Duregon, F., Vendramin, B., Bullo, V., Gobbo, S., Cugusi, L., Di Blasio, A., . . . Ermolao, A. (2018). Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: A systematic review. Critical Reviews in Oncology/Hematology, 121, 90–100.

STUDY PURPOSE: To evaluate current research evidence for exercise protocols effect on CIPN symptoms, balance control, physical function, and QOL

TYPE OF STUDY: Systematic review (no meta-analysis conducted)

DATABASES USED: Medline, Scopus, Bandolier, PEDpro, and Web of Science

YEARS INCLUDED: (Overall for all databases) This was not specified

INCLUSION CRITERIA: Studies that had physical exercise intervention and QOL or a balance evaluation, structured exercise protocol for patients with cancer with CIPN was preferable, English peer-reviewed and indexed manuscripts, comparisons of pre-/postintervention of cancer diagnosis, one or both genders, and all races/ages. 

EXCLUSION CRITERIA: Cross-sectional studies, case reports, published abstracts, dissertation materials, conference presentations

TOTAL REFERENCES RETRIEVED: N = 2221

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Literature search was clearly outlined but did not use standardized methodology (i.e., PRISMA); two reviewers independently examined abstracts, full manuscripts analyzed for eligibility and independently used the modified Cochrane Collaboration Back Review Group checklist to evaluate quality of studies on nine criteria and strength of evidence; high quality was determined if study met at least 5 out of 9 criteria, low quality was less than 5 out of 9; final quality score discussed between both reviewers for final determination of quality score, third researcher consulted for any discrepancies; extraction of data based on categorization for this study outcomes: CIPN symptoms, static balance control, dynamic balance control and quality of life and physical function

FINAL NUMBER STUDIES INCLUDED: N (studies) = 5 (2 of 5 were randomized studies, of high quality, three non-randomized and low quality) 

TOTAL PATIENTS INCLUDED IN REVIEW: 147 (25 dropouts) (n = 122)

SAMPLE RANGE ACROSS STUDIES: 14-56 years

KEY SAMPLE CHARACTERISTICS: All participants with a diagnosis of malignancy; all had peripheral neuropathy before starting the intervention; age range = 44-71.82 years (one study of older adults, four studies of mid adult); 84 females and 63 males; 131 participants were undergoing chemotherapy out of 147 before dropouts. In three studies, 100% of participants were actively undergoing chemotherapy; in two studies, 54% of participants were undergoing chemotherapy. Three studies evaluated CIPN supervised training intervention and two studies evaluated home-based intervention. Exercise types included aerobic walking/cycling, strength/elastic band training, calisthenics, core stability, sensory motor, and specific balance training alone or in combination. Exercise dosages ranged from 30 to 60 minutes per sessions, two to five times per week, for 3 to 36 weeks.

PHASE OF CARE: Multiple phases of care

APPLICATIONS: Elder care; palliative care

Three of four studies showed some modest improvement in CIPN with exercise; some small improvements found with exercise for static balance in all four studies; dynamic balance control evaluated in two studies, only one showed improvement with exercise; three of four studies showed improvements in QOL.

This systematic review of a small sample of five studies showed varying exercise interventions, with differing dose and duration of therapy, enhanced QOL and improved balance. However, this evidence synthesis is scant and drawing conclusions for practice would be premature as the majority of studies are of low quality. This systematic review highlights that more research is needed to determine specific exercise interventions targeted to specific cancer populations to understand the full benefit of exercise as an intervention strategy to reduce CIPN symptoms and related quality-of-life issues.

• Limited search
• Limited number of studies included
• Mostly low-quality/high-risk-of-bias studies
• High heterogeneity
• Low sample sizes

Other: poor choice and limited list of key terms in search strategy; literature search strategy and inclusion criteria did not specify year of studies, CIPN symptom outcome was not an inclusion criteria; study design and methodologies differed, control conditions of studies not adequately explained; different exercise interventions and time frames, different instruments across studies for outcome measures, including CIPN six, static/dynamic balance control, and QOL, some data does not fully represent the construct/categorization of study outcome measures. One study measured fear of falling substituting this as a QOL measure; one study did not measure QOL at all, one study did not evaluate CIPN symptoms as an outcome; cancer diagnoses/stage and type or number of chemotherapy regimens not specified; no effect sizes reported; only one study using intent to treat analysis; no data extraction or study reporting of adverse events of exercise interventions; selection bias in three of five studies

Exercise is a promising strategy in the management of CIPN; however, it is an understudied intervention. Large multi-center RCTs are needed to investigate specific types, doses and duration of exercise interventions tailored to specific cancer populations for CIPN, and related QOL outcome measures to identify best practices that can improve CIPN and related QOL needs.