Exercise Guidelines in Pancreatic Cancer Based on the Dietz Model
by
, , , , and
Philip J. Chang
1,*,
Andrew E. Hendifar
1,
Gillian Gresham
1,
An Ngo-Huang
2,
Paul E. Oberstein
3,
Nathan Parker
4 and
Andrew L. Coveler
5 1
Cedars-Sinai Medical Center, Los Angeles, CA 90211, USA
2
MD Anderson Cancer Center, Houston, TX 77030, USA
3
New York University, New York, NY 10012, USA
4
Moffitt Cancer Center, Tampa, FL 33612, USA
5
University of Washington, Seattle, WA 98105, USA
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(4), 630; https://doi.org/10.3390/cancers17040630
Submission received: 2 January 2025
/
Revised: 7 February 2025
/
Accepted: 8 February 2025
/
Published: 13 February 2025
(This article belongs to the Special Issue Management of Pancreatic Cancer)
Simple Summary
Pancreatic and gastrointestinal cancers commonly occur in the elderly and in patients with lower levels of physical function. Physical activity and exercise are one of the primary interventions in combating frailty and disability; however, guidelines are lacking in this patient population. Here, we propose practical exercise guidelines for every phase of disease in these cancers based on the Dietz model. During the prehabilitation phase, patients may optimize their physical abilities before undergoing surgery. Restorative rehabilitation often given through skilled therapies can help patients to recover any function lost from chemotherapy, radiation therapy, and surgery. Supportive rehabilitation can allow patients to continue with regular physical activity during stable or ongoing disease and palliative rehabilitation can help patients maintain the highest possible quality of life when they enter the end stage of life. No matter the stage of disease or phase of treatment, physical activity and exercise have important roles in maintaining well-being.
Abstract
Pancreatic and gastrointestinal cancers are associated with debility, frailty, and chemotherapy regiments with significant toxicity. Practical exercise guidelines to combat these ailments and optimize functional status are lacking. We present a model for exercise for these cancers based on the Dietz framework for rehabilitation in cancer. The Dietz framework for rehabilitation describes four phases of rehabilitation including preventative (prehabilitation), restorative, supportive, and palliative. We present practical guidelines for exercise at each phase. Prehabilitation seeks to optimize functional performance typically prior to surgical resection and may occur concurrently with neoadjuvant therapy. Restorative rehabilitation occurs following the development of a physical deficit such as after surgery and may utilize skilled therapies in the inpatient, subacute, outpatient, and home settings to address functional impairments. Supportive rehabilitation occurs during stable disease or remission and depends on the frequent monitoring of functional status and particularly the development of chemotherapy-induced neuropathy to ensure timely exercise interventions. Palliative rehabilitation occurs at the end stage of life and shifts to a focus on patient comfort and safety. Exercise is a critical component of treatment in cancer demonstrating numerous quality-of-life benefits. The customization of exercise recommendations to individual patients based on their functional status and phase in treatment is essential for safety and adherence.
