Exercise is associated with skeletal muscle preservation during preoperative treatment of pancreatic cancer

Authors: Gorzelitz J, Parker NH, Ngo-Huang A, Petzel MQB, Prakash L, Garg N, Schadler K, Fogelman D, Tzeng CW, Kim MP, Lee JE, Varadhachary G, Basen-Engquist K, Katz MHG

Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2019

Abstract Body:
Purpose: Skeletal muscle (SKM) loss is common among patients with pancreatic cancer, may be exacerbated by treatment, and is associated with a poor prognosis. We hypothesized that exercise may mitigate SKM loss in patients undergoing preoperative pancreatic cancer treatment, and therefore compared SKM change between patients enrolled in a prescribed, home-based exercise program (EP) with patients advised to exercise per usual care (UC).Methods: EP participants were prescribed moderate-intensity aerobic exercise (≥60 min/wk) and strengthening (≥60 min/wk using resistance tubes) at enrollment (T0), through preoperative treatment to pancreatectomy (T1). UC patients underwent preoperative treatment without the prescribed EP. SKM cross-sectional area at the L3 vertebra was quantified using abdominal CT scans from T0, T1, and following surgery (T2), and standardized to patient height (m2). Rates of SKM change (cm2/m2/wk) were calculated from T0 to T1 and T0 to T2. Linear regression models adjusted for sex, age, baseline SKM, change in body mass index (BMI), and type of preoperative treatment received were used to evaluate differences in rates of SKM change based on EP participation. Results: Clinical and demographic profiles of EP (n=33) and UC (n=66) patients were similar (42% vs. 47% female, mean age 67.7±6.8 vs. 64.7± 9.2, mean T1 BMI 27.1±5.4 vs. 27.3±4.7; 64% vs. 63% baseline sarcopenia; all p>.05). EP participants reported 118.7±65.3 min/wk aerobic and 46.1±35.7 min/wk strengthening exercise over 18.1±10.8 weeks of participation. Rate of SKM change from T0 to T1 was favorable among EP compared to UC patients (mean .01±.2 cm2/m2/wk vs. -.09±.2 cm2/m2/wk; p=.03). There was no significant difference from T0 to T2 (-.09±.2 cm2/m2/wk vs. -.12±.2 cm2/m2/wk; p=.4). Adjusted models showed a favorable and statistically significant association between EP participation and rate of SKM change from T0 to T1 (B=.10, p=.02) but not from T0 to T2 (B=.05, p=.1).Conclusions: Exercise may mitigate muscle loss during preoperative pancreatic cancer treatment. Exercise should be prescribed during treatment to maintain muscle mass and possibly improve oncologic treatment outcomes.

Keywords: Exercise, pancreatic cancer, prehabilitation