Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review

Eur Urol. 2022 Feb;81(2):157-167. doi: 10.1016/j.eururo.2021.05.015. Epub 2021 May 29.


Context: The Consensus on Therapeutic Exercise Training (CONTENT) scale assesses the therapeutic validity of exercise programs. To date, prehabilitation exercise programs for heath optimization before urologic cancer surgeries have not been assessed for therapeutic validity or efficacy.

Objective: To systematically assess prehabilitation exercise programs before urologic cancer surgery for therapeutic validity and efficacy, informing discussion of best practices for future intervention.

Evidence acquisition: A systematic review was performed using Ovid, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases through June 2020. The review included prospective (randomized controlled and uncontrolled) trials where patients were enrolled in prehabilitation exercise programs before urologic cancer surgery. The primary outcomes of interest included therapeutic validity and efficacy (measures of cardiorespiratory fitness and postsurgical outcomes). Studies were evaluated for the risk of bias. A narrative synthesis was carried out given heterogeneity in populations, interventions, and outcomes across studies.

Evidence synthesis: Ten unique studies and two associated post hoc analyses met the inclusion criteria. Seven studies demonstrated therapeutic validity. Eight demonstrated a high risk of bias. All demonstrated significant improvement in cardiorespiratory fitness. Four of five studies evaluating quality of life observed significant improvements. To date, zero trials have demonstrated reduction in postsurgical complications, mortality, length of stay, or readmission rates following prehabilitation exercise interventions.

Conclusions: While prehabilitation exercise may result in improved cardiorespiratory fitness and quality of life, current studies have yet to demonstrate impact on surgical outcomes. When designing prehabilitation exercise programs for use before urologic cancer surgery, the therapeutic validity of the intervention should be considered. Future prehabilitation studies should employ standardized content rubrics to ensure therapeutic validity. Consensus is needed regarding the appropriate outcomes to adjudicate prehabilitation efficacy.

Patient summary: In this report, we looked at the effectiveness and quality of prehabilitation exercise programs before urologic cancer surgery. We found that these programs effectively improve presurgical fitness, but may benefit from the use of structured methodology and outcome assessment to understand their potential to improve surgical outcomes.

Keywords: Neoplasms; Perioperative care; Prehabilitation; Preoperative exercise; Urologic surgical procedures.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Exercise
  • Female
  • Humans
  • Male
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Preoperative Care / methods
  • Preoperative Exercise*
  • Prospective Studies
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Urologic Neoplasms* / surgery