Structured step-based prehabilitation before radical cystectomy and its impact on postoperative recovery and perioperative burden: Interim analysis of the PRACTICE randomized trial (NCT06806059).

Abstract

662 Background: Radical cystectomy (RC) is associated with substantial morbidity, functional decline, and impaired quality of life (QoL). Prehabilitation through structured physical activity may enhance surgical resilience, but evidence in uro-oncology is scarce. The ongoing bi-center PRACTICE randomized controlled trial evaluates whether a simple, step-based walking intervention can improve perioperative, functional, and patient-reported outcomes after RC. Methods: Patients scheduled for RC were randomized 1:1 to an intervention group (daily walking goal 8,000–10,000 steps) or a control group without a step target. All participants wore activity trackers from randomization until surgery. Functional performance (six-minute walk test [6MWT], chair-rising test, handgrip strength) and QoL (EORTC QLQ-C30) were assessed 4 weeks and 1 day preoperatively, 1 week postoperatively, at discharge, as well as 3 and 12 months postoperatively. Primary endpoint was perioperative morbidity (Clavien-Dindo≥III); secondary endpoints included ICU admission, transfusion, bowel recovery, analgetic demand and functional/quality-of-life changes. Results: Currently, 32 patients have been enrolled, and data from 25 patients (intervention = 14, control = 11) were available for analysis. Baseline characteristics and surgical parameters were comparable. The intervention group achieved significantly higher preoperative step counts (median 8,474 vs 4,098; p = 0.003). Major complications occurred in 14% vs 36% (p = 0.20). ICU admission (15% vs 73%; p = 0.005) and transfusion rates (8% vs 46%; p = 0.033) were markedly lower in the intervention arm, while length of stay and bowel function were similar. One week after RC, the intervention group showed superior functional recovery with greater 6MWT distance (399 m vs 282 m; p = 0.004) and faster chair-rising time (10.7 s vs 16.8 s; p = 0.009); handgrip strength was comparable. QoL improved in 54% vs 10% of patients (p = 0.029) during the preoperative period. Preoperative step count correlated strongly with postoperative mobility (r = 0.68). No adverse events related to the walking intervention occurred. Conclusions: This interim analysis demonstrates that a simple, wearable-guided walking intervention before RC is feasible, safe, and clinically meaningful. Patients who achieved higher preoperative activity experienced fewer transfusions and ICU admissions, faster functional recovery, and improved QoL. Step-based prehabilitation represents a low-cost, scalable strategy to enhance perioperative outcomes and patient-centered recovery in major uro-oncologic surgery. Clinical trial information: NCT06806059 .