Strength and Balance Training

• FINAL NUMBER STUDIES INCLUDED = 18
• TOTAL PATIENTS INCLUDED IN REVIEW = 841 total patients in 10 randomized, controlled trials (RCTs) and 8 controlled clinical trials (CCTs)
• KEY SAMPLE CHARACTERISTICS: 11 studies in diabetic neuropathy, 1 study in chemotherapy-induced PNP, 6 studies with PNP of other derivations, 12 high quality studies (levels 1 and 2), 6 poor quality studies (level 4)

PHASE OF CARE: Multiple phases of care

Five studies assessed the influence of balance training on the side effects of PNP and showed a significant impact on balance control. Two studies also showed improved gait parameters. Improved motor, sensory, and metabolic symptoms was observed with tai chi. Combinations of endurance, balance, and strengthening exercises showed a positive effect on motor performance only if exercises were performed standing or walking. One RCT in chemotherapy-induced PNP showed that exercise (sensorimotor, endurance, and resistance training) can reduce quality of life, level of activity, and sensitivity. Only three studies in the cohort of those with PNP from various causes showed they were able to achieve improvements through the exercise regimen. The other three studies in this group showed no significant changes after intervention. None of the studies reported serious adverse effects, although one of the diabetic neuropathy studies reported one calf strain from treadmill walking.

Evidence for exercise interventions in those with PNP has improved, although study quality is diverse. Overall, the quality of studies included in this review was 2b with the best evidence in those with diabetes and PNP. Current data suggest that exercise is feasible, safe, and beneficial.  Exercise compliance was overall good, and only mild adverse events were reported. Specific treatment for nerve damage was not available, and the efficacy of pharmaceutical interventions is questionable.

Patient cohorts were very heterogeneous. Because of the heterogeneity, the results are not very generalizable. Eighteen studies were included (small sample).

More research is needed on exercise interventions, particularly in regard to the patients with cancer who have other symptoms to contend with as well. Nurses should educate patients about PNP and encourage enrollment in clinical trials if available.

To test the hypothesis that an exercise program for aerobic endurance, sensorimotor training, and strength training would improve neuromuscular function, improve balance control, and reduce peripheral neuropathy side effects in patients with lymphoma

Patients were randomly assigned to the training intervention or control group. The training intervention was provided twice weekly for 36 weeks under the supervision of a certified sport therapist or physiotherapist. Aerobic endurance training was done on a treadmill or bicycle dynamometer for 10–20 minutes. Four postural stabilization tasks were carried out with increasing task difficulty and surface instability. Resistance exercises with a theraband were included for strength training. Study measures were obtained prior to chemotherapy and after 12, 24, and 36 weeks. Both groups were asked to maintain a weekly diary of physical activities.

• N = 56  
• MEAN AGE = 46 years (range = 19–73 years)
• MALES: 77%, FEMALES: 23%
• KEY DISEASE CHARACTERISTICS: Patients with Hodgkin disease, multiple myeloma, or non-Hodgkin lymphoma
• OTHER KEY SAMPLE CHARACTERISTICS: At baseline, before the intervention, 37 patients had already begun treatment with neurotoxic drugs, and nine patients had symptoms of peripheral neuropathy.

• SITE: Single-site    
• SETTING TYPE: Outpatient    
• LOCATION: Germany

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• Tuning fork evaluation of sensitivity
• Activity level diary
• Pressure displacement measurement for balance
• Subjective global assessment questionnaire for side effects monitoring

During the first 12 weeks, there were significant differences between the groups in aspects of quality of life; however, there was no difference between the groups after 36 weeks. The incidence of reduced peripheral deep sensitivity was lower in the intervention group compared to the control group (p = 0.002), and this symptom diminished in 87.5% of those in the intervention group. No symptoms declined in the control group. Those in the intervention group had a greater improvement in time to regain balance than those in the control group, but this difference was not significant. There were differences between groups in various aspects of balance control and ability to complete attempts for balance control.

The training intervention provided here demonstrated some benefits for reductions in peripheral neuropathy symptoms and some aspects of balance control.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Measurement/methods not well described
• Other limitations/explanation: The specific method of measurement of quality of life was not stated even though quality of life was the primary outcome of this study. The individual, specific sensory-motor measurements were difficult to interpret in terms of overall comprehensive effect because aspects of measurement varied in their results and data presentation.

Sensory-motor training may be beneficial for reducing symptoms of peripheral neuropathy and improving at-risk patients’ balance and motor function. Additional, well designed research studies with larger samples are warranted.