Boccia G; University of Torino, 10043 Orbassano, Italy.
Beratto L; Tarperi C; Rainoldi A; Calliera C; Ierace D; Satolli
MA; Bo S; Costelli P

Medical Sciences. 14(2), 2026 Apr 07.

BACKGROUND: Patients with pancreatic cancer (PC) commonly present with
reduced aerobic fitness, sarcopenia, and malnutrition, which may increase
perioperative risk and compromise access to chemotherapy treatments.
Although exercise-based prehabilitation can improve physical fitness, its
implementation is often limited by short diagnostic-to-surgery intervals
and treatment-related toxicity.

METHODS: We conducted a pilot prospective pretest-posttest feasibility
study in Torino, Italy. Patients with PC undergoing neoadjuvant
chemotherapy prior to surgery were offered a 4-week, partially supervised,
home-based bimodal exercise prehabilitation program (single-arm design)
combining remotely monitored high-intensity interval training (HIIT) on a
cycle ergometer with functional and resistance exercises. The primary
outcome was adherence to prescribed exercise frequency, intensity, and
duration, objectively assessed via remote monitoring. Secondary outcomes
included cardiorespiratory fitness (CPET), muscle function, body
composition, fatigue, quality of life, and circulating inflammatory
markers.

RESULTS: From July 2022 to February 2024, 23 patients were screened; 15
were eligible and 10 enrolled. Four participants discontinued the
intervention (two due to asthenia/fatigue, one due to chemotherapy-related
adverse events, and one for organizational reasons), leaving six
participants who completed the program. Among completers, fatigue and
quality of life did not change meaningfully. Aerobic capacity and muscle
function outcomes were generally stable, with few pre-post changes
exceeding the minimum clinically important difference (MCID) thresholds
used. Body composition markers and the assessed circulating
cytokines/chemokines remained unchanged except for IL-6 levels, which
decreased significantly (p < 0.05).

CONCLUSIONS: A partially supervised, home-based HIIT-based
prehabilitation program is feasible for a subset of PC patients undergoing
neoadjuvant therapy, but a substantial attrition rate suggests the need
for more flexible symptom-adapted prescriptions and enhanced supportive
strategies.