Exercise to Improve Outcomes in Pancreatic Cancer

Summary

Pancreatic cancer surgery (Whipple's procedure) is a major operation that can lead to reduced physical fitness, delayed recovery, and difficulty starting chemotherapy after surgery. Exercise before and after surgery may help improve recovery, but it is not known whether a personalised exercise programme delivered throughout the surgical pathway is practical or acceptable for patients. The Exercise to Improve Outcomes in Pancreatic Cancer (ExO-PanC) study is a single-arm feasibility study that will recruit adults with suspected pancreatic ductal adenocarcinoma who are scheduled to undergo Whipple's procedure. Participants will receive an individualised exercise programme before surgery, during their hospital stay, and after discharge until the start of adjuvant chemotherapy. The programme will include aerobic exercise and resistance training prescribed according to each participant's fitness level. The primary objective is to determine whether this exercise programme is feasible by assessing recruitment, participant adherence, compliance with the prescribed exercise programme, and retention. Secondary exploratory objectives include evaluating surgical complications, initiation of adjuvant chemotherapy, physical fitness, quality of life, nutritional status, and blood, stool, and tumour biomarkers associated with clinical outcomes. Findings from this feasibility study will inform the design of a future multicentre randomised controlled trial evaluating the effectiveness of the ExO-PanC programme.

Interventions

• ExO-PanC Personalised Exercise Programme · BEHAVIORAL

  Participants will receive the ExO-PanC personalised exercise programme alongside standard perioperative care. The intervention comprises four phases delivered across the surgical pathway: (1) prehabilitation before surgery, (2) supervised exercise during postoperative hospital admission, (3) structured home-based recovery following hospital discharge, and (4) rehabilitation before the commencement of adjuvant chemotherapy. Exercise prescriptions are individualised using cardiopulmonary exercise testing (CPET), muscle strength, and functional assessments. The programme includes aerobic, resistance, flexibility, and home-based exercise, with intensity and progression tailored to each participant's fitness level. Exercise may be delivered in supervised or semi-supervised formats, with heart rate monitoring used to support exercise prescription and progression. Participants continue to receive all standard NHS perioperative care throughout the study.

Published eligibility criteria

Verbatim from the registry. Only the site can decide how these apply to a specific patient.

Inclusion Criteria:

* Adults aged 18 years or older.
* Planned to undergo upfront pancreatoduodenectomy (Whipple's procedure) for a suspected malignant periampullary mass.
* Able and willing to provide written informed consent.

Exclusion Criteria:

* \<18 years age
* Cardiopulmonary exercise test (CPET) contraindications
* Physical inability to perform CPET or undertake the program.
* Lacking the capacity to consent
* Unable to understand instructions in English
* Not scheduled for surgery
* A new diagnosis of Type 1 or Type 3c diabetes requiring management with insulin prescription will be excluded from the study.

Sites (1)

• University of Surrey, Guildford, Surrey, United Kingdom · RECRUITING