Exercise as it relates to Disease/The Effects of Physical Activity after Urinary Cancer Surgery

Porserud, Sherif, and Tollback’s research published in Clinical Rehabilitation in 2014 explores the effects of physical exercise on patients aged 60–80 who had recently undergone a radical cystectomy as a method of treatment for urinary bladder cancer. This has been created by u3110341.

Background
A predictor of longer survival in patients with urinary bladder cancer is high physical activity, and it is seen to increase the quality of life of many patients. Following a radical cystectomy in patients with invasive urinary bladder cancer the survival rate as seen in 66-68% of male patients and 58-66% of female patients is five years.

Credibility of the Study
The Karolinska University Hospital has seen over 22,000 papers published since its establishment in 2004. While the three authors; Andrea Porserud, Amir Sherif, and Anna Tollbäck are all reputable within their fields and have a significant number of papers published between them. The authors stated in the paper that no conflict of interest or funding biases were present to their knowledge.

Type of Research
The study conducted was a randomised controlled trial (RCT). Eighteen patients were allocated to either an intervention group or a control group. This is an effective study method as the randomisation of patients reduces any bias, and with a larger sample size creates a good sample of the population.

Methods
The study was conducted over 2 years, from 2008 to 2010. Patients aged 60 to 80 who had undergone a radical cystectomy as the result of having urinary bladder cancer received an invitation to participate in the RCT.

After their surgery, all patients received verbal and written communication regarding the necessity of daily walks and avoidance of heavy lifting.


 * Baseline data measurements were conducted within 7 days after discharge.
 * Patients were randomly allocated to the intervention or control group, this was done by picking cards out of an envelope.
 * 45-minute group exercise training programs were held at the Karolinska University Hospital twice a week for those in the intervention group. This consisted of a variety of exercises targeting endurance, strength, balance, mobility, and flexibility.
 * Participants of the control group were also asked to walk for at least 15 minutes at a self-chosen pace three to five days each week.
 * Patients of the control group received no further guidance than what was provided to them on their discharge from hospital.
 * A physiotherapist conducted a number of tests to evaluate endurance, strength, balance, mobility, and flexibility of all participants. These tests were conducted 14 weeks post baseline measurement and one year post surgery

Limitations of the study
The small sample size of the study does not provide adequate information from which relevant statistical data can be extrapolated. It is addressed in the paper that for the results to be statistically relevant, each group, the control and the intervention, should have a minimum of 23 individuals each.

While a RCT lowers the risk of bias in participants, this study was conducted as a single blind experiment, rather than a double blind, so patients were still aware of which experimental group they were a part of, this may have influenced some bias in a number of patients.

Being an exercise study, the participants were aware if they were in the exercise group or the control group. Perhaps a way to combat this in future is to have participants record how much exercise they are regularly doing prior to surgery and have the control group almost complete an exercise program that is in line with the average amount of exercise done in participants prior to surgery.

The study also relied on patient to self-report data, it is well known that self-reported data is often inaccurate, especially in the case of exercise where individuals often over report the amount of exercise they have been partaking in.

Results
The baseline measurements of all participants showed no statistical difference between the data sets of those in the intervention ‘exercise’ group, and those in the control group.

At the 14-week assessment both groups showed an increase in the average distance walked in a six-minute period. At the one-year assessment the intervention group surpassed the control group in their average walking distance in six minutes.

Other tests that were conducted showed no statistical relevance, with values increasing or decreasing minutely from the baseline measurement.

Conclusions
The study displayed that those who completed the exercise program gained endurance as displayed by the six-minute walking test, whereas the control group showed an increase to a much lower extent, however all other areas of exercise testing saw little to no increase in either group.

The small sample size does however render the study inconclusive, especially considering the number of patients who deceased not only prior to the study starting, but after the study had started, where four participants died prior to the 14th week measurement and one more within a year post surgery, as well another 3 who dropped out of the study for other reasons, leaving the intervention group with only 4 participants, and the control with 6.

For the results to be viable, the trial would need to be conducted again with a much larger participant base as well as having some of the previously mentioned limitations addressed.