group post-intervention, the HIIT group reported meaningfully lower motivation, lower confidence, and higher difficulty to exercise on their own for the next 6 months. The most common perceived benefits of HIIT included cardiovascular endurance and physical functioning. The most common exercise barriers were being too busy/having limited time. Despite limited accrual, the BRAVE trial demonstrated that HIIT during or after intravesical therapy was feasible and safe for NMIBC patients and resulted in significant improvements in several indicators of physical functioning. Moreover, HIIT was more motivating than anticipated with many perceived benefits and few perceived harms or barriers, however, it appeared to reduce confidence and motivation to exercise on their own over the next 6 months.<br>
Study 3 (Chapter 6, Paper 5) was a scoping review of physical activity in kidney cancer patients. A comprehensive search identified 17 articles from nine independent studies, including one cross-sectional study (n=8 articles), one randomized controlled trial (n=2 articles) and seven cohort studies (n=7 articles). Due to limited evidence, no conclusions can be drawn from current research on the role of physical activity in patients with kidney cancer. <br>
Chapter 7 discusses the strengths and limitations of the dissertation and proposes future directions for research. In summary, this dissertation provides novel findings and important future directions for research examining how exercise could benefit patients with bladder and kidney cancer and ultimately be incorporated into the standard clinical care.</p>