Cancer care

Exercise intervention advised for chemotherapy-induced peripheral neuropathy


Exercise has been backed as an intervention for preventing chemotherapy-induced peripheral neuropathy (CIPN) by one of the first studies showing it improved objective outcomes.

Cancer patients who took part in a structured program of balance and resistance training showed less of an increase in neuropathic symptoms in the feet during chemotherapy  compared to those who receive usual care, according to a German study.

The trial, which involved 170 patients receiving chemotherapy at the Division of Medical Oncology, Heidelberg University Hospital, also showed exercise participants had better balance, less fear of falling, better quality of life and were able to tolerate higher doses of chemotherapy compared to the usual care group.

The patients in the study were mostly female (83%) and had breast cancer (74%) , had a median age of 53 and were receiving neurotoxic chemotherapy such as taxanes.

They were randomised to receive usual care or exercise training of 105 minutes per week throughout the duration of their chemotherapy, which lasted an average of  17.2 (± 5.3) weeks.

The exercise consisted of either supervised resistance training and home-based core-strengthening session; or sensorimotor (balance) exercise training either at home or supervised in a group setting.

The primary outcome was Total Neuropathy Score-reduced (TNSr), a composite measure that included patient-reported and objective clinical CIPN symptoms including sensory, motor, deep tendon reflexes and strength.

When assessed at the end of chemotherapy there was no overall difference seen between exercise participants and the control group in signs and symptoms of CIPN.

However when the assessment was restricted to the patients who adhered to exercise, there were significant reductions in sensory neuropathic feet symptoms during chemotherapy compared to the usual care  group (P = 0.039, ES = 1.27). There were also significantly better balance scores in the exercise group, although these benefits did not persist on assessment at three and six months after the end of chemotherapy.

The study investigators said the findings showed real benefits on CIPN for patients who were willing to take part in an exercise program, acknowledging that only about half adhered to the program.

They noted that exercise participants had higher chemotherapy compliance (96.6vs  92.2% in the control group, P = 0.045), “which could have important clinical implications due to receiving nearer to their prescribed dose.”

There were also meaningful benefits in functional and patient-reported outcomes such as physical and social functioning as well as fatigue and a trend to less pain  with exercise, they noted.

The benefits on neuropathic symptoms mirrored those seen in previous studies that had relied on subjectively perceived CIPN symptoms.

“Based on our results and those of other authors, it might be advisable to recommend a multimodal training approach to preventively influence as many facets of CIPN as possible. This multimodal training approach should consist of SMT and RT and possibly also endurance training,” they concluded.

They added that measures would be needed to overcome the barriers to participation, noting that sessions were often missed due to side effects of chemotherapy such as fatigue and nausea.

An accompanying commentary said the findings added to the limited evidence for exercise as an intervention for CIPN, and suggested that aerobic exercise also be included in any recommendations  because this had also been shown to have benefits in cancer patients

The findings are published in British Journal of Cancer.

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