title: Exercise as medicine in the management of pancreatic cancer: a case study.
abstract: BACKGROUND
  Given the poor prognosis for patients diagnosed with pancreatic cancer, therapies that enhance the ability to tolerate adjuvant treatments, reduce the loss of physical functioning and optimize quality of life are critically important. Exercise may represent such a therapy; however, no previous research has investigated the potential impact of exercise on outcomes in pancreatic cancer patients.
  
  
  OBJECTIVE
  This study aimed to determine the safety and efficacy of a 6-month supervised exercise program in a pancreatic cancer patient undergoing adjuvant treatment.
  
  
  METHODS
  A case study was performed on a 49-yr-old male diagnosed with stage IIb pancreatic cancer. The patient had surgery (Whipple resection) followed by adjuvant chemotherapy (gemcitabine and fluorouracil) and radiotherapy (45 Gy). The patient initiated a supervised exercise program involving twice weekly resistance and aerobic exercise sessions during adjuvant therapy. Outcomes were assessed at baseline and after 3 and 6 months of exercise.
  
  
  RESULTS
  The exercise program was well tolerated with 73% attendance throughout the 6 months. No treatment toxicities prevented the patient from complying with adjuvant treatment plans. Considerable improvements were observed at both 3- and 6-month assessment points for all measures of physical capacity and functional ability, lean mass, physical activity levels, general health and disease-specific quality of life, cancer-related fatigue, sleep quality, and psychological distress.
  
  
  CONCLUSIONS
  In this first reported clinical case, exercise led to improvements in a variety of patient outcomes during adjuvant therapy for pancreatic cancer. This initial evidence has important clinical implications, indicating that exercise may be an effective adjunct therapy for the management of pancreatic cancer. Future trials are needed to confirm and expand our initial findings.
authors.affiliation: 1Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, AUSTRALIA; 2Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, AUSTRALIA; 3Faculty of Medicine, University of Western Australia, AUSTRALIA; 4Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, AUSTRALIA; 5Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, AUSTRALIA; 6Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, AUSTRALIA.
authors.forename: Prue
authors.initials: P
authors.lastname: Cormie
authors.forename: Nigel
authors.initials: N
authors.lastname: Spry
authors.forename: Kevin
authors.initials: K
authors.lastname: Jasas
authors.forename: Mikael
authors.initials: M
authors.lastname: Johansson
authors.forename: Ian F
authors.initials: IF
authors.lastname: Yusoff
authors.forename: Robert U
authors.initials: RU
authors.lastname: Newton
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Galvão
mesh_terms: D000230:Adenocarcinoma / Q000534:rehabilitation* / Q000628:therapy; D001823:Body Composition; D015519:Bone Density; D017024:Chemotherapy, Adjuvant; D005080:Exercise Test; D005081:Exercise Therapy; D005221:Fatigue / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000534:rehabilitation* / Q000628:therapy; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012893:Sleep Wake Disorders / Q000517:prevention & control; D013315:Stress, Psychological / Q000517:prevention & control