Efficacy of exercise-based interventions for the management of chemotherapy-induced peripheral neuropathy in patients with breast cancer: A systematic review and meta-analysis.

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Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dose-limiting side effect in breast cancer patients, particularly those receiving taxane-based regimens. CIPN manifests as sensory, motor, and autonomic dysfunction, significantly impacting quality of life and physical function. While pharmacological treatments often yield limited efficacy or adverse effects, exercise-based interventions have emerged as a potential non-pharmacological strategy. This meta-analysis aims to evaluate the efficacy of exercise in reducing the symptom burden of CIPN in breast cancer patients. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted. Eligible studies investigated the impact of various exercise modalities (e.g., aerobic, resistance, or sensorimotor training) compared to standard care on CIPN symptoms in breast cancer patients. Primary outcomes were sensory, motor, and autonomic symptom scores, as well as overall CIPN burden. Data were pooled using a random-effects model. Standardized Mean Differences (SMD) and 95% Confidence Intervals (CI) were calculated to account for the use of diverse assessment scales. Heterogeneity was assessed using the I ² statistic. Results: Eight RCTs involving 722 patients were included. Exercise interventions resulted in a statistically significant reduction in sensory symptoms (SMD -1.61; 95% CI -2.59 to -0.63; P = 0.001) and motor symptoms (SMD -1.81; 95% CI -2.96 to -0.65; P = 0.002), although heterogeneity was high for both (I ² = 96% and 95%, respectively). Autonomic symptoms were also significantly reduced (SMD -0.69; 95% CI -1.10 to -0.28; P = 0.001), with notably low heterogeneity (I ² = 0%). Furthermore, the overall CIPN burden was significantly lower in the exercise group compared to controls (SMD -1.34; 95% CI -2.16 to -0.53; P = 0.001; I ² = 91%). While effect sizes varied across studies, the direction of effect consistently favored exercise interventions. Conclusions: Exercise-based interventions significantly alleviate sensory, motor, and autonomic symptoms of CIPN and reduce the overall neuropathy burden in breast cancer patients. These findings support the integration of structured exercise programs as a core component of supportive care for patients at risk of or experiencing CIPN. Given the high heterogeneity observed in sensory and motor outcomes, future research should focus on identifying the optimal exercise dose and modality for specific CIPN phenotypes.