Predictors of physical activity and exercise among participants in a randomized trial of home-based prehabilitation during preoperative pancreatic cancer treatment

Authors: Parker NH, Ngo-Huang A, Schadler K, Petzel MQB, Prakash L, Cotto AM, Tzeng CWD, Ikoma N, Basen-Engquist KM, Katz MHG

Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2023

Abstract Body:
Purpose: Exercise prehabilitation ("prehab") can improve fitness, physical functioning (PF), and health related quality of life (HRQoL) prior to cancer resection. We sought to evaluate predictors of exercise and physical activity (PA) among participants in a randomized trial of home-based prehab for pancreatic cancer (PC). Methods: Patients presenting with localized PC were randomized to enhanced usual care (UC+) or home-based exercise prehab (EP). UC+ participants received a Fitbit and encouragement to be physically active. EP participants received a Fitbit, resistance tube sets, and instruction to engage in moderate-intensity aerobic exercise (≥30 minutes on 5 days/week) and progressive, full-body resistance training (RT, 2x/week). EP participants received biweekly phone calls to encourage adherence. Participants completed questionnaires at baseline/enrollment (T0) assessing exercise (modified Godin Questionnaire), PF (PROMIS12a), HRQoL (FACT-Hep), exercise motivation (BREQ-3), and exercise barrier self-efficacy (BSE). PA and exercise during the study period were assessed using Fitbits (daily steps, weekly active minutes) and repeat modified Godin questionnaires at pre-surgical clinical restaging (T1). Results: 151 participants were randomized to UC+ (n=76, age mean ± SD 66.2 ± 8.2 years, 33% female) and EP (n=75, age 66.1 ± 8.5 years, 26% female). There were no significant clinicodemographic differences between groups and no significant differences in self-reported exercise or Fitbit steps or active minutes at T1. With UC+ and EP combined in pooled analyses, females showed fewer daily steps and fewer weekly active minutes than males (p=.02 and p<.001, respectively). T0 self-reported aerobic exercise, PF, HRQoL, exercise motivation, and BSE were all positively correlated with exercise and/or PA variables at T1 (all p<.05). Conclusions: Randomization to a more formal home-based exercise program did not lead to more exercise or PA among patients preparing for PC resection compared to general PA recommendations and Fitbit provision. Correlations among T1 exercise and PA and T1 functional status (PA, PF, HRQoL) and exercise readiness (motivation, BSE) suggest that these may warrant additional considerations for intervention tailoring and support.

Keywords: Physical activity, exercise, prehabilitation, pancreatic cancer