Systematic Review of Exercise for Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent and dose-limiting toxicity of many widely used chemotherapy regimens for the treatment of common cancers including lung, breast, prostate, gastrointestinal, and blood cancers. Symptoms include numbness, tingling, pain, and cramping in the hands and feet, as well as impaired balance and gait that collectively increase the risk of falls and compromise activities of daily living. Among the extremely limited treatment options for CIPN, exercise has emerged as a promising intervention based on a growing body of studies. Here, we review preclinical and clinical evidence on the use of exercise and related modalities for the prevention, treatment, and management of CIPN. We identified 2 studies in rodents plus 23 studies in humans, including 15 randomized studies (10 comparing exercise vs. non-exercise control), plus 19 pre-registered studies. The 10 randomized studies collectively suggest that exercise is beneficial for the treatment and prevention of CIPN with little to no side effects. However, these studies tend to be either rigorous yet small or large yet simple and exploratory, with no Phase III randomized studies published or pre-registered. Next, we discuss biological and psychosocial mechanisms by which exercise might exert its effects. We are optimistic for the trajectory of this work including seeking definitive answers to whether exercise is beneficial, what dose of exercise is needed, how it exerts its effects mechanistically, and how to best disseminate exercise to patients in the real world.