Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis.

Background: Exercise can improve the symptoms of chemotherapy-induced peripheral neuropathy. Traditional pairwise meta-analyses of exercise interventions can only identify the difference in effect between an exercise intervention and usual care. It is necessary to conduct network meta-analyses to establish evidence on the comparative effectiveness of all relevant exercise intervention strategies.

Objective: To evaluate the comparative effectiveness of all known exercise interventions for chemotherapy-induced peripheral neuropathy, rank the best exercise intervention and explore the influencing factors of exercise intervention.

Design: Systematic review and network meta-analysis.

Methods: A comprehensive search was conducted in 14 databases. Risk of bias assessment, quality of evidence, sensitivity analysis, subgroup analysis and meta-regression were performed on the included studies. A network meta-analysis was used to identify the optimal exercise intervention.

Results: Twenty-four eligible studies were included, and a total of 19 interventions were identified. Regular physical training combined with sensorimotor exercise, sensorimotor exercise, aerobic combined with resistance and balance training, aerobic exercise and resistance training had statistically significant differences in reducing CIPN symptoms with SMD and 95 % CI were - 1.06 (-1.77, -0.36), -0.61 (-1.08, -0.14), -1.88 (-2.81, -0.94), 0.94 (0.39, 1.49) and - 1.31 (-1.87, -0.74). For pain, the most effective interventions included hand-foot exercises, aerobic combined with resistance training, muscular strength combined with balance exercises, SMD and 95 % CI were - 1.99 (-2.85, -1.13), -1.13 (-1.58, -0.67) and - 1.04 (-1.66, -0.41). Endurance combined with strength training, endurance combined with resistance and balance training, regular physical training combined with sensorimotor exercise and balance training were found to be effective in treating balance with SMD and 95 % CI were 1.61 (0.74, 2.48), 1.10 (0.31, 1.88), 0.92 (0.23, 1.61), and 1.40 (0.59, 2.21). Nerve gliding exercises, aerobic combined with resistance and flexibility exercises, endurance combined with strength training, aerobic combined with resistance training and balance training were found to be effective in treating muscular strength with SMD and 95 % CI were 1.09 (0.48, 1.70), 0.94 (0.29, 1.60), 1.13 (0.32, 1.94), 0.75 (0.51, 1.00) and 1.00 (0.23, 1.76). Subgroup analysis showed that frequency of exercise, duration of exercise, exercise time per session, type of exercise supervision, types of cancer, types of chemotherapy drugs and age had a significant effect on CIPN patients.

Conclusions: This network meta-analysis found that multimodal exercise, consisting of aerobic, balance, resistance and sensorimotor training, was the most effective intervention for CIPN in adults. Healthcare professionals should consider the effects of patient characteristics and different exercise doses on CIPN patients.

Registration: CRD42024500334.