Polyneuropathy: Exercise Therapy to Protect the Nerves During Cancer Therapy—VISCIPH A and B

Introduction: Cancer patients often experience treatment-related side effects, with 30%–90% developing peripheral polyneuropathy (PNP) after neurotoxic chemotherapy. Neuropathic symptoms have also been described in association with immunotherapy. This study evaluated the feasibility of two exercise models for upper-extremity PNP, both as a preventive measure (before the onset of PNP) and as a treatment approach (after onset). Methods: This prospective randomized controlled trial comprised two substudies: VISCIPH A, which enrolled patients starting neurotoxic therapy without PNP, and VISCIPH B, which included patients with PNP under continued treatment. Participants were randomly assigned to one of two interventions, PNPEX (sensorimotor and vibration training) or MREX (moderate resistance exercise), which were performed for 12 wk under supervision. Primary outcomes were feasibility, acceptability, safety, and adherence; secondary outcomes were PNP incidence and severity. Results: VISCIPH A enrolled 50 patients, 40 of whom completed the intervention. Exercise adherence was 91.0% and the response rate for symptom documentation was 97.6%. VISCIPH B enrolled 63 patients, 42 of whom completed the intervention. Exercise adherence was 86.7% and symptom documentation was 94.9%. No serious adverse events were reported. In VISCIPH A, PNPEX participants showed a significant increase in symptoms after treatment initiation (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity questionnaire, P = 0.050), whereas there was no significant change in MREX participants ( P = 0.094). Both groups experienced a significant increase in discomfort ( P = 0.001). In VISCIPH B, PNPEX participants had significant improvements in Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity scores ( P = 0.017) and hand discomfort ( P = 0.001), whereas MREX participants did not ( P = 0.460 and P = 0.064, respectively). Conclusions: Both exercise interventions were feasible and safe for patients with treatment-related upper-extremity PNP. In VISCIPH B, PNPEX produced greater improvements than MREX in symptoms and hand discomfort. In VISCIPH A, changes in hand-related discomfort were observed during neurotoxic therapy, and symptom progression remained mild, with some participants not experiencing clinically significant PNP symptoms. The high exercise adherence and absence of serious adverse events underscore the feasibility and safety of these exercise-based interventions, suggesting their potential role in managing and preventing PNP.