Targeted sensorimotor training vs. general aerobic exercise for chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis.

Abstract

e24175 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity in breast cancer patients receiving taxane-based regimens. While pharmacological efficacy remains limited, exercise is a promising adjunct therapy. However, the optimal modality remains undefined. This meta-analysis evaluates the efficacy of specific exercise modalities: targeted sensorimotor training (SMT) versus general aerobic/resistance training (GAT) in reducing CIPN symptom burden. Methods: This systematic review and meta-analysis of randomized controlled trials (RCTs) followed a formal study protocol developed prior to implementation in accordance with PRISMA guidelines and reviewed by the Departmental Research Committee at Chitwan Medical College Teaching Hospital. Data were sourced from PubMed, EMBASE, and the Cochrane Library. The primary endpoints were sensory and motor symptom scores. Statistical analysis used a random-effects model to calculate Standardized Mean Differences (SMD) and 95% Confidence Intervals (CI). Methods for handling missing data included available-case analysis. Risk of bias was assessed using the Cochrane RoB 2.0 tool. To account for confounding by intervention type, pre-specified subgroup analyses were conducted to differentiate between targeted SMT and GAT protocols. Results: Eight RCTs (N = 722) were included. Exercise resulted in a significant reduction of overall sensory symptoms (SMD -0.72 [-1.24 to -0.20]; P = 0.006) and motor symptoms (SMD -0.76 [-1.23 to -0.28]; P = 0.002). In subgroup analyses, targeted sensorimotor training significantly improved sensory (SMD -0.99 [-1.55 to -0.44]; P = 0.0005) and motor outcomes (SMD -1.07 [-1.36 to -0.78]; P < 0.00001). Conversely, general aerobic protocols did not significantly reduce sensory (SMD -0.34 [-1.11 to 0.44]; P = 0.40) or motor symptoms (SMD -0.03 [-0.43 to 0.37]; P = 0.87). Autonomic symptoms were significantly improved (SMD -0.69 [-1.10 to -0.28]; P = 0.001). Overall CIPN burden was significantly lower in exercise groups (SMD -1.34 [-1.88 to -0.80]; P < 0.00001), with patient-reported outcomes (SMD -1.64) showing higher sensitivity than physician-reported scores (SMD -0.14). Conclusions: Exercise significantly alleviates CIPN, but efficacy is modality-dependent. Targeted sensorimotor and hand-foot exercises provide robust benefits for sensory and motor dysfunction, whereas general aerobic activity may not be sufficient for symptom-specific reduction. These findings support the integration of structured, targeted exercise into supportive care for taxane-treated patients.