Unlocking Relief: The Impact of Exercise on Chemotherapy-Induced Peripheral Neuropathy
- Julian Simpson
- 2 days ago
- 4 min read
Unlocking Relief: The Impact of Exercise on Chemotherapy-Induced Peripheral Neuropathy
Chemotherapy, a common cancer treatment, works by disrupting cell division and inducing apoptosis in both cancerous and healthy cells. Consequently, chemotherapy has adverse effects, some of which are well established, such as anemia, diarrhea, nausea, vomiting, immune depression, fatigue, hair loss, and infertility. Chemotherapy-induced peripheral neuropathy (CIPN)
Patients with chemotherapy-induced peripheral neuropathy often present sensory symptoms such as tingling and numbness, and some complain of pain, namely spontaneous pain and increased sensitivity to innocuous (allodynia) or noxious (hyperalgesia) stimuli
The current thinking for recommendations for cancer patients is:
To do at least 150 to 300 minutes of moderate-intensity aerobic activity
75 to 150 minutes of vigorous-intensity activity
OR a combination of both, combined with muscle-strengthening exercises at least 2 days a week
Functional balance training at least 3 days a week, and
Flexibility training 2 to 3 days a week
Why is exercise important for cancer patients?
Physical exercise prevents the loss of muscle mass; contributes to stability and gait, promoting balance control and a reduction in the number of falls; improves cardiovascular and metabolic fitness; and promotes pain reduction
How common are neurological complications in cancer treatment?
Oxaliplatin-induced neuropathy occurs in 90% of patients and usually reverses within one week. In contrast, more than 50% of patients receiving a cumulative dose of paclitaxel above 250 mg/m2 complain of paresthesia or hyperalgesia
Why do cancer patients get chemotherapy-induced peripheral neuropathy?
Brain hyperactivity—caused by factors such as reduced GABAergic inhibition, neuroinflammation, or overactivation of G protein-coupled receptor/mitogen-activated protein kinase (GPCR/MAPK) pathways—is linked to the severity of CIPN.
Some studies show that drugs like Oxaliplatin increase levels of PROINFLAMMATORY mediators and their receptors in the periaqueductal grey area ( this area is involved in pain processing, emotional behaviours and regulates cardiovascular and respiratory functions)
Let's talk about exercise and chemotherapy-induced peripheral neuropathy
We know that greater physical activity is associated with a decreased likelihood of experiencing neuropathic pain when compared to lower levels of activity
Some suggested programmes of exercise are:
Supervised endurance (walking exercise in the hallway—6 min and stair walking exercise—2 min, 5 days a week) and strength training (abdominal exercise, a biceps curl exercise, and a triceps extension exercise for 3 sets, with patient-dependent number of repetitions, the other days) while the patient received three cycles of chemotherapy (breathing techniques or manual therapy
Supervised exercise program, including endurance, resistance and balance training (2×/week for 60 min
Home Exercise (walking prescription, increasing the total number of steps walked daily by 5–20% each week + therapeutic band prescription, with varying levels of resistance)
The Australian cancer council has some great resources for patients and can be found here:https://www.cancercouncil.com.au/cancer-information/living-well/exercise-cancer/strength-training/
They recommend the following exercise for cancer patients
standing wall push up
Knee push ups
calf raise
shoulder press
upright row
bicep curl
clamshell
pelvic tilt
bird dogs
standing row
chair raise
wall squat
How can home exercise help chemotherapy-induced peripheral neuropathy?
Chemotherapy-induced peripheral neuropathy is linked to oxidative stress and neuroinflammation, leading to neurodegeneration and demyelination.
Glia cells release pro-inflammatory mediators such as TNF-alpha, IL-1beta, IL-6 and IL-8, both through receptor-mediated pathways and indirectly through the activation and accumulation of macrophages.
Chemotherapy-induced peripheral neuropathy also affects neuronal function, leading to spontaneous activity and sensitisation, which may account for hyperalgesia and allodynia. Exercise may counteract those effects
Here's a nice little summary of the impact of exercise on chemotherapy-induced peripheral neuropathy and why it helps
Mechanism | Effect of Exercise | Impact on CIPN | |
| Increased expression of GDNF, BDNF and IGF-1 | Promotes axonal regeneration, cellular survival, and neuroprotection | |
| Release of anti-inflammatory cytokines (IL-10 and IL-1RA (…)); reduction of oxidative stress markers | Ameliorates CIPN via anti-inflammatory cascades | |
| Increases activation of MOR, KOR, and DOR by endorphins, enkephalins and dynorphins | Analgesia; pain modulation | |
| Activates noradrenergic system; increases 5-HT in pain control areas of the brain | Pain modulation | |
| Increases endocannabinoid levels; activates CB1 and CB2 receptors | Analgesia decreases mechanical allodynia and thermal hyperalgesia, euphoria | |
| Increases connectivity in important neurocircuits (salience network, including the amygdala and the anterior cingulate cortex), executive control network, and default mode network (including the hippocampus) | Psychological well-being | |
| Release of endorphins, neurotrophic factors and neurotransmitters, involvement of the hypothalamic-pituitary-adrenal axis, reducing stress and improving mood | Psychological well-being | |
| Influences gut microbiota composition and diversity | Decreased inflammatory signalling, increased neuroprotection; antidepressant effects |
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Loureiro J, Costa-Pereira JT, Pozza DH, Tavares I. The Power of Movement: How Exercise Influences Chemotherapy-Induced Peripheral Neuropathy. Biomedicines. 2025 May 1;13(5):1103. doi: 10.3390/biomedicines13051103. PMID: 40426930; PMCID: PMC12109246.
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