Physical exercise may help prevent nerve damage during chemotherapy, study finds

• Researchers found that neuromuscular training can reduce the occurrence of chemotherapy-induced peripheral neuropathy (CIPN) by 50 to 70 percent.
• CIPN, a side effect of chemotherapy, can cause chronic pain and balance issues and interrupt therapy. There is no direct pharmacological treatment for it.
• Experts say the findings are an exciting step toward treating CIPN, especially because it’s an easy process with no outsized costs.

People undergoing chemotherapy for cancer treatment are likely to experience chemotherapy-induced peripheral neuropathy (CIPN), which can adversely affect treatment, quality of life, and survival rates. In a recent study published in JAMA Internal Medicine , scientists at the University of Basel and the German Sport University Cologne found that neuromuscular training can reduce the occurrence of CIPN by 50 to 70 percent and may improve rates of survival by making chemotherapy patients more resilient and adaptable to the therapy.

The scientists, led by lead author Fiona Streckmann , conducted a randomized trial of 158 people who were taking cancer therapies oxaliplatin or vinca alkaloids . In up to 90 percent of people taking either, side effects can include various degrees of pain or numbness and issues with balance ; nearly half of these people have these side effects chronically. Researchers divided the cohort into three groups:  sensorimotor training (SMT), which involved challenges in balance; whole-body vibration (WBV), which involved training on a vibrating plane; and treatment as usual (TAU), which is essentially standard care.

Over a five-year period, the researchers found that the control group (TAU) developed CIPN nearly twice as much as those in either of the other two groups. The participants in the two exercise groups had better quality of life, less mortality rates, and less need to adjust medication, which can often occur when CIPN has a significant effect on a person.

Can exercise help prevent nerve damage from chemotherapy?

One significant aspect of the study is a relatively easy — and affordable — way to treat CIPN, for which there is no pharmacological remedy. Because there is no way to treat CIPN, it can result in disruption of chemotherapy treatments, which can create other problems.

Dr. Diana Garrett , PT, DPT, FAAOMPT, CLT, CSCS board certified orthopedic clinical specialist and program director of physical therapy services of the Women’s Health & Wellness Institute at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, told Medical News Today that the benefits of exercise for cancer patients have been gaining wider acceptance.

“This study supports the trend we are seeing of an exponential increase in examining the role exercise plays in cancer survivorship. Physical activity has been associated with reduced overall cancer risk, reduced mortality rate, and reduced cancer recurrence, with the strongest evidence found in breast and colon cancer ,” Dr. Garrett said.

“This study supports previous research that supports use of exercise to reduce the risk of developing chemotherapy-induced peripheral neuropathy. It would be interesting to see these types of studies expanded to larger sample sizes, differentiating between specific cancers and risk for CIPN, and including different chemotherapy drugs to see the potential of mitigation of symptoms.”

Study findings could lead to improved cancer treatment

Dr. Melinda Irwin , deputy director of Yale Cancer Center and the Susan Dwight Bliss Professor of Epidemiology and associate dean of research at the Yale School of Public Health, who was also not involved in the study, told Medical News Today that the study’s results were “practice-changing,” notably because of how easy it can be to implement physical activity.

“CIPN is a common chemotherapy-related toxicity, yet there are no available pharmacological treatments to prevent or treat CIPN. There is a growing body of research showing exercise can treat CIPN,” Dr. Irwin said.

“This current study is the first to examine the prevention of CIPN in patients receiving chemotherapy. The sensorimotor training (SMT) and whole-body vibration (WBV) training are novel and relatively easy to administer during chemotherapy. This trial found that only twice-weekly sessions of 15-30 minutes per session were necessary to result in a significant and clinically meaningful decreased onset of CIPN by 50% to 70%! This is indeed a milestone for CIPN prevention,” Dr. Irwin explained.

What kind of exercise is good for chemotherapy patients?

Dr. Garrett said the goal would be 30 minutes of exercise a day, preferably something that a person can enjoy.

“Typically, I recommend an activity of moderate intensity where the individual can sustain a conversation while participating. The activity shoulder be something that the person enjoys doing because then they will be more likely to continue.  One validated exercise program is the Exercise for Cancer Patients (EXCAP), which is a home-based progressive aerobic walking and resistance program,” Dr. Garrett said. “Exercise affects multiple organ systems, including the cardiovascular and immune systems. Regular exercise increases immune cell activity, especially of the lymphocytes and natural killer cells. The mechanism of how exercise affects chemotherapy-induced peripheral neuropathy is not completely understood but may be related to maintaining muscle strength during treatment and/or increase blood flow to peripheral nerves.”

Dr. Irwin cited the low cost and convenience of a relatively small time commitment each week as huge benefits to people experiencing CIPN, with the advantage of being able to continue treatment.

“Current physical activity guidelines for patients receiving treatment or who have completed treatment include aerobic exercise such as brisk walking of 2.5 hr/week and twice-weekly resistance/strength training sessions per week,” Dr. Irwin said. “This intervention could easily be translated into clinical practice as well as home-based exercises, as the exercises were low intensity, short duration, and only twice per week. There is minimal cost to the intervention and few, if any, side effects. While more studies should be conducted to replicate the findings and to also test a home-based version, the findings are very exciting and should be implemented in oncology care.”