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Table 1 Summary of included studies

From: Exercise efficacy and prescription during treatment for pancreatic ductal adenocarcinoma: a systematic review

Author (date) Study type Diagnosis Age (y) Treatment Intervention Control/ comparison Outcomes Results
Banzer et al. (2014) Single-arm prospective Stage I-IV pancreatic cancer
(n = 3)
Range: 54–65 years Adjuvant chemotherapy w/ Gemcitabine Home-based aerobic exercise N/A Measured pre and post intervention
Aerobic capacity
(CPET-VO2peak)
Quality of life (EORTC)
Fatigue
(EORTC Fatigue symptom subscale)
VO2peak
Participant 1: +  5.7 ml/kg/min− 1
Participant 2: + 8.7 ml/kg/min− 1
Participant 3: − 3.2 ml/kg/min− 1
Quality of life (point change score)
Participant 1: 0
Participant 2: + 25
Participant 3: + 17
Fatigue symptom scale
Participant 1: + 22
Participant 2: + 11
Participant 3: + 11
Cormie et al. (2014) Case report invasive colloid adenocarcinoma
T2 N1 M0 stage IIb
49 years Surgery > adjuvant chemotherapy and radiotherapy Supervised exercise (aerobic /resistance exercise)
3 months post-surgery
N/A Measures at baseline, 3, 6 months
400 m walk, 1RM leg press, 5xSTS, stair climb, usual / fast paced − 6 m walk, static balance
Body composition, BMD
(DXA)
PA levels (GLTEQ)
Quality of life (SF-36, FACT-Hep)
Fatigue (FACT-fatigue)
Adherence: 35 / 48 sessions completed (73%)
Change from baseline-
400 m walk time (s) at 3 months: − 5.9%, at 6 months: − 17.5%
Leg press 1RM (kg) 3 months: + 31.6%, 6 months: + 42.1%
5xSTS (s) 3 months: − 17.2%, 6 months: − 28.2%
Stair climb (s) 3 months: − 9.9%, 6 months: − 19.1%
Whole body lean mass (kg) 3 months: + 2.9%, 6 months + 3.3%
Appendicular lean mass (kg) 3 months: + 3.4%, 6 months: + 8.2%
Lumbar spine BMD (g.cm− 2) 3 months: − 0.5%, 6 months: + 0.4%
Quality of life:
S-36
Improved subscales at 3 months: range 19–61%, 6 months: 34–150%
FACT-Hep
improved subscales at 3 months: range 20–109%, 6 months: 15–127%
Fatigue
Improved at 3 months: 350%, 6 months: 488%
Marker et al. (2018) Case series Recently diagnosed (< 4 weeks) borderline-resectable pancreatic adenocarcinoma
(n = 3)
Range: 70–74 years Neo-adjuvant chemotherapy Supervised, tailored exercise (aerobic/resistance/flexibility) for duration of neo-adjuvant therapy No control Measures at baseline, 2 wks preoperatively, 6wks post discharge (* participant 3 received no surgery, post intervention only)
Body composition, 400 m walk, fast gait speed, usual gait speed, 30STS, HGS, stair climb
Quality of life (FACT-G)
Fatigue (FACIT-F)
Lean body mass change from baseline,
Participant 1: at pre-op + 15%, at follow-up + 3
Participant 2: at pre-op + 1%, at follow-up − 6%
*Participant 3: post intervention + 4%
400-m walk
Participant 1: at pre-op + 11%, follow up + 8%
Participant 2: pre-op − 4%, follow up 0%
Participant 3: post intervention + 11%
USG
Participant 1: pre-op − 8%, follow-up 0%
Participant 2: pre-op + 7%, follow-up + 13%
Participant 3: post intervention − 6%
FSG
Participant 1: pre-op 0%, follow-up 0%
Participant 2: pre-op + 4%, follow-up − 22%
Participant 3: post intervention + 9%
Stair climb
Participant 1: pre-op − 11%, follow-up − 14%
Participant 2: pre-op − 21%, follow-up − 28%
Participant 3: post intervention + 5%
HGS
Participant 1: pre-op + 3% (D), − 8% (ND), follow-up − 2% (D) -1% (ND)
Participant 2: pre-op + 2% (D), − 7% (ND), follow-up − 12% (D), − 23% (ND)
Participant 3: post intervention − 1% (D), − 4% (ND)
30STS
Participant 1: pre-op + 54, follow up + 8%
Participant 2: pre-op + 44% follow-up + 11
Participant 3: post intervention 0%
McLaughlin et al. (2019) Case report locally advanced pancreatic adenocarcinoma with invasion of the superior mesenteric vein stage III 47 Adjuvant chemotherapy w/ Folfirinox Supervised exercise (aerobic/resistance exercise) N/A Measured at baseline, 4, 8, 12-week
Aerobic capacity (estimated VO2max)
Lower / upper body strength (12-RM)
Flexibility: seated toe-reach
Function: 5xSTS, usual/fast/backwards 6-m walk
Body composition (BIA)
Quality of life (FACT-Hep)
Fatigue (FACIT-fatigue)
Adherence 94% (15/16)
Results reported as improvement from baseline at 4, 8, 12 weeks, but not explicitly stated. Figures are estimated from study graphs
Estimated VO2max: + 6%, + 8%, + 8%
All strength measures improved from baseline at each time point
Flexibility: not reported
5xSTS: + 2%, + 17%, + 8%
6-m walk: + 17%, + 7%, + 15%
Body composition reported as change from baseline to 12 weeks
Body fat % -4.4
Lean mass % + 4.3
Quality of life: + 42%, + 40%, + 38%
Fatigue: + 78%, + 84%, + 114%
Mouri et al. (2018) Single-arm prospective Stage III and IV pancreatic cancer (n = 6) 74 ± 3 gemcitabine plus nab-paclitaxel Home-based resistance training No control Quality of life (EORTC) Global QOL score: T1–56 ± 37, T2–60 ± 32, T3–55 ± 34
Physical subscale QoL: T1–82 ± 21, T2–85 ± 20, T3–75 ± 28
Naito et al. (2018) Single-arm prospective Stage III and IV pancreatic cancer (n = 6) 74 ± 3 gemcitabine plus nab-paclitaxel Home-based resistance training No control 6 min walk test
5 m gait speed
5xSTS
Hand grip strength
6MWT: T1–459 ± 56 m, T2 – N/R, T3–477 ± 51 m
5 m gait speed: T1–1.2 ± 0.2 m/s, T2 – N/R, T3–1.1 ± 0.3 m/s
5xSTS: T1–11 ± 1, T2–10 ± 3, T3–13 ± 10
Hand grip strength: T1–23.7 ± 4.3 kg, T2–24.0 ± 5.1 kg, T3–22.3 ± 4.6 kg
Ngo-Huang et al. (2017) Single-arm prospective Resectable pancreatic adenocarcinoma (n = 15) Mean: 66 ± 6 Chemotherapy and/or chemoradiation Pre-operative aerobic and resistance exercise (home-based, unsupervised) No control Measures at baseline (n = 20), 1-week pre-surgery (n = 15), 4 weeks post-surgery
Primary outcome: Adherence-Self-report exercise minutes (IPAQ)
Secondary outcomes:
10-m walk
Dynamic gait index (Balance)
5 x STS (strength)
Self-report physical function (PROMIS-sf)
12/15 met aerobic exercise recommendation
6/15 met resistance exercise recommendation
11/15 met or exceeded weekly exercise recommendation (120mins)
Pre-operative: 98.6 ± 69.8 mins (aerobic), 57.4 ± 36 min (resistance)
Mean: 156.0 ± 64.5 weekly total exercise
During chemoradiation aerobic (128.6 ± 106 vs 48.0 ± 35.3 resistance, p = .04
PROMIS declined baseline to post-operative p = .03
Grip strength decline pre-op to post op, p = .03
No other changes in secondary measures
Ngo-Huang et al. (2019) Single-arm prospective Resectable pancreatic adenocarcinoma (n = 45) Mean: 66 ± 8 Surgery + neo-adjuvant chemo-radiotherapy Pre-operative aerobic and resistance exercise (home-based, unsupervised) No control Measures at baseline and follow-up
6MWT, 5xSTS, HGS, 3-m walk
FACT-Hep, FACT-G
48% underwent curative surgery
Change form baseline to follow-up
6MWT + 26 m, p = .001
5xSTS 0.8 s, p = .049
3-m walk + 0.5 m.s, p = .009
No change in HGS, p = .90
No significant changes in QoL outcomes, p = .09
Niels et al. (2018) Case report Stage IV pancreatic carcinoma in tail (peritoneal metastases) 46 yr old Palliative, neo-adjuvant, surgery, adjuvant Supervised concurrent exercise N/A Measures at baseline, 3 months and 7 months
Leg extension, curl, chest press, row, back extension, ab crunch, 30/15 W cross walker and bicycle test
EORTC, HADS
Physical activity levels (GPAQ)
Progressed - palliative therapy > neo-adjuvant therapy >surgery > adjuvant
Body weight maintained during neo-adjuvant chemotherapy. All functional outcomes improved at 3 months
Performed watt + 39% endurance exercise
Seated row + 9
Leg extension + 79%
Chest press + 38%
Global QoL + 16.6%
All functional outcomes improved at 7 months, with the exception of:
Abdominal crunch − 88.4%
Leg curl − 3.6%
Stiendorf et al. (2019) 3 arm RCT Resectable or non-resectable PDAC (I-IV)
(n = 47)
Mean: 60.5 ± 8.4 neo-adjuvant chemotherapy Home-based RT and/vs supervised RT Usual care Measures: baseline (n = 65), 3 months (n = 55), 6 months (n = 47)
Quality of life (EORTC + PAN26 module)
Fatigue (MFI)
No change in quality of life or fatigue outcomes at 6 months
When resistance exercise groups pooled, mean group difference at 3 months for Global quality of life (p = 0.016), physical functioning (p = 0.016), cognitive functioning (p = 0.008) and sleep problems (p = 0.016) were all significantly different.
Similar results reported for Physical fatigue subscale (p = 0.019), reduced activity (p = 0.018) and reduced motivation (p = 0.028)
Wiskemann et al. (2019) 3 arm RCT Resectable or non-resectable PDAC (I-IV) (n = 43) Supervised: 62.8 (6.4)
Home-based: 61.1 (8.7)
UC: 57.8 (8.2)
neo-adjuvant chemotherapy Home-based RT and/vs supervised RT Usual care Measures at: baseline (n = 65) 6 months (n = 43)
Adherence (self-report logs)
Strength (isokinetic), HGS
CPET, 6MWT,
Mean overall adherence was 59.2%
MIPT: RT1 vs CON elbow flexors (p = 0.02) extensors (p = 0.01) but not lower limb.
RT1 vs RT2 elbow flexors and extensor (p < 0.05)
MVIC: RT1 vs CON elbow flexors (p = 0.02) knee extensors (p = 0.01). RT2 vs CON knee extensors (p = 0.05
RT1 vs RT2 no difference
CPET: RT1 vs CON / RT2 peak work rate (both p < 0.05)
VO2peak (L/min)
RT1 vs RT2 p > 0.05, RT1 vs CON, p > 0.05, RT2 vs CON, p > 0.05
Body weight: + 3.2% RT1, − 0.4% RT2.
Weight loss > 5% observed in n = 14 over intervention
Yeo et al. (2012) 2 arm prospective RCT
(n = 102)
Resected pancreatic and periampullary cancer (n = 102) Mean:
IG: 66 (38–87)
UCG: 67 (48–91)
Adjuvant chemotherapy Home-based walking Usual care Measures: baseline, post intervention (3–6 months)
Fatigue (FACIT)
Pain (VAS)
Observed walk (distance / time)
Self-report diary (monthly)
General health (SF-36v2)
ECOG
Walking distance; IG 2 miles, vs 1 mile UCG (p = 0.1)
IG sig more likely to be walking / active (80 v 58%, p = 0.04)
At baseline, mod-severe fatigue in 85% of participants
Baseline fatigue not different between groups (mean 27 vs 30). At POST, IG group fatigue better (p = 0.05)
Pain (mild in both groups at baseline, VAS = 2.9). improved in both groups POST (1.6 & 1.8)
ECOG scores fell in IG (1.6–1.5), increased in UCG (1.5–1.8)
SF-36 health survey, 6 of 8 domains improved in IG, 4 of 8 UCG
Mental and physical components both improved IG, MCS in UCG
  1. BIA bioelectrical impedance analysis, BMD bone mineral density, CPET cardiopulmonary exercise test, DXA dual-energy x-ray absorptiometry ECOG Eastern Cooperative Oncology Group, EORTC QLQ C30 / PAN26 European Organization for Research and Treatment of Cancer Quality of Life Core 30 / pancreatic cancer specific questionnaire, FACT Functional Assessment of Cancer Therapy, FACIT Functional Assessment of Chronic Illness Therapy-Fatigue, HADS (Hospital Anxiety and Depression Scale, HGS hand grip strength IG – intervention group, MFI Multi-dimensional Fatigue Inventory MIPT maximum isokinetic peak torque, MVIC maximum isometric voluntary contraction N/R not recorded, VAS UC usual care, UCG usual care group, FSG– fast speed gait, USG usual speed gait, MCS mental component summary, STS sit to stand, VAS visual analogue scale, (* participant 3 received no surgery, post intervention only)