Radikal Prostatektomi Sonrasında Aerobik Egzersiz ve Gevşeme Eğitimlerinin Pelvik Taban Kas Eğitimine İlave Etkileri

Post-prostatectomy urinary incontinence (PP-UI) and erectile dysfunction (ED) are among the most common and distressing complications following radical prostatectomy (RP), significantly affecting the quality of life and psychosocial well-being of prostate cancer survivors. Although pelvic floor muscle training (PFMT) is widely recommended as the first-line conservative approach to manage these complications, recent evidence highlights the importance of multimodal, structured rehabilitation programs supervised by physiotherapists to optimize continence recovery and sexual function.

This randomized controlled trial aims to investigate the additional effects of aerobic exercise and relaxation training when combined with PFMT in men with urinary incontinence and erectile dysfunction following nerve-sparing robotic-assisted radical prostatectomy. The study is designed as a two-arm parallel-group, single-center trial involving 48 male participants aged between 40 and 65 years. Eligible participants must be within one year post-surgery, demonstrate voluntary pelvic floor muscle contraction, and exhibit sufficient cognitive function as assessed by the Montreal Cognitive Assessment (MoCA).

Participants will be randomly allocated (1:1) into either the intervention group or the control group using a computer-generated block randomization procedure. All participants will receive standardized patient education and a 12-week PFMT protocol guided by biofeedback. The PFMT sessions will be conducted individually by a physiotherapist three times per week and include a home-based exercise program monitored through an exercise diary.

In the intervention group, aerobic exercise and relaxation training will be added to PFMT. Aerobic exercise will consist of treadmill walking at moderate intensity (Modified Borg RPE scale 4-6) for 60 minutes (10 min warm-up, 40 min loading, 10 min cool-down), three times per week for 12 weeks. Relaxation training will be conducted once weekly and will include guided breathing, imagery, and meditation techniques in a quiet, dimly lit environment. Patients will be encouraged to practice these relaxation techniques at home using a standardized script.

Assessments will be performed at baseline and at the end of the 12-week intervention. Primary outcome measures include changes in urinary symptoms (ICIQ-MLUTS), erectile function (IIEF-15), and prostate cancer-specific quality of life (EPIC). Secondary outcomes include objective incontinence severity (1-hour pad test), subjective continence impact (ICIQ-SF), functional exercise capacity (6-minute walk test), psychological status (HADS), and exercise adherence (self-reported exercise diary).