Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis

Abstract

PurposeAlthough exercise is recommended for cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN), the effective types of exercise for preventing and treating CIPN remain unclear. This systematic review and network meta-analysis (NMA) aimed to evaluate the comparative effects of exercise on CIPN.MethodsWe included relevant randomized controlled trials (RCTs) identified in a 2019 systematic review that evaluated the effects of exercise on CIPN and conducted an additional search for RCTs published until 2023. We evaluated the risk of bias for each RCT; the comparative effectiveness of exercise on patient-reported quality of life (QOL) through an NMA; and the effectiveness of exercise on QOL scores, patient-reported CIPN symptoms, and pain through additional meta-analyses.ResultsTwelve studies (exercise, n=540; control, n=527) comparing 8 exercise interventions were included in the analysis. All studies were determined to have a high risk of bias. The meta-analyses showed significantly improved QOL (standard mean differences [SMD] 0.45; 95% confidence interval [CI] = 0.12 to 0.78) and CIPN symptoms (SMD 0.46; 95% CI = 0.11 to 0.82). No severe adverse events were reported. Pain tended to improve with exercise (SMD 0.84; 95% CI = -0.11 to 1.80). An NMA suggested that the interventions of combination of balance and strength training showed the significant improvement in QOL scores compared to the control.ConclusionExercise interventions are safe and effective in improving QOL. For exercise categories, the combination of balance and strength training would be the promising program. Patients with CIPN will benefit from frequent exercise focusing on the declined symptoms.Strengths and Limitations of This StudyIt organized the details of exercise regimens used in clinical trials and their adherence. It considered the diversity of exercise frequencies and types to ensure adequate and comprehensive analysis of exercise interventions in the management of CIPN.We included the exercise clinical trials for cancer patients who underwent chemotherapy.However, the timing of exercise interventions (prevention or intervention), type of cancer, and chemotherapy regimen used were not stratified.Network meta-analysis methods were used to analyze differences in intervention effects by type of exercise. However, the robustness of the inclusion and exclusion of studies is a limitation that prevents us from drawing clear conclusions. The generalizability of the findings is because of the reliance on the small sample size and exploratory nature of the exercise clinical trials, and there remained a risk that the bias may influence the results.