When specific exercise is more effective than medication - Sensorimotor training is currently the most promising option to treat and prevent chemotherapy-induced peripheral neuropathy (CIPN).

Abstract

Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent and clinically relevant adverse effect of chemotherapy, negatively impacting patient quality of life. The lack of effective preventive or therapeutic options regarding CIPN often requires changes in cancer therapy, potentially resulting in reduced survival. Meanwhile 10 studies have shown that specific exercise can reduce relevant symptoms of CIPN (Streckmann eu al. 2021). In our most recent study (Streckmann et al. 2024) we have been able to show that CIPN can even be prevented by up to 70%.

Methods we performed a prospective multicenter randomized clinical trial (STOP) and followed up patients over 5 years (May 2014 – Nov. 2020) at 4 centers and around Cologne, Germany. Patients undergoing treatment with oxaliplatin or vinca alkaloids were recruited. Participants in the intervention groups performed supervised sensorimotor training (SMT) or whole-body vibration training (WBV), twice a week, concomitant to medical therapy. The primary end point was the incidence of CIPN. Secondary end points included subjective neuropathy symptoms, balance control, physical activity levels, quality of life, and clinical outcome. For cross-stratum evaluations, the Mantel-Haenszel test (MH) was used, and within individual strata, Fisher exact test was used for analysis.

Results A total 158 patients (mean [SD] age, 49.1 [18.0-82.0] years; 93 [58.9%] male) were randomized into 1 of 3 groups: 55 (34.8%) in SMT, 53 (33.5%) in WBV, and 50 (31.6%) in treatment as usual (TAU). The incidence of CIPN in participants was significantly lower in both intervention groups compared to the control group (TAU): (SMT, 12 of 40 [30.0%; 95% CI, 17.9%-42.1%] and WBV, 14 of 34 [41.2%; 95% CI, 27.9%-54.5%] vs TAU, 24 of 34 [70.6%; 95% CI, 58.0%-83.2%]; P = .002 for intention to treat–MH). Improvements in favor of SMT compared to TAU were furthermore found for balance control bipedal with eyes open; bipedal with eyes closed; monopedal, vibration sensitivity, sense of touch, lower leg strength, pain reduction, burning sensation, chemotherapy dose reductions, and mortality.

Discussion/Conclusion Specific exercise can reduce and even prevent the symptoms of a neuropathy. Sensorimotor training seems essential. More high-quality research is needed to derive evidence-based recommendations. Overall, it seems that sensorimotor training has great potential to target most neuropathies and is therefore currently the best treatment option for neuropathies.

References

Streckmann, F., Balke, M., Cavaletti, G., Toscanelli, A., Bloch, W., Décard, B. F., Lehmann, H. C., & Faude, O. (2022). Exercise and neuropathy: Systematic review with meta-analysis. Sports Medicine, 52(5), 1043–1065. https://doi.org/10.1007/s40279-021-01596-6

Streckmann, F., Elter, T., Lehmann, H. C., Baurecht, H., Nazarenus, T., Oschwald, V., Koliamitra, C., Otten, S., Draube, A., Heinen, P., Steinmetz, T., Hallek, M., Leitzmann, M., Bloch, W., & Balke, M. (2024). Preventive effect of neuromuscular training on chemotherapy-induced neuropathy: A randomized clinical trial. JAMA Internal Medicine, 184(9), 1046–1053. https://doi.org/10.1001/jamainternmed.2024.2354