Exercise to Improve Outcomes in Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is associated with poor survival, reduced physical function, and a high burden of treatment-related morbidity. Patients undergoing pancreaticoduodenectomy (Whipple's procedure) often experience substantial declines in cardiorespiratory fitness and muscle function before and after surgery, which may contribute to postoperative complications, delayed recovery, and reduced likelihood of receiving adjuvant chemotherapy. While prehabilitation programmes are increasingly incorporated into routine care, current approaches are not typically individualised using objective measures of physical fitness and generally do not extend across the entire perioperative pathway. The Exercise to Improve Outcomes in Pancreatic Cancer (ExO-PanC) study has been developed to evaluate the feasibility of a personalised exercise programme delivered before surgery, during hospital admission, and throughout postoperative recovery until the commencement of adjuvant chemotherapy. Exercise prescriptions will be individualised using cardiopulmonary exercise testing (CPET), muscle strength assessments, and functional performance measures, allowing exercise intensity and progression to be tailored to each participant's physiological capacity. Participants will undergo repeated assessments of cardiorespiratory fitness, physical function, muscle strength, nutritional status, quality of life, and biological sampling throughout the study. Blood, stool, and surgically resected tumour tissue will be collected to explore biomarkers associated with clinical outcomes and responses to exercise. The primary objective of this feasibility study is to determine whether the ExO-PanC intervention can be successfully delivered across the perioperative pathway by evaluating participant recruitment, adherence, compliance with prescribed exercise, and study retention. Exploratory analyses will investigate surgical complications, initiation of adjuvant chemotherapy, changes in physical fitness and quality of life, and relationships between biological markers and clinical outcomes. Results from this study will establish the feasibility of implementing a personalised perioperative exercise programme for patients undergoing pancreatic cancer surgery and will provide essential data to inform the design of a future adequately powered multicentre randomised controlled trial evaluating the effectiveness of the ExO-PanC intervention.