When a patient begins chemotherapy, the fight is double one against the cancer cells, and another against the side effects that can linger long after the last dose. Among the most painful and debilitating of these side effects is chemotherapy-induced peripheral neuropathy (CIPN): damage to the nerves, leading to tingling, numbness, burning sensations, weakness, balance difficulties, and sometimes chronic pain. These symptoms can greatly reduce quality of life and even force patients to reduce or stop their cancer treatment.
Recently, researchers have explored a promising idea: could physical exercise during chemotherapy help prevent or reduce nerve damage? This shifts the paradigm: not just treating neuropathy after it appears, but possibly buffering against its onset. Small trials especially in neuromuscular and sensorimotor trainingreport reductions in neuropathy incidence. Yet guidelines remain cautious: due to limited and heterogeneous evidence, exercise is not yet widely endorsed as a preventative therapy for CIPN.
Understanding Chemotherapy-Induced Peripheral Neuropathy
What Is CIPN
Chemotherapy drugs (especially platinum compounds, taxanes, vinca alkaloids, etc.) can damage peripheral nerves, leading to sensory and sometimes motor symptoms commonly in hands and feet
How Common Is It
Estimates suggest 30–40 per cent of patients undergoing chemotherapy will experience clinically significant neuropathy.
Why It matters
Neuropathy can impair daily tasks (walking, dressing, gripping), increase falls, reduce therapy adherence, and persist long-term.
Current treatments
We have few strong medical treatments for CIPN, and much is supportive: pain relief, physical therapy, dose adjustments.
How Exercise Might Help
Biological Plausibility
Exercise can promote neuroplasticity, nerve repair, improved blood flow, reduced inflammation, and better mitochondrial health in nerve cells.
Sensorimotor training (balance, coordination) may buffer stress on nerves by improving stability and compensatory mechanisms.
Evidence From Studies
In one trial, neuromuscular training (balance + other movements) reduced incidence of neuropathy by 50 to 70 per cent compared to usual care.
In a six-month aerobic exercise study of women post-chemotherapy, patients doing home aerobic exercise reported modest improvement in neuropathy symptoms vs controls.
A recent meta-analysis found exercise improved muscular strength and balance, though evidence was less clear on direct symptom (neuropathy) improvement.
Some studies caution that heterogeneity in design (type of exercise, timing, dosage) makes it difficult to generalize.
Current oncology guidelines consider evidence insufficient to strongly recommend exercise as a neuropathy preventive measure, though supportive in symptom management.
Practical Tips For Patients
If you or someone you know is undergoing chemotherapy, here are exercise tips and precautions to potentially reduce nerve damage. Always coordinate with oncologists, physiotherapists, or cancer rehab specialists.
1. Consult Before Beginning
Get clearance from oncology team (check blood counts, side effects, overall fitness).
Work with a physical therapist or cancer rehab expert if possible.
2. Focus On Neuromuscular And Balance Training
Balance exercises: single-leg stands, tandem walking (heel-to-toe), using soft or unstable surfaces.
Coordination drills, proprioceptive tasks (e.g. gentle step-ups, shifting weight).
Neuromuscular training in trials has shown promise in lowering neuropathy incidence.
3. Add Aerobic And Moderate Resistance Exercise
Gentle aerobic work (walking, stationary cycling) for 15–30 minutes, several times per week.
Resistance or strength training (light weights, resistance bands) two to three times weekly.
Some trials used these combined approaches to improve symptom scores.
4. Progress Gradually And Listen To Your Body
Start slowly, especially if you have fatigue, anemia or other side effects.
Monitor for pain, burning, swelling; back off if symptoms worsen.
Adjust intensity or rest if needed.
5. Be Consistent But Flexible
Consistency tends to yield benefits, but rest days are essential.
If certain movement aggravates symptoms, modify or skip it.
The goal is long-term movement, not maximal intensity.
6. Track Symptoms And Adjust
Keep a symptom diary: tingling, numbness, balance, strength.
Reassess periodically with clinicians and physiotherapists.
Use objective tests (e.g. physical function, balance) to gauge improvement.
7. Combine With Other supportive Care
Good nutrition, safe pain management, management of other side effects (e.g. anemia, vitamin deficiencies) support nerve health.
Address other risk factors: diabetes, vitamin B12 deficiency, alcohol use.
Use of protective agents (e.g. supplements or drugs under trial) may complement but only under medical supervision.
