Participants in this arm will receive standard information and recommendations from a surgeon prior to HoLEP. These include recommendations to participate in exercise and information about what to expect with the procedure.

Participants in this arm will receive the standard of care recommendations from a urologist but will also complete a comprehensive prehabilitation program over 12-weeks within 5 months of the procedure.

This prehabilitation program will include an exercise component consisting of once weekly pelvic floor physiotherapy sessions as well as recommendations to complete pelvic floor strengthening exercises and 150 minutes of moderate to intense cardiovascular exercise at home. Completion of these exercises will be self-reported biweekly through an exercise tracking form submitted to study staff. This program will also include access to a comprehensive online module with information about BPH and the HoLEP procedure. Lastly, this will consist of access to mental health supports including individual and couples counselling.

Feasibility will be assessed through a feasibility questionnaire administered only to participants in the intervention group prior to surgery. This questionnaire is a modified version of a previously established system usability scale which consists of 10 questions assessing the feasibility of the program which participants will rate on a 1-5 Likert scale. Four additional yes/no questions regarding feasibility for further assessment. Feasibility will also be assessed based on recruitment (with a goal of 30% of patients approached based on previous studies), adherence to the exercise protocol (with a goal of 70% adherence based on previous studies), and retention through the full 12-weeks of the intervention (with a goal of 80% based on previous studies.

Safety will be assessed through a modified version of safety questionnaires used in previously reported exercise and counselling studies. This will consist of 8 questions (graded on a 0-10 Likert scale) assessing the side effects of exercise programming, 4 questions (graded on a 0-10 Likert scale) assessing the side effects of mental health supports, and a question assessing adverse events. Any adverse events would be reported and graded minor (Grade ≤1 - not requiring medical intervention) or serious (Grade ≥2 - requiring medical intervention) based on previously established National Health Institute criteria.

The IPSS is a 7 question screen for lower urinary tract symptoms with each question graded on a 0-5 Likert scale. Greater scores indicate more severe dysfunction with the following cutoffs: mild (0-7), moderate (8-19), or severe (20-35).

This is a 7-item measure which collects information regarding the minutes of physical activity performed per week across different domains including: walking, mild activity, moderate activity, and strenuous activity. While patients are participating in the prehabilitation program an item will also be added for participants to report their adherence to home pelvic floor strengthening exercises and the questionnaire will be modified for them to report their 3-week physical activity average rather than only for a single week. This measure assesses minutes of physical activity per week so the minimum value is 0 minutes and the maximum value is 10080 minutes with greater values representing more physical activity. Each minute also has a multiplier applied for the metabolic equivalent of the task (METs) in order to generate a weekly number of METs. Again higher numbers are associated with more physical activity.