Peripheral Neuropathy: Can Exercise Help?

Admin Balance Training, Exercise Oncology, Neuropathy, News, Side Effects

What is Chemotherapy-Induced Peripheral Neuropathy? 

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a type of nerve damage, affecting predominantly the hands and feet, that can occur as a result of cancer treatment. Chemotherapy is the most common cause of peripheral neuropathy in cancer patients, and can affect up to 70% of survivors during treatment. Studies also suggest 30% of survivors continue to experience symptoms 6 months post-treatment, whilst in some cases symptoms may even be permanent.

CIPN Symptoms 

Symptoms of CIPN may include numbness, discomfort and sensitivity, tingling, loss of sensation, pain, balance difficulties and difficulty manipulating objects.

CIPN symptoms typically increase in severity the further an individual is into their chemotherapy regime, but the actual symptoms themselves may change over that time. Where severe symptoms are experienced a chemotherapy dose reduction may be required, or cessation of a treatment program altogether.  Hence it’s important that these symptoms are monitored to ensure treatment can be as effective as possible.

How is CIPN treated?

There are unfortunately no currently known cures for CIPN, however there are treatments available that can help to ease and manage the symptoms. These treatments include physical therapy, medication, acupuncture and Transcutaneous Electrical Nerve Stimulation (TENS).

In the last few years, there has been an increase in the literature about the prevention and treatment of CIPN, and the role of exercise in managing the side-effects of chemotherapy treatments.

How can exercise be beneficial?

Preliminary research suggests that a pre-existing exercise history may reduce the risk of developing of CIPN as well as the severity of the symptoms experienced, however the exact mechanism around this is still unknown and more research is still required in the area. 

Existing literature indicates that exercise can be a significantly beneficial therapy in mitigating or improving the symptoms of CIPN in cancer patients. Patients in these studies completed a range of aerobic, resistance and balance exercise programs over 2–12 months and showed significant improvement in their CIPN symptoms and long term recovery from the condition.

What sort of exercise is best?  

As mentioned above, there’s still a lot of research to be done in the area of CIPN before we have set recommendations on exactly what exercise is best, and how much to complete. More studies are needed to assess the efficacy of specific exercise interventions in order to confirm which kind of exercise is preferred to manage CIPN symptoms.

Based on the above-mentioned research, it could be suggested that a combination of aerobic, resistance and balance training is most beneficial for the treatment of CIPN. Given that CIPN can result in symptoms affecting foot numbness & sensation, balance training should be highlighted as a very important exercise modality for reducing falls risk.

Further considerations: 

  • As with most cancer-related exercise guidelines, it’s important to consider that there is not a “one size fits all” approach to exercise prescription for individuals managing this condition.
  • Supervised exercise programs overseen by an oncology-trained Exercise Physiologist or Physiotherapist are known to be more effective at managing the common side effects of chemotherapy compared to a home-based program.  Although supervised exercise is preferred, a home-based program still has benefits and is better than no exercise program at all!
  • Oncology-trained exercise professionals are also adept at adjusting programs to cater to those with CIPN.  Such strategies may include reducing falls risk during exercise, eliminating impact-exercise (which may trigger pain) and adapting the positioning of extremities for different activities where sensitivity is more severe.
  • Prior to the commencement of an exercise program, individuals with cancer are recommended to undergo pre-screening evaluations. This can be completed by your GP, an Accredited Exercise Physiologist (AEP) or a Physiotherapist.

Until recently most research for CIPN has focussed on pharmaceutical interventions, which can sometimes help with pain. But these drugs often come with their own set of side effects and don’t necessarily assist with the decline in day-to-day functioning.

However a 2014 study of reasonable validity conducted on Lymphoma patients was able to demonstrate that a program of sensorimotor (nerve-stimulating), endurance and strength training exercises performed twice per week was able to significantly decrease pain, whilst also improving balance, level of activity and quality of life. Good news!

To round this one up, the answer to the title question is quite possibly: whilst the evidence remains low, the results are promising. Given that the study also determined the exercise intervention to be not only beneficial but certainly safe for participants, a tailored exercise prescription should be sought if you suffer from CIPN. Aside from the specificity of the exercises required, there are precautions to exercising with neuropathy, including avoiding high impact and high falls-risk activities. Ensure you seek the guidance of an Accredited Exercise Physiologist for yourself or your loved one when considering exercise as a supportive therapy for CIPN.

– Jason Canterford, Accredited Exercise Physiologist at Movement Against Cancer & DNA Health Group

References: 

  • Bland, K. A., Kirkham, A. A., Bovard, J., Shenkier, T., Zucker, D., McKenzie, D. C., Davis, M. K., Gelmon, K. A., & Campbell, K. L. (2019). Effect of Exercise on Taxane Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial. Clinical breast cancer, 19(6), 411–422. https://doi.org/10.1016/j.clbc.2019.05.013
  • Brett Whalen, L., Zachary Wright, W., Kundur, P., Angadi, S., & Modesitt, S. C. (2022). Beneficial effects of exercise on chemotherapy-induced peripheral neuropathy and sleep disturbance: A review of literature and proposed mechanisms. Gynecologic oncology reports, 39, 100927. https://doi.org/10.1016/j.gore.2022.100927
  • Chung, K. H., Park, S. B., Streckmann, F., Wiskemann, J., Mohile, N., Kleckner, A. S., Colloca, L., Dorsey, S. G., & Kleckner, I. R. (2022). Mechanisms, Mediators, and Moderators of the Effects of Exercise on Chemotherapy-Induced Peripheral Neuropathy. Cancers, 14(5), 1224. https://doi.org/10.3390/cancers14051224
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  • Kanzawa-Lee, G. A., Larson, J. L., Resnicow, K., & Smith, E. M. L. (2020). Exercise Effects on Chemotherapy-Induced Peripheral Neuropathy: A Comprehensive Integrative Review. Cancer nursing, 43(3), E172–E185. https://doi.org/10.1097/NCC.0000000000000801
  • Kleckner, I. R., Kamen, C., Gewandter, J. S., Mohile, N. A., Heckler, C. E., Culakova, E., Fung, C., Janelsins, M. C., Asare, M., Lin, P. J., Reddy, P. S., Giguere, J., Berenberg, J., Kesler, S. R., & Mustian, K. M. (2018). Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26(4), 1019–1028. https://doi.org/10.1007/s00520-017-4013-0
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