It turns out that there is yet another thing that exercise helps for – chemo-induced peripheral neuropathy (CIPN).
It not only helps to diminish the symptoms of neuropathy that already took place, but it can prevent it (!), which many other things that have been vigorously tried before (vitamins, fish oil, medications, etc.) failed to do so.
It is potentially quite paradigm changing finding that – if further confirmed – should change the way we think about the prevention and treatment of CIPN.
Painful peripheral neuropathy is the most common, frustrating, and disabling symptom I see in patients who have received neurotoxic chemotherapy. It profoundly affects the quality of life, sleep, function, social functions, and work.
And current treatments only offer modest benefits. It is also costly (estimated cost of treatment per patient: 17,000 USD).
📚 This JAMA Internal Medicine study (STOP trial) by @Fiona Streckmann explores prevention through structured exercise – specifically sensorimotor training (SMT) and whole-body vibration. The findings are intriguing: twice-weekly SMT sessions significantly reduced CIPN incidence and the need for chemotherapy dose modifications.
🏋️♀️ The SMT protocol was specific but manageable:
- Balance exercises on unstable surfaces
- 4 exercises, 3 sets each
- 15-30 minutes, twice weekly
How does it work? The treatment:
- Affects the level of BDNF
- Improves blood perfusion
- Increases the sensitivity of mechanoreceptors
⚠️ Important context to remember: the study population was younger than typical cancer patients, with limited enrollment and adherence challenges.
🤔 In my practice, physical therapy has been a reliable ally in treating established CIPN. But these findings invite us to reimagine its role – not just as a response to symptoms, but as a proactive measure against one of chemotherapy’s most challenging complications.
🔑 Could SMT as a preventative measure become a new treatment paradigm? Breaking down barriers of access while developing strategies for older patients and conducting further research on how best to implement the treatment could transform how we prevent this debilitating side effect.
- Important links and resources referenced in this post:
- STOP Trial (2024, JAMA Internal Medicine): “Preventive Effect of Neuromuscular Training on Chemotherapy-Induced Neuropathy: A Randomized Clinical Trial”
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2814292 - Exercise and Neuropathy Review (2022, Sports Medicine): “Exercise and Neuropathy: Systematic Review with Meta-Analysis”
https://link.springer.com/article/10.1007/s40279-021-01596-6 - ASCO Guidelines on CIPN Management (2020):
https://ascopubs.org/doi/10.1200/JCO.20.01399 - Physical Therapy in Cancer Care – APTA Oncology:
https://oncologypt.org/
Marcin Chwistek, MD 