Trimodal Prehabilitation with Supervised Exercise During Neoadjuvant Chemotherapy in Localized Pancreatic Cancer

Background: Pancreatic cancer (PC) is highly lethal, with surgery as the only curative option but significant postoperative morbidity. Prehabilitation shows promise in other cancers, yet no trials have examined supervised exercise during neoadjuvant chemotherapy in PC. Objectives: The primary objective was to evaluate recruitment and adherence to a trimodal prehabilitation program during neoadjuvant chemotherapy in patients with non-metastatic PC. Secondary aims included assessing changes in physical condition, fatigue, quality of life (QoL) and some biomarkers. Methods: A prospective single-center study recruited adults diagnosed with non-metastatic PC scheduled for chemotherapy. Inclusion criteria were ECOG 0–2 and the ability to perform the one mile walk test. The intervention involved supervised exercise, respiratory muscle training, nutritional counselling, and psychological support. Primary outcomes were recruitment (10 patients/year) and adherence (≥70% of exercise, nutrition, or psychological sessions). Secondary outcomes included cardiorespiratory fitness (6-minute walking test [6MWT], mile time walk test, estimated VO₂peak), muscular strength (sit-to-stand [5STS] test and handgrip), global QoL (EORTC QLQ-C30), fatigue (PERFORM and FACIT), and body composition (body mass index (BMI)). Results: Among 35 screened patients, 14 completed the prehabilitation program and 12 underwent surgery (in 30 months). 10 patients were recruited in 12 months. Adherence was acceptable across all components, with physical training achieving 100% attendance. Significant improvements were observed in respiratory capacity (p=0.000), gait speed (p=0.001), estimated VO₂peak (p=0.002), 6MWT (p=0.021), one mile walk test (p=0.000), 5STS (p=0.000), BMI (p=0.047), fatigue PERFORM (p=0.023) and FACIT (p=0.000), and QoL (p=0.017). Conclusions: Trimodal prehabilitation during neoadjuvant chemotherapy in PC can be implemented and may be associated with clinically meaningful improvements in physical fitness, fatigue, and QoL. Multicenter randomized controlled trials are warranted to determine its impact on postoperative outcomes.