Home-based exercise during preoperative therapy for pancreatic cancer

Abstract

Purpose: Exercise concurrent with neoadjuvant chemotherapy and/or chemoradiation for pancreatic adenocarcinoma (PDAC) may mitigate the decline in function that may occur as a result of the disease or its treatment in the preoperative period. The primary objective of this single-arm prospective trial was to determine adherence to a home-based exercise program administered during preoperative therapy.

Methods: Twenty patients from a quaternary cancer center with potentially resectable PDAC were enrolled. Patients were prescribed a minimum of 120 min of moderate-intensity exercise weekly: at least 60 min of aerobic exercise and 60 min of resistance exercise. Self-reported exercise was recorded in daily logs. Functional and survey measures were collected upon enrollment, following preoperative therapy, and 1 month after surgery.

Results: Fifteen out of 20 patients participated in the program. They reported a mean (standard deviation (SD)) of 98.6 (69.8) min of aerobic exercise weekly and 57.4 (36.0) min of strengthening exercise weekly over a median of 17 weeks (range, 5-35 weeks) of preoperative therapy, for a mean (SD) of 156.0 (64.5) min of total exercise weekly. Eighty percent reported a mean of least 120 min of total exercise weekly during preoperative therapy. Patients with low baseline physical activity based on the International Physical Activity Questionnaire significantly increased their preoperative physical activity (p = .01). There were no adverse events associated with the exercise program.

Conclusions: Patients with PDAC will participate in a home-based exercise program of aerobic and strengthening exercise and will increase physical activity, concurrent with preoperative chemotherapy and/or chemoradiation.

Keywords: Cancer rehabilitation; Pancreatic cancer; Prehabilitation; Preoperative exercise.

Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

FIGURE 1.

Screening to determine exercise program eligibility. Patients had to pass all 3 components to be eligible for the program. Patients were eligible pending medical/physical assessment if triaged or referred to physicians. Abbreviations: PROMIS, Patient Reported Outcomes Measurement Information System Physical Function 12a Short Form; PM&R, Physical Medicine and Rehabilitation, P.T., Physical Therapy, O.T., Occupational Therapy.

FIGURE 2.

Study schema and progression of patients. Abbreviations: CES-D, Center for Epidemiologic Studies Depression Scale; IPAQ, International Physical Activity Questionnaire; PROMIS, Patient Reported Outcomes Measurement Information System Physical Function 12a Short Form.

FIGURE 3.

a) Frequency of self-reported minutes of aerobic exercise per week. b) Frequency of self-reported minutes of strengthening exercise per week. c) Frequency of self-reported minutes of total exercise per week. d) Frequency of preoperative exercise.

FIGURE 4.

Minutes of self-reported exercise by phase of preoperative therapy among participants (n = 15). Bars represent 1 standard deviation.