Bladder and kidney cancers are commonly diagnosed in older adults. Surgery remains the primary treatment modality for patients with kidney or bladder cancer. In older patients, common co-morbidities include fatigue, physical deconditioning characterized by reduced cardiorespiratory fitness and progressing sarcopenia, pain- whether disease- related or treatment-induced- and undernutrition. These factors increased the risk of post-operative complications and exacerbate patient frailty.
The investigators propose a personalized 6-month program both pre- and post-surgery, including adapted physical activity sessions, therapeutic education workshops, and systematic referral to the department's DAPAP program.
Diagnosis of bladder or kidney cancer
Surgical treatment
No severe cognitive impairment preventing understanding of the protocol
Affiliated or entitled to a social security scheme
Surgery already done
Significant co-morbidities that contraindicate physical activity: associated cardiac pathologies, respiratory pathologies, disabling joint pathologies, etc.
Deprived of liberty or under guardianship
Benefiting from a prehabilitation prescription with a private physiotherapist.
Parallel
APA
Procedure/Surgery2 adapted physical activity (APA) sessions per week for 4 weeks before and after surgery
Therapeutic education workshops
BehavioralTherapeutic education workshops tailored to individual needs, covering topics as physical activity, nutrition, treatments, fatigue, and relaxation.
DAPAP
Procedure/SurgeryReferral to the department's DAPAP for a 12-week "bridge program", consisting of one session per week.
Patient frailty
Frailty will be measured using the walking distance (in metres) achieved during the 6-minute walk test (6MWT) 6 months after the patient's inclusion.
Cumulative Illness Rating Scale for Geriatrics (CIRS-G)
The CIRS (Cumulative Illness Rating Scale) score provides a relevant comparison of the medical burden and treatment outcomes in geriatric patients with variable and complex pathologies. The score ranges from 0: no problem to 4: very serious problem.
Fried's frailty phenotype (FP)
Frailty will be measured using Fried's frailty phenotype (FP), defined by exhaustion (EX), unexplained weight loss (WL), weakness (WK), sluggishness (SL) and low physical activity (LA). Three or more components define the frailty state, and one or two the pre-fragility state.
level of physical activity
Objective measures of PA (in MET-hours/week) via accelerometry (Actigraph GT3x, Pensacola, Florida, USA) and subjective measurements of PA (in METhours/week) using the e-Adult Physical Activity Questionnaire (EA SNA-EPIS, Université Jean Monnet, Saint-Etienne, France).
level of sedentary lifestyle
Objective measures of sedentary time (in h/d) via accelerometry (Actigraph GT3x, Pensacola, Florida, USA) and subjective measurements of sedentary behaviour (in hours/day) using the e-Adult Physical Activity Questionnaire (EA SNA-EPIS, Université Jean Monnet, Saint-Etienne, France).
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