The role of preoperative and postoperative exercise in enhancing quality of life following cystectomy for bladder cancer: a systematic review and meta-analysis

Background/aim: Bladder cancer is among the most common malignancies, often treated with radical cystectomy (RC) for muscle-invasive cases. However, RC is associated with high postoperative complication rates. Preoperative and postoperative exercise programs have been proposed to enhance recovery and quality of life (QoL) in bladder cancer patients. This systematic review aims to evaluate the impact of exercise interventions on QoL in patients undergoing cystectomy. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD42024623205). A comprehensive search across Web of Science, PubMed, Scopus, and Cochrane databases identified studies on exercise interventions in cystectomy patients. Eligibility criteria included randomized controlled trials, cohort studies, and case reports involving bladder cancer patients undergoing pre- or postoperative exercise. Data were analyzed using R version 4.3.1, applying random-effects models to calculate mean differences (MDs) and 95% confidence intervals (CIs). Heterogeneity was assessed using tau(2), I-2, and Q-tests. Results: Ten studies (n = 564) met the inclusion criteria. Meta-analysis revealed that preoperative exercise significantly improved postoperative QoL scores (standardized mean difference [SMD] = 0.62; 95% confidence interval [CI]: 0.44-0.80; p < 0.001; I-2 = 22%). Postoperative exercise also enhanced cardiorespiratory function and reduced postoperative complications (SMD = 0.48; 95% CI: 0.32-0.64; p < 0.001; I-2 = 18%). Combined pre- and postoperative exercise yielded the highest QoL improvements. Conclusion: Exercise programs significantly enhance QoL in bladder cancer patients undergoing cystectomy by reducing complications and improving physical and emotional resilience. However, high heterogeneity, inconsistent outcome measures, and limited statistically significant effects in some domains highlight the need for standardized protocols and further high-quality research.