Preventive Effect of Sensorimotor Exercise and Resistance Training on Chemotherapy-induced Peripheral Neuropathy: a Randomised-controlled Trial

Overview

Journal Br J Cancer

Specialty Oncology

Date 2021 Jul 6

PMID 34226683

Citations 25

Authors

Jana Muller

Markus Weiler

Andreas Schneeweiss

Georg Martin Haag

Karen Steindorf

Wolfgang Wick

Joachim Wiskemann

Affiliations

Soon will be listed here.

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN.

Methods: Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy.

Results: Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (-8.3 points (-16.1 to -0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2-30.4); P < 0.001, ES = 0.57) and QoL (+12.9 points (3.9-21.8); P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups.

Conclusions: This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved.

Clinical Trial Registration: NCT02871284.

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References

Molassiotis A, Cheng H, Lopez V, Au J, Chan A, Bandla A . Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy. BMC Cancer. 2019; 19(1):132. PMC: 6368751. DOI: 10.1186/s12885-019-5302-4. View

Cavaletti G, Alberti P, Argyriou A, Lustberg M, Staff N, Tamburin S . Chemotherapy-induced peripheral neurotoxicity: A multifaceted, still unsolved issue. J Peripher Nerv Syst. 2019; 24 Suppl 2:S6-S12. DOI: 10.1111/jns.12337. View

Bao T, Basal C, Seluzicki C, Li S, Seidman A, Mao J . Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk. Breast Cancer Res Treat. 2016; 159(2):327-33. PMC: 5509538. DOI: 10.1007/s10549-016-3939-0. View

Ezendam N, Pijlman B, Bhugwandass C, Pruijt J, Mols F, Caroline Vos M . Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry. Gynecol Oncol. 2014; 135(3):510-7. DOI: 10.1016/j.ygyno.2014.09.016. View

Fino P, Horak F, El-Gohary M, Guidarelli C, Medysky M, Nagle S . Postural sway, falls, and self-reported neuropathy in aging female cancer survivors. Gait Posture. 2019; 69:136-142. PMC: 6579642. DOI: 10.1016/j.gaitpost.2019.01.025. View

Varedi M, Lu L, Howell C, Partin R, Hudson M, Pui C . Peripheral Neuropathy, Sensory Processing, and Balance in Survivors of Acute Lymphoblastic Leukemia. J Clin Oncol. 2018; 36(22):2315-2322. PMC: 6067801. DOI: 10.1200/JCO.2017.76.7871. View

Hershman D, Lacchetti C, Dworkin R, Smith E, Bleeker J, Cavaletti G . Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014; 32(18):1941-67. DOI: 10.1200/JCO.2013.54.0914. View

Kneis S, Wehrle A, Muller J, Maurer C, Ihorst G, Gollhofer A . It's never too late - balance and endurance training improves functional performance, quality of life, and alleviates neuropathic symptoms in cancer survivors suffering from chemotherapy-induced peripheral neuropathy: results of a randomized.... BMC Cancer. 2019; 19(1):414. PMC: 6498676. DOI: 10.1186/s12885-019-5522-7. View

Streckmann F, Lehmann H, Balke M, Schenk A, Oberste M, Heller A . Sensorimotor training and whole-body vibration training have the potential to reduce motor and sensory symptoms of chemotherapy-induced peripheral neuropathy-a randomized controlled pilot trial. Support Care Cancer. 2018; 27(7):2471-2478. DOI: 10.1007/s00520-018-4531-4. View

10.

Schonsteiner S, Bauder Missbach H, Benner A, Mack S, Hamel T, Orth M . A randomized exploratory phase 2 study in patients with chemotherapy-related peripheral neuropathy evaluating whole-body vibration training as adjunct to an integrated program including massage, passive mobilization and physical exercises. Exp Hematol Oncol. 2017; 6:5. PMC: 5297221. DOI: 10.1186/s40164-017-0065-6. View

11.

Zimmer P, Trebing S, Timmers-Trebing U, Schenk A, Paust R, Bloch W . Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial. Support Care Cancer. 2017; 26(2):615-624. DOI: 10.1007/s00520-017-3875-5. View

12.

Dhawan S, Andrews R, Kumar L, Wadhwa S, Shukla G . A Randomized Controlled Trial to Assess the Effectiveness of Muscle Strengthening and Balancing Exercises on Chemotherapy-Induced Peripheral Neuropathic Pain and Quality of Life Among Cancer Patients. Cancer Nurs. 2019; 43(4):269-280. DOI: 10.1097/NCC.0000000000000693. View

13.

Schwenk M, Grewal G, Holloway D, Muchna A, Garland L, Najafi B . Interactive Sensor-Based Balance Training in Older Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Controlled Trial. Gerontology. 2015; 62(5):553-63. PMC: 6644035. DOI: 10.1159/000442253. View

14.

Streckmann F, Kneis S, Leifert J, Baumann F, Kleber M, Ihorst G . Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol. 2014; 25(2):493-9. DOI: 10.1093/annonc/mdt568. View

15.

Kleckner I, Kamen C, Gewandter J, Mohile N, Heckler C, Culakova E . Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Support Care Cancer. 2017; 26(4):1019-1028. PMC: 5823751. DOI: 10.1007/s00520-017-4013-0. View

16.

Vollmers P, Mundhenke C, Maass N, Bauerschlag D, Kratzenstein S, Rocken C . Evaluation of the effects of sensorimotor exercise on physical and psychological parameters in breast cancer patients undergoing neurotoxic chemotherapy. J Cancer Res Clin Oncol. 2018; 144(9):1785-1792. DOI: 10.1007/s00432-018-2686-5. View

17.

Bland K, Kirkham A, Bovard J, Shenkier T, Zucker D, McKenzie D . Effect of Exercise on Taxane Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial. Clin Breast Cancer. 2019; 19(6):411-422. DOI: 10.1016/j.clbc.2019.05.013. View

18.

Henke C, Cabri J, Fricke L, Pankow W, Kandilakis G, Feyer P . Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV. Support Care Cancer. 2013; 22(1):95-101. DOI: 10.1007/s00520-013-1925-1. View

19.

McCrary J, Goldstein D, Boyle F, Cox K, Grimison P, Kiernan M . Optimal clinical assessment strategies for chemotherapy-induced peripheral neuropathy (CIPN): a systematic review and Delphi survey. Support Care Cancer. 2017; 25(11):3485-3493. DOI: 10.1007/s00520-017-3772-y. View

20.

Cavaletti G, Jann S, Pace A, Plasmati R, Siciliano G, Briani C . Multi-center assessment of the Total Neuropathy Score for chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv Syst. 2006; 11(2):135-41. DOI: 10.1111/j.1085-9489.2006.00078.x. View