<qa>  What is the main reason for the multi-modal approach?The multi-modal approach comprises both pre-operative optimisation of organ function, patient education, effective pain management, early post-operative mobilisation and early oral nutrition 9. The concept has proven effective, though primarily documented in connection with colorectal surgery 9-11,12,13,, with increased survival, reduced LOS and reduced costs compared with conventional patient pathways14,15. The combination of a major surgical intervention and an increasing number of elderly comorbid patients with bladder cancer poses a challenge to treatment and care in all phases of the patient pathway. The above studies primarily focus on the pre- and post-operative effort. Evidence is sparse concerning the importance of an optimised pre-operative effort in rehabilitation 11. It is hypothesised that an optimised patient pathway calls for an inter-professional pre-operative clinical evaluation and a pre-optimisation of the patients general condition including nutrition and physical activity11,16-18. There is low evidence of the efficacy of multi-modal pre-optimisation efforts in major surgical procedures in urology 2,19. Especially concerning the importance of a multi-facilitated pre-operative intervention for rehabilitation and health-related quality of life 7,8. Generally, there has been a post-operative effect concerning early nutritional intervention and LOS 20. Early nutritional intervention increases the number of patients fulfilling the threshold for sufficient nutritional status 15,21. Nutrition strategies are increasingly combined with physical training consisting of exercise to increase muscle strength and endurance, to increase hypertrophy of muscle cells by increasing muscle protein synthesis and reducing disintegration 22. Thus, a pre-operative multi-modal intervention involving nutritional optimisation and physical training should be a part of future studies. A muli-modal patient pathway will involve expectations of an increased risk that the economic burden will shift to the primary sector 23, an increased frequency of readmissions, complications and reduced quality of life. This thesis investigates the efficacy of pre- and post-operative multi-modal interventions in the rehabilitation of patients with bladder cancer undergoing cystectomy. 