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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)