In this qualitative investigation, we interviewed nine bladder cancer survivors (median age 72) who had undergone neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) to explore their experiences, motivations, and attitudes toward exercise and digital health technologies. Using reflexive thematic analysis of semi-structured Zoom interviews, we identified key barriers and facilitators to physical activity adherence.
Barriers included treatment related debilitation and lack of provider follow-up, whereas facilitators included structured exercise prescriptions, physician encouragement, exercise as a means of control, and the mere presence of an upcoming doctor’s appointment. We also captured nuanced perspectives on wearables and exercise apps, highlighting desires for real-time provider feedback, progress tracking, peer comparison, and balanced notifications. These findings will directly inform the design of a forthcoming Phase II pragmatic perioperative home-based exercise trial (GetMoving, NCT06040762) and offer practical, patient-centered guidance for improving physical activity adherence and digital technologies in bladder cancer care.
Author’s Perspective
As we embarked on this qualitative exploration, our primary goal was to center the voices of bladder cancer survivors—individuals whose journeys through NAC and RC often feel dictated by the side effects of treatment rather than guided by their own goals and capabilities. We were struck by how frequently participants described feeling unprepared for the physical toll of chemotherapy and left unsupported in the early stages of surgical recovery. In sharing these narratives, we hope to convey to readers the profound impact that even small gestures, like a doctor’s single encouraging remark, such as “Keep it up, great work!”—can have on a patient’s motivation to move and reclaim agency over their bodies.
One of the most rewarding aspects of this work was uncovering the clear, actionable guidance our participants sought: “If there’s a plan, I’m all in.” This simple statement underscores the power of structure and specificity. When we present exercise recommendations with detail and a lack of ambiguity, we would have a medication prescription—detailing type, duration, and frequency—we not only remove guesswork but also send a strong message that physical activity is an integral component of both care and recovery, not an optional add-on.
Our findings around digital health technologies similarly revealed both enthusiasm on the part of patients and practical considerations that inform successful implementation. We learned that while technical features such as real-time feedback, progress tracking, and peer comparison are valued, they must be carefully balanced against notification fatigue and individual preferences. Integrating wearable devices and apps into routine care thus demands an empathetic approach: one that respects each patient’s baseline familiarity with technology and adapts reminders to their unique rhythms.
We also found it illuminating to learn how rapidly patients shifted from passivity to empowerment when given the right tools and encouragement. Observing survivors describe exercise as a way to regain control over their bodies, underscoring the fact that prehabilitation is as much a psychological intervention as it is a physical one. By embedding opportunities for agency—including the setting of personalized goals, access to tangible progress metrics, and engaging in friendly competition—we believe care teams can foster resilience alongside strength.
Looking ahead, we are keen to explore interdisciplinary collaborations that bring together urologists, physical therapists, PM&R providers, behavioral scientists, and digital health designers. Only through such partnerships can we craft interventions that address the multifaceted needs of this population. We are also mindful of the digital divide; as we refine apps and wearables, we must ensure accessibility for older adults who may have limited tech experience or variable internet access.
Finally, we wish to acknowledge the generosity of our participants. Their candid reflections, shared in the midst of recovery and uncertainty, provided the foundation for this work. We hope that our work not only guides future programs but also honors our patients’ stories by driving tangible improvements in uro-oncologic care.
Written by: Alex Zhu, DO, and Sarah Psutka, MD, MS, FACS
- University of Washington, Seattle, WA
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