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Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial

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Abstract

Purposes

Physical activity is supposed to decrease mortality of colorectal cancer (CRC) and is suggested to reduce side-effects of the disease and its treatment. However, the knowledge about the influence of exercise interventions on patients suffering from CRC and metastasized CRC (mCRC) is still sparse. One frequently observed side effect in mCRC is chemotherapy-induced peripheral neuropathy (CIPN). This randomized controlled trial investigated the influence of a supervised exercise program on CIPN in mCRC.

Methods

Thirty patients (stage IV) undergoing outpatient palliative treatment including a median of 23.5 chemotherapy cycles of various regimens were randomly assigned to an intervention or control group (IG, n = 17; CG, n = 13). The IG participated in an eight-week supervised exercise program, including endurance, resistance and balance training (2×/week for 60 min) whereas the CG received written standard recommendations to obtain physical fitness. CIPN was assessed using the FACT/GOG-NTX questionnaire. Moreover, endurance capacity (6MWT), strength (h1RM) and balance (GGT-Reha) were evaluated before (t 0) and after (t 1) the intervention as well as after 4 weeks follow-up (t2).

Results

Neuropathic symptoms remained stable in the IG over time, while CIPN significantly worsened in the CG from t 0 to t 1 and t 0 to t 2. In contrast to the CG, the IG significantly improved in strength and balance function. Changes in CIPN correlated with changes in balance.

Conclusions

This is the first investigation showing positive effects of a multimodal exercise program on CIPN, balance and strength on mCRC patients in a palliative setting, thereby consequently increasing patients` quality of life. The results support earlier findings stating a positive influence of balance exercise on CIPN.

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Acknowledgements

We would like to thank all patients who participated in this clinical trial and all physicians and hospitals who supported recruitment, especially C. Müller, dpt. for internal oncology and hematology, Essen-Mitte Clinics.

The intervention was supported by Novitas BKK and AOK Rheinland/Hamburg.

Author information

Author notes

  1. Philipp Zimmer and Sina Trebing contributed equally to this work (shared first)

  2. Fiona Streckmann and Freerk T. Baumann contributed equally to this work (shared last)

Authors and Affiliations

  1. Department for Molecular and Cellular Sports Medicine, German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany

    Philipp Zimmer, Sina Trebing, Alexander Schenk, Wilhelm Bloch & Fiona Streckmann

  2. Department for Physical Activity, Preventive Research and Cancer, German Cancer Research Center, Im Neuenheimer Feld, 280, Heidelberg, Germany

    Philipp Zimmer

  3. VGSU Essen, Association for Health Related Fitness and Sports Therapy at University Duisburg-Essen, Henri-Dunant-Str. 65, 45131, Essen, Germany

    Ursula Timmers-Trebing

  4. Contilia Group, Institute for Psychosocial Medicine, Klara-Klopp-Weg 1, 45138, Essen, Germany

    Rainer Paust

  5. Outpatient Tumor Centre Essen, Henricistr. 40, 45136, Essen, Germany

    Roland Rudolph

  6. Department of Sport, Exercise and Health, University of Basel, Birsstr. 320B, 4052, Basel, Switzerland

    Fiona Streckmann

  7. Department of Medical Oncology, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland

    Fiona Streckmann

  8. Department I of Internal Medicine, Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Freerk T. Baumann

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  1. Philipp Zimmer
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Correspondence to Philipp Zimmer.

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Zimmer, P., Trebing, S., Timmers-Trebing, U. et al. Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial. Support Care Cancer 26, 615–624 (2018). https://doi.org/10.1007/s00520-017-3875-5

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