Specific Exercise Shown to Reduce Chemotherapy-Induced Peripheral Neuropathy

A team of researchers from the University of Basel, Switzerland, and colleagues in Germany has demonstrated the benefit of specific exercise that can reduce a common side-effect of cancer treatment, chemotherapy-induced peripheral neuropathy (CIPN).

As many as 90% of patients receiving therapies such as oxaliplatin or vinca alkaloids experience a range of often debilitating nerve-related effects such as pain, balance issue, numbness, burning, or tingling. While these can disappear after treatment, in about half of all patients these become long lasting, or CIPN.

But the University of Basel investigators report that a specific exercise done during the course of cancer treatments can help prevent the nerve damage that leads to CIPN. Their findings are published in the journal JAMA Internal Medicine.

Building on its previous research the team hypothesized that sensorimotor training (SMT) and/or whole-body vibration training (WBV) could reduce symptoms and decrease the onset of CIPN.

Their prospective, multicenter, randomized, controlled trial spanning five years enrolled 158 patient who were receiving either oxaliplatin or vinca-alkaloid treatments. Study subjects were both male and female and divided at random into three groups. The control group received standard care. The two other groups completed two exercise sessions ranging from 15–30 minutes a week for the length of their chemotherapy treatment, one focused primarily on balancing on an increasingly unstable surface and the second group on a vibration plate.

The participants were followed over the course of five years, which revealed the control group patients were twice as likely to develop CIPN as patients in either of the exercise groups. Analysis showed that when the patients exercised during their chemotherapy regimen the incidence of nerve damage was reduced between 50% and 70% compared with the control group. The patients’ subjective measures of the quality of life also improved, made it less likely that their medications would need to be reduced during treatment due to harsh side effects, and also had a reduced five-year mortality rate. Best results were experienced by the patients receiving vinca-alkaloid treatments combined with SMT.

“Considering the present results and previous studies, it becomes clear that specific exercises have significant potential to counter chemotherapy side effects,” the researchers wrote. “We were able to show that SMT can decrease CIPN, maintain and improve subjective as well as objective outcomes, such as vibration sensitivity, sense of touch, lower leg strength, less pain and burning sensation, and better balance control. Furthermore, patients needed less dose reductions, had less mortality, a tendency to better quality of life and higher physical activity levels.”

The team noted that while treatments have been developed over the years to treat CIPN and there have been improvements in their efficacy, reports have noted that the medications themselves can often provoke neuropathy. “Doctors prescribe medications despite everything, because patients’ level of suffering is so high,” noted Fiona Streckmann, PhD, a sports scientist from the University of Basel and the German Sport University Cologne who led the study.

Specifically, the researchers said that the study supports their notion that SMT has high neuro-modulating potential that can stimulate regenerative and adaptive mechanisms of muscle spindles resulting in neuroplasticity, while WBV seemed to target superficial nerves.

Factors that could influence the adoption of these exercises for chemotherapy patients can be standardized, are feasible and include the options for both low intensity through high impact based on a patient’s phase of therapy and can be done at home. SMT has the added benefit of being low cost, while showing no contraindications or side-effects.

“Based on our results as well as the current literature, this specific exercise regime currently not only presents the most promising treatment option but also has the potential to prevent CIPN, improve quality of life, and have a positive impact on the course of oncological treatment,” the investigators concluded. “Though more studies are necessary to verify these results, the present results are of high clinical relevance and present a milestone for the management of CIPN and supportive care in oncology.”

Streckman and her team are now developing guidelines for hospitals so the exercises can be integrated as supportive therapy in clinical practice. In addition a second study was launched in 2023 at six children’s hospitals in Germany and Switzerland to prevent sensory and motor dysfunction in children receiving neurotoxic chemotherapy.