Resistance Training Intervention to Improve Physical Function in Patients With Pancreatic Cancer Receiving Combination Chemotherapy or Have Undergone Surgery, PancStrength Study

Will be assessed with the following variables: 1)Uptake rate: Study enrollment will be considered feasible if 70% of eligible patients who are approached to consider study enrollment actually consent and enroll. 2) Study completion rate: If 70% of participants who complete T0 measures (fitness and survey measures) also complete measures at T1. 3) Tele-RT session attendance rate: If the rate of session completion is >= 70%. 4) Adherence to prescribed exercise volume (sets x repetitions x resistance): If the volume of exercise completed is >= 70% of the volume prescribed.

Assessed with the Participant Evaluation of Feasibility and Acceptability questionnaire, adapted from Ingram, et al (2010). This questionnaire includes both Likert Scale and open-ended questions. Likert Scale items will be rated on 5-point scales (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). Acceptability will be assessed on an item-by-item basis and as an average item score, with scores >= 4 ("agree" to "strongly agree") indicating acceptability. Responses to open-ended questions will be analyzed qualitatively to inform development of further iterations of the exercise intervention. Qualitative analysis will follow a content analysis strategy to systematically define units of text, quantify them, and group them into meaningful categories.

Assessed with a brief program evaluation questionnaire distributed to all GI medical oncologists, GI surgeons, advanced practice providers, and clinical dietitians who are involved in participants' care and have some interaction with intervention personnel during recruitment, referral, scheduling, or follow up. Provider acceptability questionnaires will be distributed via REDCap immediately following collection of T1 data from the final study participant and will include Likert Scale items and open-ended items adapted from the Participant Evaluation of Feasibility and Acceptability.

Strength in upper- and lower-body muscle groups will be measured using the following 1-repetition maximum (1RM) lifts: chest press, seated row, leg press, and leg extension. 1RM tests are considered the gold standard for assessing muscular strength in non-laboratory situations. 1RM tests are defined as the maximal weight that can be lifted once with correct lifting technique and are used by athletic trainers, health and fitness professionals and rehabilitation specialists to assess strength and to evaluate training programs. They will be performed in the following sequence, ordered from largest to smallest muscle groups and alternating between upper and lower body movements to allow for sufficient rest: leg press, chest press, leg extension, seated row.

Endurance of upper and lower body muscle groups as measured by the maximum number of repetitions performed at 70% of the T0 1RM for each of the following lifts: leg press, chest press, leg extension, seated row. Participants will rest sufficiently between movements and will perform tests in the same order that they performed 1RM testing. Participants who undergo remote enrollment and exercise testing will undergo the following exercise "field tests" to assess muscular strength and endurance: 1) 30-second chair stand test (to assess lower body strength and muscular endurance) and 30-second arm curl test (to assess upper body strength and muscular endurance).

Self-reported fatigue will be measured using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F). The FACT-F consists of 13 fatigue-related items and has demonstrated validity and reliability as a brief, standalone measure of fatigue among cancer survivors. The FACT-F will provide a single score, with higher scores indicating better quality of life (QOL) (less fatigue). The FACT-F will be distributed and completed via REDCap at T0 and T1.

CIPN will be self-reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - CIPN-20 item scale. This is a 20-item questionnaire regarding sensory, motor, and autonomic neuropathy symptoms with each item scored from 1 (not at all) to 4 (very much), and all items are summed to result in a score range of 20 to 80. A higher score on the questionnaire indicates more symptom burden from CIPN. Will only administer and score items 1-19 with scores ranging from 16 to 76. This questionnaire will be distributed and completed via REDCap at T0 and T1.

Will be self-reported using the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire (FACT-Hep). The FACT-Hep is composed of two parts: the 27-question FACT General (FACT-G) and the 18-question Hepatobiliary Subscale (HS). The FACT-G measures cancer-related QOL in four domains: physical, social/family, emotional, and functional well-being. The HS evaluates the severity of hepatobiliary cancer-specific symptoms. All questions are scored on a Likert scale from 0 to 4 (some are reversed) and added to create FACT-G and HS scores, and these are added to create a FACT-Hep score. A higher FACT-G subscore denotes better QOL. A higher HS subscore denotes a lower degree of disease-related symptoms. The FACT-Hep will be distributed and completed via REDCap at T0 and T1.

Chemotherapy tolerance will be assessed based on relative dose intensities (RDI; defined as the ratio of administered cumulative dose over planned cumulative dose) of the 4 drugs comprising the FOLFIRINOX regimen (39). These data will be collected from participants' electronic health records. Will record if there are any changes in the prescribed regimen (reduction in dose or change in medications) during the study period.

Will be measured using Behavioral Regulation in Exercise Questionnaire-Version 3 (BREQ-3). The BREQ-3 has subscales measuring external (i.e., performed because of an outside demand or potential reward), introjected (i.e., performed to demonstrate an ability), identified (i.e., consciously valuing exercise), and intrinsic forms of exercise behavior regulation. Participant responses will be evaluated as separate subscale scores and as an overall score, with higher overall scores indicating higher relative autonomy in exercise regulation (i.e., higher personal valuation of exercise and higher intrinsic motivation to exercise). The BREQ-3 will be distributed and completed via REDCap at T0 and T1.

Participants will complete the Barriers Self-efficacy survey developed by Marcus et al. and adapted by Tirado-Gomez et al. This survey includes 14 questions that assess how confident an individual is in his or her ability to exercise when facing various barriers, such as sickness, fatigue, and lack of time. Participants will indicate their level of confidence using a scale ranging from 1 (not at all confident) to 5 (extremely confident). Responses to the 14 individual items will be summed to obtain an overall score, with a range of 14 to 70.

Social support for exercise from family and friends will be measured using the Social Support for Exercise Survey (SSES). The SSES lists 13 items that family members or friends may do or say to someone who is trying to exercise regularly, from providing emotional support. The SSES also captures social influences that may hinder exercise. Patients responded to each item separately for friends and family, scoring each item on a Likert-like scale from 1=none to 5=very often. Scores for family and friend participation and family rewards and punishment will be computed following published protocols. Participants will also complete the 13 item scale regarding perceived social support from study interventionists/staff, with instructions to record "does not apply" for items such as "planned for exercise on recreational outings" and "helped plan activities around my exercise." The SSES will be distributed and completed via REDCap at T0 and T1.

Measured using a modified version of the Godin-Shephard Leisure Time Physical Activity Questionnaire (GLTPAQ). The GLTPAQ will be modified as in Vallerand, et al. (2017) to include both aerobic exercise and strengthening exercise related questions and to ascertain performance of guideline-concordant physical activity. To reflect current exercise recommendations, patients will be instructed to include any exercise that lasted at least 5 minutes. Additionally, we will include a single item that asks how many times per week participants perform strengthening exercise (i.e., exercise that improves muscular strength such as weight lifting, resistance bands, sit ups, or push-ups). This question will be extracted from the Health Information National Trends Survey (HINTS) conducted by the National Cancer Institute.

Self-reported physical functioning will be measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Short Form v1.0 - Physical Function 12a. The instrument consists of 12 questions assessing respondents' abilities to perform physical tasks and activities of daily living. Items are scored on 5-point Likert scales, with higher scores indicating higher physical functioning. The PROMIS will be distributed and completed via REDCap at T0 and T1.

Will be assessed by determining the proportion of participants who complete the survey at each target assessment. We will measure the adoption of nutrition recommendations by comparing the recall responses from within the study period to their baseline responses at the time of enrollment. Will also compare adherence to our nutrition recommendations (i.e., protein intake) through the ASA-24 survey at each targeted assessment.