Exercise May Prevent Nerve Damage During Chemotherapy

Physical exercise may help prevent nerve damage in patients receiving chemotherapy, according to a recent study published by Streckmann et al in JAMA Internal Medicine.

Background

Cancer therapies have improved in recent years. Physicians are no longer concerned just about survival; patients’ quality of life following recovery may be increasing in significance. However, many cancer therapies—including chemotherapy and modern immunotherapy—often attack the nerves as well as tumor cells, causing nerve damage that can lead to long-lasting symptoms. Up to 90% of patients who receive therapies such as oxaliplatin or vinca alkaloids experience pain; balance issues; or sensations of numbness, burning, or tingling. Although these symptoms can disappear following cancer treatment, about 50% of patients experience chemotherapy-induced peripheral neuropathy.

“This side effect has a direct influence on clinical treatment. [F]or example, patients may not be able to receive the planned number of chemotherapy cycles that they actually need, the dosage of neurotoxic agents in the chemotherapy may have to be reduced, or their treatment may have to be terminated,” stressed lead study author Fiona Streckmann, PhD, a sports scientist at the University of Basel and the German Sport University Cologne.

Despite investments made to reduce the incidence of chemotherapy-induced peripheral neuropathy, there are currently no effective pharmacologic treatment options. Previous studies have shown that drugs can neither prevent nor reverse this nerve damage. Nonetheless, estimates suggest that $17,000 are spent per patient every year in the United States to attempt to treat nerve damage associated with chemotherapy.

“[Physicians] prescribe [drugs] despite everything, because patients’ level of suffering is so high,” Dr. Streckmann added.

Study Methods and Results

In the recent study, researchers randomly assigned 158 patients with cancer who were receiving therapy with either oxaliplatin or vinca alkaloids to receive 15- to 30-minute exercise sessions twice weekly for the duration of their chemotherapy—either focusing primarily on balancing on an increasingly unstable surface or training on a vibration plate—or standard care.

After a follow-up of 5 years, the researchers found that compared with the exercise groups, the patients in the standard care group were twice as likely to develop chemotherapy-induced peripheral neuropathy. They emphasized that the exercises undertaken alongside chemotherapy were able to reduce the incidence of nerve damage by 50% to 70%. In addition, they increased the patients’ subjectively perceived quality of life, minimized the need to reduce their cancer therapy doses, and reduced mortality following chemotherapy. The researchers reported that the patients who received vinca alkaloids and performed sensorimotor training had the greatest benefits.

The findings substantiated the positive effects of physical exercise in this patient population, which may be more affordable compared with pharmacologic interventions.

The researchers are currently developing guidelines hospitals can use to integrate the exercises into clinical practice as supportive therapy. Since 2023, a study has been ongoing in six children’s hospitals in Germany and Switzerland to explore strategies to prevent sensory and motor dysfunctions in pediatric patients receiving neurotoxic chemotherapy.

“The potential of physical activity is hugely underestimated,” underscored Dr. Streckmann.

The researchers hope the results of their study will lead to greater employment of sports therapists in hospitals to better exploit the potential benefit of physical exercise.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.