These Simple Exercises May Prevent Chemo-Induced Neuropathy

Key Takeaways

• Many chemotherapy drugs cause damage to the nerves, significantly affecting quality of life in people with cancer.
• A recent study found that simple exercises with a physical therapist twice a week reduced the onset of neuropathy by up to 70 percent.
• Not everyone may want to add exercise therapy during cancer treatment, but for those who do, it can help them have a greater sense of control during a difficult time.

People who do simple exercises with a physical therapist during chemotherapy treatment may decrease their likelihood of developing chemo-related neuropathy, according to a new study.

The randomized clinical trial found that exercise training reduced the onset of chemotherapy-induced peripheral neuropathy (CIPN) by 50 to 70 percent, depending on the type of chemo used.

These findings show that not only can these debilitating symptoms be targeted, they can also be prevented, says the lead author, Fiona Streckmann, PhD , a research associate in the department of Sport, Exercise and Health at University of Basel in Switzerland.

"This can empower patients to contribute to their own health and maintain their quality of life while receiving their optimal cancer therapy," says Dr. Streckmann.

The Majority of People Who Receive Cancer Treatment Develop Neuropathy

With the improvement of cancer therapies over the years and better survival rates, quality of life after recovery has gained more importance.

Unfortunately, many cancer medications - including chemotherapy and modern immunotherapies - can attack the nerves along with the tumor cells and cause neuropathy, leaving 65 to 85 percent of patients experiencing pain, balance issues, or feelings of numbness, burning or tingling, says Katie Schmitt, DPT , an oncology physical therapist at the Hollings Cancer Center at the Medical University of South Carolina in Charleston, who was not involved in this study.

"I've had people tell me it feels like they are walking on rocks, numbness, or like a vice grip. In the hands, [neuropathy] can make it hard to grip things and go about daily activities, and in the legs and feet, it can cause balance and walking issues," she says.

Although these debilitating symptoms can go away after cancer treatment ends, they become chronic about 50 percent of the time, according to the authors.

There are a few medications that can sometimes help with neuropathy symptoms, but no medications consistently improve nonpainful symptoms such as numbness or tingling.

Simple Exercises Twice a Week Cut the Incidence of Neuropathy

To find out if certain exercises could decrease symptoms and the onset of CIPN, Streckmann and a German research team randomly placed 158 people receiving chemo (either oxaliplatin or vinca alkaloids) into one of three treatment groups:

1. Sensorimotor training twice a week for 15 to 30 minutes per session: These exercises focused on balance, such as standing with one foot in front of the other, as if on a balance beam. People in this group did 4 exercises per session. Each exercise was performed 3 times for 20 seconds, with a 40-second rest between sets.
2. Whole-body vibration training twice a week for 15 to 30 minutes per session: Patients would stand on a side-alternating vibration platform on their forefeet (front of feet) for 4 sets of 30- to 60-second vibration periods, followed by a minute of rest. The rapid rocking of the platform causes a tilting motion of the pelvis (as in walking) but much more frequently. This activates muscles in the legs, abdomen, and up through the core.
3. Standard care: Chemo and recommended medications, but not physical therapy

The physical therapy exercise sessions were conducted during the same time period as the chemotherapy treatment sessions. The oncologists treating the study participants were told to ask about any symptoms of neuropathy at regular visits, and the participants were assessed 12 weeks after completing their course of chemotherapy.

Regular examinations over the next five years showed that about 70 percent of the control group (those who received standard care) developed CIPN compared with 30 percent in the sensorimotor training and 41 percent in the whole-body vibration group.

In other words, the exercises undertaken alongside chemotherapy reduced the incidence of nerve damage by 50 to 70 percent.

Those in the exercise intervention groups gained better balance control and reduced neuropathic symptoms, such as pain and tingling, compared with the control group. They also reported a better quality of life, were less likely to have to reduce their dose of cancer medications, and were less likely than the usual-care group to die during the five years after chemotherapy.

These findings show that exercise should be taken more seriously as a promising option to reduce the risk of neuropathy caused by chemotherapy, as treatment options are lacking, says Streckmann.

The reduction in neuropathy in the exercise groups aligns with what Dr. Schmitt sees in her own work with cancer patients, she says, adding that some people experience such painful neuropathy that their chemotherapy doses have to be reduced, which could have an impact on outcomes.

"I think it's great that they started the interventions 24 to 48 hours after chemotherapy was introduced. This makes sense given what a big side effect neuropathy is for the majority of patients," says Schmitt. "These exercises could help people get their optimal treatment, and get through their treatment stronger."

Chemo-Induced Neuropathy Doesn't Have to Be Inevitable

In the cancer treatment world, it's often assumed that neuropathy is an inevitable side effect of chemotherapy, says Schmitt.

"That's not the right answer. We know that we can do exercise interventions like this to help make a big difference, and it's something that this study shows really well," she says.

Schmitt believes that as the evidence for these exercises continues to grow, it could become a standard therapy that would go along with chemotherapy treatment to reduce neuropathy.

An Exercise Program May Not Be Accepted by Everyone

The study did have a few limitations. Only about 10 percent of screened patients ended up in the trial, suggesting that this type of intervention isn't for everyone. The average age was 49 years (participants were predominantly younger people with lymphoma), which is about 20 years younger than the median age of people in the United States diagnosed with cancer. Finally, about 1 in 4 people didn't attend enough of the exercise sessions to be included in the results, which highlights one of the challenges of this type of intervention.

A cancer diagnosis and all that goes with it can be very difficult on many fronts, says Schmitt. It can cause anxiety, lots of emotions, and challenges because of how much time treatments and appointments take, and how you feel throughout the process, she says.

"Adding another commitment like the exercises in this study may be difficult, but there are a lot of benefits. Not only might it help manage your symptoms and [help] complete your treatment, but it can also make you feel more in control during a process where you're often not able to be in control," she says.

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Sources

1. Streckmann F et al. Preventive Effect of Neuromuscular Training on Chemotherapy-Induced Neuropathy. JAMA Internal Medicine . July 1, 2024.
2. Cavallo J. Surviving, but Not Always Thriving, After Cancer. ASCO Post . May 25, 2023.
3. Loprinzi CL et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. Journal of Clinical Oncology . July 14, 2020.
4. Gupta A et al. Exercise and Physical Medicine Interventions for Managing Chemotherapy-Induced Peripheral Neuropathy. JAMA Internal Medicine . July 1, 2024.