Highlights | Exercise as an intervention
- Patients with bladder cancer are typically older and tend to have multiple comorbidities.
- Regular exercise may help patients with bladder cancer better tolerate treatment.
- The Get Moving program tests whether digital patient-facing tools can help improve outcomes for patients with bladder cancer.
Can prescribed exercise improve results for patients with bladder cancer? Three UW Medicine researchers are working to find out.
Cancer has a profound effect on public health in the United States. In 2022 alone, there were 1.9 million newly diagnosed cases of all types of cancer, resulting in 609,360 deaths. Research suggests frequent exercise may reduce risks of cancer, help cancer survivors and potentially even help patients diagnosed with cancer tolerate treatment better.
“Patients with bladder cancer are commonly older and have several other issues that make it harder for them to handle the treatments we have to offer,” says Sarah Psutka, MD, associate professor of Urology at the UW School of Medicine and a urologic oncologist at UW Medicine. “Exercise is a potential tool we can leverage to make them a better candidate for treatment and maybe even boost their abilities to tolerate treatment and thrive in therapy.”
Psutka and her co-investigators Cindy Lin, MD, director of clinical innovation for The Sports Institute at UW Medicine, and Hanna Hunter, MD, medical director of cancer rehabilitation at Fred Hutchinson Cancer Center, recently received a $1.1 million grant from the Bladder Cancer Advocacy Network to launch the Get Moving Trial. This study will examine how a personalized exercise prescription delivered by an innovative digital exercise tool, ExerciseRx, specifically affects outcomes for patients undergoing treatment for bladder cancer.
Why bladder cancer and exercise?
Bladder cancer accounts for roughly 5% of all diagnosed cancer cases in the United States. The American Cancer Society estimates there will be 83,190 new cases of bladder cancer in 2024 and 16,840 related deaths.
With the average age for a bladder cancer diagnosis being 73, sarcopenia, or age-related loss of muscle mass and strength, is quite common. Patients with bladder cancer may also have several other chronic conditions. Consequently, they have more difficulty tolerating bladder cancer treatments, including chemotherapy, abdominal surgery to remove the bladder and other pelvic organs, and urinary tract reconstruction.
Hunter says exercise during the treatment process can potentially produce positive outcomes for patients.
“We have general ideas of the benefits of exercise during cancer treatment, but we’re still learning the amount, the frequency, and the type of exercise that offers the most benefit,” she says. “We do know exercise and physical activity during treatment not only help maintain strength but can also improve fatigue, mood and quality of life.”
How do providers prescribe and track a patient’s exercise? That’s where ExerciseRx comes in.
The role of ExerciseRx
ExerciseRx is a unique digital tool developed through a partnership between The Sports Institute at UW Medicine, UW Ubiquitous Computing Lab and UW Human Centered Design and Engineering. The research app aims to make physical activity and rehabilitation more accessible to patients as part of routine care, Lin says.
A link between a provider dashboard and a patient-facing app lets providers recommend exercises and movement goals before and during cancer treatments. ExerciseRx uses personal smartphone or fitness tracker devices to capture specific information about each patient’s physical activity, such as step count and completed exercises.
“Low-cost, patient-centric, and home-based activity options are not readily available to patients, and it’s often a missing piece in treatment and recovery,” says Lin. “ExerciseRx meets that need.”
For this project, the investigators will focus on patients with muscle-invasive bladder cancer — when tumors spread into or through the muscle of the bladder wall. All patients will be undergoing chemotherapy and bladder removal (cystectomy). The researchers will monitor improvements in strength and stamina from the start of chemotherapy until three months after surgery.
The team will evaluate whether the integrated digital health program reduces adverse events during treatment and how it impacts physical function, hospital length of stay, frailty, quality of life and body composition.
“We hope to demonstrate that we can prescribe personalized exercise programs for patients using ExerciseRx without additional healthcare visits or going to physical therapy that financial and time constraints can limit,” Hunter says.
Expanding exercise impact
Psutka notes a growing interest among cancer care experts and patients in exercise-based interventions and prehabilitation (improving mobility before surgery).
Through a partnership with the Bladder Cancer Advocacy Network, the team has connected with physicians, scientists and patients to expand awareness of their initiative. They hope to create multicenter databases that will evaluate various prehabilitation interventions.
“We are working to develop an exercise prescription tool to expand our precision medicine approach to prehabilitation in a pragmatic and scalable way. Importantly, we want it to be inclusive and generalizable,” Psutka says. “We need to be able to offer prehabilitation to all patients, especially those with baseline frailty and physical restrictions.”
