Exercise training beneficial for chemo-induced neuropathy

Blood cancers

By Geir O'Rourke

8 Jul 2024

Neuromuscular training can decrease the risk of chemotherapy-induced peripheral neuropathy by up to 70%, with improvements in metrics like quality of life and balance control, a study has found.

By preventing neurological deficits, such a regime may also impact clinical outcomes and overall survival by improving tolerability and adherence to oncological treatment, the authors say.

The prospective multicentre randomised clinical trial included 158 German patients commencing treatment with oxaliplatin or vinca alkaloids, with participants undertaking twice-weekly sessions involving one of two training approaches, as well as a control group receiving usual care.

Assessment after 12 weeks showed the greatest benefit in the third of participants who performed sensorimotor training, which was based around balance exercises.

This group had an incidence of chemotherapy-induced peripheral neuropathy (CIPN) of 30%, as diagnosed via physical examination, compared with 71% of the usual care arm, according to the investigators.

They also improved their vibration sensitivity, balance control, burning sensation and lower leg strength.

Additionally, those undergoing sensorimotor training needed fewer dose reductions and had less mortality, the team reported in JAMA Internal Medicine (link here).

But training also had a positive effect in the other active treatment arm, who underwent whole body vibration training on a specially designed vibration platform, resulting in a CIPN rate of 41%. Vibration training also improved bipedal stance, according to the study.

Overall, patients receiving vinca alkaloids were more sensitive to the interventions than patients receiving oxaliplatin, especially when combined with sensorimotor training, the authors said.

“Based on our results as well as the current literature, this specific exercise regimen not only presents potentially the best current treatment option for CIPN but also has the potential to prevent CIPN, improve quality of life, and have a positive impact on the course of oncological treatment,” they wrote.

“Although 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.”

Data points to broader benefits of ‘exercise oncology’

In an attached commentary, US experts said the result should provide hope for those keen to address a common and distressing complication of many chemotherapy drugs, which frequently resulted in clinicians being forced to reduce dosages, with negative oncological consequences.

With few evidence-based treatment options available for CIPN, there was growing recognition of the importance of primary prevention, said the authors (link here).

“This study adds to the burgeoning evidence about the benefits of exercise and physical medicine interventions in patients at risk of or with neuropathy,” they wrote.

“Such interventions have also shown benefit for nonchemotherapy-associated neuropathy. For example, sensorimotor training and endurance training are associated with improvements in balance, timed up-and-go test results, and metabolic markers and nerve conduction velocities in patients with diabetic neuropathy.”

This pointed to a potential need for better training of physiotherapists and other exercise professionals to deliver better cancer care, noting there were other proven benefits of exercise for cancer patients.

“Exercise oncology has proven benefits for improving cancer-associated anxiety, depressive symptoms, fatigue, health-related quality of life, and physical function, with emerging evidence for CIPN, pain, sleep, and cognitive impairment,” they wrote.

“Highlighting these more global benefits can aid advocacy and funding efforts.”

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