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Effects of Preoperative Exercise on Physical Fitness and Body Composition in Pancreatic Cancer Survivors Receiving Neoadjuvant Therapy

A Case Series

Marker, Ryan J., PT, DPT, PhD1; Peters, John C., PhD2; Purcell, W. Thomas, MD3; Jankowski, Catherine A., PhD, FACSM4

doi: 10.1097/01.REO.0000000000000122

Background and Purpose: Poor preoperative physical fitness and muscle mass are associated with increased morbidity and mortality in pancreatic cancer survivors. While neoadjuvant therapy improves viability for and effectiveness of a surgical resection in patients with borderline-resectable pancreatic adenocarcinoma, it also reduces preoperative fitness and muscle mass. The purpose of this investigation was to prevent fitness and muscle mass declines in this population with a supervised, preoperative exercise program.

Methods: Patients recently diagnosed with borderline-resectable pancreatic adenocarcinoma and prescribed neoadjuvant therapy were recruited. Assessments of body composition, physical fitness, and health-related quality of life were assessed at baseline (<4 weeks from diagnosis), preoperatively, and 6 weeks after hospital discharge. Participants attended 2 to 3 supervised exercise sessions per week for the duration of neoadjuvant therapy. Sessions consisted of aerobic, resistance, and flexibility exercises tailored to the individual. Adherence to the exercise program was recorded to assess feasibility.

Results: Only 3 participants were recruited in an 8-month window, primarily due to location limitations, and are presented as a case series. All participants increased lean muscle mass and physical fitness after the exercise program. Two participants met cancer cachexia diagnostic criteria at baseline but not after the exercise program. One participant developed metastatic disease and did not receive surgery. Neither of the participants who underwent surgery was readmitted to the hospital after discharge.

Conclusion: This study provides preliminary evidence that a preoperative exercise program during neoadjuvant therapy may be effective at maintaining or improving muscle mass and physical fitness in pancreatic cancer survivors.

1Assistant Professor, Ithaca College, Ithaca, NY

2Professor, University of Colorado, Anschutz Medical Campus, Aurora, CO

3Assistant Professor, University of Colorado, Anschutz Medical Campus, Aurora, CO

4Assistant Professor, University of Colorado, Anschutz Medical Campus, Aurora, CO

Correspondence: Ryan J. Marker, PT, DPT, PhD, School of Health Sciences and Human Performance, Physical Therapy, Ithaca College, 953 Danby Rd, Ithaca, NY 14850 (

Grant Support: Funding was received from the University of Colorado Cancer Center.

The authors have no conflicts of interest to disclose.

©2018 (C) Academy of Oncologic Physical Therapy, APTA
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