Caracterização da Capacidade Funcional e Muscular de Doentes com Cancro da Bexiga Candidatos a Cistectomia Radical: Base para Estratégias de Pré-habilitação

Abstract

Introduction: Bladder cancer is a prevalent urological malignancy, associated with high morbidity, particularly in advanced stages and in patients undergoing radical cystectomy. Exercise-based prehabilitation has emerged as a promising strategy to optimize functional reserve and reduce postoperative complications, although specific evidence in this population remains limited. Objectives and Hypotheses: This study aimed to characterise the functional and muscular profile of patients with bladder cancer who were candidates for radical cystectomy, evaluated within the framework of the PROBEX project. It was hypothesised that these patients would present heterogeneous functional profiles, with relevant differences between subgroups (gender and neoadjuvant chemotherapy status). Methods: We recruited 17 patients, evaluated during a physiatry consultation at Hospital de São João. The assessment included segmental muscle strength (isometric dynamometry), functional tests (SPPB, TUG, 6MWT, 1-min STS), physiological parameters (heart rate and SpO₂), and muscle ultrasound (rectus femoris and quadriceps thickness). Results: The sample was predominantly male (88.2%), with a mean age of 67.76 ± 8.25 years and a mean BMI of 26.44 ± 2.55 kg/m². Most participants (82.4%) were classified as sarcopenic, and 58.8% underwent neoadjuvant chemotherapy. Male participants showed higher values of muscular strength and muscle thickness, while female participants demonstrated similar or even superior functional performance in some tests. Overall, participants without sarcopenia showed better functional outcomes and slightly higher strength values, although these differences should be interpreted with caution due to the small size of this subgroup. Similarly, participants who did not receive neoadjuvant chemotherapy tended to perform slightly better in several functional tests, although with substantial individual variability, possibly related to uncontrolled clinical factors. Conclusion: The functional assessment of patients scheduled for radical cystectomy revealed a wide range of strength and performance levels, with a high 5 prevalence of structural sarcopenia identified through ultrasound. These findings highlight the importance of comprehensive and structured preoperative evaluations. The implementation of individualized prehabilitation programs may help optimize surgical outcomes, although larger studies with longitudinal followup are needed to validate these preliminary findings.