Effects of exercise therapy in patients with pancreatic cancer: A systematic review and meta-analysis

Abstract

Introduction: The reported benefits of exercise therapy in patients with pancreatic cancer include maintaining and improving physical fitness and muscle strength, reducing treatment-related side effects, and enhancing quality of life. However, the evidence remains inconclusive, necessitating the integration of interventional studies to reach a consensus. This study aimed to elucidate the effects of exercise interventions for patients with pancreatic cancer through a meta-analysis of randomized controlled trials.

Methods: A literature search was conducted to identify articles published prior to May 2024, using the PubMed/MEDLINE, Scopus, CINAHL, and PEDro databases. Search terms included pancreatic cancer, exercise-related terminology, physical function, and quality of life. The primary outcome was quality of life, and the secondary outcome was physical function. All meta-analyses were conducted using a random-effects model.

Results: The final analysis included 6 studies, with sample sizes ranging from 40 to 172 patients. The intervention types were resistance training in 3 studies and a combination of aerobic exercise and resistance training in 3 studies. The timings of the interventions were after surgery or chemotherapy in 4 studies and during chemotherapy or chemoradiotherapy in 2 studies. Three randomized controlled trials used European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 to assess quality of life. Physical function was evaluated using muscle strength measurements (isokinetic and isometric strength), the 5-chair stand test, and the 6-min walk test for exercise capacity. Exercise intervention was effective for improving physical quality of life (standardized mean difference = 0.41, 95 % confidence interval = 0.07-0.74, p = 0.02). In addition, improvements in both upper extremity muscle strength (standardized mean difference = 0.50, 95 % confidence interval = 0.21-0.80, p = 0.0008) and lower extremity muscle strength were observed (standardized mean difference = 0.35, 95 % confidence interval = 0.14-0.56, p = 0.0009). On the other hand, the 6-min walk test showed no significant difference in the effect of exercise therapy between the exercise and control groups.

Conclusion: The findings of this study indicate that exercise therapy for pancreatic cancer patients effectively increases muscle strength in the upper and lower limbs while improving their physical quality of life. However, because all the included studies were assessed as having a high risk of bias, the findings of this review should be interpreted with caution.

Keywords: Exercise; Meta-analysis; Pancreatic cancer; Physical function; Quality of life.

Fig. 1

Study flow diagram of the selection process.

Fig. 2

Risk of bias for randomized controlled trials (Cochrane Risk of Bias 2 tool).

Fig. 3

Effect of exercise on quality of life.

Fig. 4

Effect of exercise on upper limb muscle strength.

Fig. 5

Effect of exercise on lower limb muscle strength.

Fig. 6

Effect of exercise on exercise capacity.