Exercise and sport medicine during chemo(radio)therapy in patients with pancreatic cancer

Background: Chemotherapy alone or in conjunction with radiotherapy plays an integral role in all clinical stages of pancreatic cancer (PanCa). Problematically, available chemotherapy drugs, in particular, the oft-used intensive combination regimens, are associated with extensive toxicities and patients often present with debilitating syndromes/symptoms, collectively reducing treatment tolerability, quality of life (QoL), and in turn, survival. Exercise and sportbased interventions are emerging as potential therapies to prevent or alleviate cancer-related and treatment-related sequalae. However, current evidence on physical activity interventions in oncology care is primarily derived from patients with prevalent cancers and better prognoses (e.g., breast cancer). Clinical research in PanCa remains scant and has focused largely on conventional resistance and/or aerobic exercise in patients with potentially curable disease, a relatively younger age and/or higher functioning level. Purpose: This doctoral research aimed to investigate the feasibility, tolerability, and safety of exercise and sport medicine programs in patients with different stages of PanCa, in particular, older individuals with advanced disease during chemo(radio)therapy as well as the efficacy for health-related parameters and QoL. Methods: A series of 4 interrelated studies were undertaken: (1) a systematic review of clinical trials examining the health-related effects of physical activity interventions in PanCa to identify research gaps; (2) an integrative review summarising current evidence of sport-based programs in cancer to inform intervention development; (3) an original analysis to examine the feasibility, tolerability, and safety as well as the health-related effects of exercise at a moderate-intensity to vigorous-intensity in patients with PanCa during chemo(radio)therapy; and (4) a case series to assess the feasibility and initial efficacy of a combined exercise and sport-based intervention