Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

Abstract

Objectives Loss of body weight is often seen in pancreatic cancer and also predicts poor prognosis. Thus, maintaining muscle mass is an essential treatment goal. The primary aim was to investigate whether progressive resistance training impacts muscle and adipose tissue compartments. Furthermore, the effect of body composition on overall survival (OS) was investigated. Methods In the randomized SUPPORT-study, 65 patients were assigned to 6-month resistance training (2x/week) or a usual care control group. As secondary endpoint, muscle strength of the upper and lower extremities was assessed before and after the intervention period. Routine CT scans were assessed on lumbar L3/4 level for quantification of total-fat-area, visceral-fat-area, subcutaneous-fat-area, intramuscular-fat-area, visceral-to-subcutaneous fat ratio (VFR), muscle-area (MA), muscle-density and skeletal-muscle-index (SMI). OS data were retrieved. Results Of 65 patients, 53 had suitable CT scans at baseline and 28 completed the intervention period with suitable CT scans. There were no significant effects observed of resistance training on body composition (p>0.05; effect sizes ω2p <0.02). Significant moderate to high correlations were found between MA and muscle strength parameters (r = 0.57–0.85; p<0.001). High VFR at baseline was a predictor of poor OS (VFR≥1.3 vs. <1.3; median OS 14.6 vs. 45.3 months; p = 0.012). Loss of muscle mass was also a predictor of poor OS (loss vs. gain of SMI; median OS 24.6 vs. 50.8 months; p = 0.049). Conclusion There is anabolic potential in patients with resectable pancreatic cancer. A progressive resistance training may help patients to maintain their muscle mass and avoid muscle depletion. CT-quantified muscle mass at the level of L3/4 showed a good correlation to muscle strength. Therefore, maintaining muscle mass and muscle strength through structured resistance training could help patients to maintain their physical functioning. A high VFR at baseline and a high loss of muscle mass are predictors of poor OS. Registered on ClinicalTrials.gov (NCT01977066).

Exercise intervention during chemotherapy for pancreatic cancer: Changes in body composition and function

“…We observed a marginally significant positive correlation between a measure of change in strength (grip strength) and changes SMI. A similar relationship of changes in muscle parameters to change in function was reported by Wochner et al, who found a correlation in muscle strength with changes in SMI but not with SMD 34 …”

“…Outcomes were muscle strength of different groups. 34 Our study adds to the two previous studies by including Stage IV patients and presenting outcomes with commonly used physical performance measures, such as chair stands, Timed Up and Go, hand grip strength, and tandem balance. These physical outcome measures are widely used in exercise studies but had not yet been reported in pancreatic cancer patients.…”

“…Of these, 28 patients completed the study and had eligible CT scans at the second time point. Outcomes were muscle strength of different groups 34 . Our study adds to the two previous studies by including Stage IV patients and presenting outcomes with commonly used physical performance measures, such as chair stands, Timed Up and Go, hand grip strength, and tandem balance.…”

Evaluation of a Clinic-Based Exercise Program in Patients with Pancreatic Cancer Undergoing Nonsurgical Treatment

“…Notably, however, there are also data indicating that resistance exercise has no effect on body composition in patients with PanCa, where the majority (>85%) had already completed resection and underwent concurrent chemotherapy (39). In addition, vast heterogeneity exists in the scant evidence available for PanCa with regard to patient characteristics, exercise programs, and methods for the assessment of body composition (10,38,39). As such, further investigations are needed to better understand the effect of exercise on body composition in this patient group.…”

Prognostic value of pretreatment skeletal muscle index in pancreatic carcinoma patients: A meta-analysis

“…Pancreatic carcinoma patients are frequently observed to experience body weight loss, especially skeletal muscle loss, which is related to the cancer progression. [11][12][13] The loss of skeletal muscle mass is relatively objective and accurate. Meanwhile, a lot of studies have demonstrated that the nutritional status of the body is closely associated with disease progression and long-term survival of cancer patients.…”