Exercise and sport medicine during chemo(radio)therapy in patients with pancreatic cancer

Author Identifier



Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Supervisor

Dennis Taaffe

Second Supervisor

Daniel Galvão

Third Supervisor

Robert Newton

Fourth Supervisor

Colin Tang


Background: Chemotherapy alone or in conjunction with radiotherapy plays an integral role in all clinical stages of pancreatic cancer (PanCa). Problematically, available chemotherapy drugs, in particular, the oft-used intensive combination regimens, are associated with extensive toxicities and patients often present with debilitating syndromes/symptoms, collectively reducing treatment tolerability, quality of life (QoL), and in turn, survival. Exercise and sportbased interventions are emerging as potential therapies to prevent or alleviate cancer-related and treatment-related sequalae. However, current evidence on physical activity interventions in oncology care is primarily derived from patients with prevalent cancers and better prognoses (e.g., breast cancer). Clinical research in PanCa remains scant and has focused largely on conventional resistance and/or aerobic exercise in patients with potentially curable disease, a relatively younger age and/or higher functioning level.

Purpose: This doctoral research aimed to investigate the feasibility, tolerability, and safety of exercise and sport medicine programs in patients with different stages of PanCa, in particular, older individuals with advanced disease during chemo(radio)therapy as well as the efficacy for health-related parameters and QoL.

Methods: A series of 4 interrelated studies were undertaken: (1) a systematic review of clinical trials examining the health-related effects of physical activity interventions in PanCa to identify research gaps; (2) an integrative review summarising current evidence of sport-based programs in cancer to inform intervention development; (3) an original analysis to examine the feasibility, tolerability, and safety as well as the health-related effects of exercise at a moderate-intensity to vigorous-intensity in patients with PanCa during chemo(radio)therapy; and (4) a case series to assess the feasibility and initial efficacy of a combined exercise and sport-based intervention in older patients with advanced PanCa during first-line chemotherapy.

Results: The systematic review found that low- to moderate-intensity exercise appears feasible and safe and may improve cancer-related fatigue, psychological distress, and physical fitness in patients with PanCa; however, further work is required with a particular focus on advanced disease. Integrative review of 15 quantitative and qualitative studies concluded that sport-based programs may be an alternative strategy to conventional forms of exercise in managing cancer with derived benefits potentially dependent on the physical/physiological, motor, and cognitive demands as well as the motivational climate featured in a program. The original analysis including 22 patients further supports the concurrent use of supervised resistance and aerobic exercise with chemo(radio)therapy for PanCa, where acceptable feasibility and tolerability, and promising health benefits were noted. Similarly, in the case series of 6 older ( ≥ 60 years) patients with de novo or recurrent advanced PanCa undergoing first-line chemotherapy, we observed favourable feasibility, acceptability, and safety outcomes and promising physical and psychological results after a ≤ 12-week program including resistance and aerobic training, and boxing-related activities.

Conclusions and Implications: Exercise and sport-related (boxing) activities appear feasible, well-tolerated, and safe and may benefit physical structure/capacity, psychological health, and QoL in patients with PanCa during chemo(radio)therapy. This research is a critical first step in the quest to integrate physical exercise into standard care for PanCa and provides insights and guidance for future research in this clinical population.



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