Structured Exercise During Chemotherapy for Locally Advanced or Metastatic Pancreatic Cancer: A Single-Arm, Feasibility Trial

Introduction: Evidence on structured exercise during systemic treatment for patients with locally advanced or metastatic pancreatic cancer is still limited, and detailed feasibility data in real-world clinical settings remain scarce. This study aimed to assess the feasibility, safety, and preliminary efficacy of a 12-week exercise intervention in this population. Methods: In this prospective single-arm trial, 20 patients undergoing chemotherapy participated in a supervised exercise program comprising aerobic and resistance training, delivered twice weekly for 12 weeks. Participants could choose between supervised gym-based or home-based sessions. Primary outcomes included recruitment, retention, attendance, adherence, tolerance, and safety. Secondary outcomes were changes in physical fitness and patient-reported outcomes. Descriptive statistics and paired t-tests or Wilcoxon signed-rank tests were used for analyses. Exploratory subgroup analyses were conducted by tumor stage and exercise delivery mode. Results: The recruitment rate was 80%, with a 43% dropout rate primarily due to disease progression or treatment-related toxicities. Median session attendance was 79%, and adherence to prescribed exercise volume reached 77%. Only three non-serious adverse events were reported. Significant improvements were observed in grip strength (p = 0.049), total weekly physical activity (p = 0.024), and time spent in moderate-intensity activity (p < 0.001). Emotional (p = 0.022) and social functioning (p = 0.048) significantly improved, while appetite loss decreased (p = 0.010). Subgroup analyses suggested greater benefits in patients with stage IV disease and those in the home-based group. Conclusions: Exercise during chemotherapy appears feasible and safe for patients with advanced/metastatic pancreatic cancer, and it may help maintain physical fitness, enhance emotional and social well-being, and alleviate appetite loss. However, different strategies are required to reduce the dropout rate.