Sharon Leslie, PT, DPT, is a physical therapist specializing in cancer rehabilitation and survivorship. She founded the cancer rehabilitation program at the Palo Alto Medical Foundation and is an advisory panelist on the Cancer.Net Editorial Board. Sharon is also the founder of VaxVolunteers.org, a centralized hub for volunteer opportunities at COVID vaccine sites across the United States. She is currently working in the Department of Humanitarian Health at Johns Hopkins School of Public Health focusing on global and humanitarian health issues.

Cancer and its treatment can cause many side effects, including a common one called peripheral neuropathy. Peripheral neuropathy occurs when nerves are damaged and cannot send signals to your brain, spinal cord, and other parts of the body.

Peripheral neuropathy can be caused by certain medications, including many types of chemotherapy. This is commonly called chemotherapy-induced peripheral neuropathy or CIPN. It is estimated that 30% to 40% of people treated with chemotherapy that impacts the peripheral nerves will develop peripheral neuropathy, according to a 2017 review published in Annals of Neurology. The peripheral nerves are all the nerves in your body that are not in the brain and spinal cord. Peripheral neuropathy can also occur when a tumor is pressing on or growing into a nerve.

Peripheral neuropathy can cause problems related to sensing, feeling, and moving. It can lead to numbness, pain, and tingling in your hands and feet and can affect your balance and strength. Some people with peripheral neuropathy might feel tightness in their hands and feet, as if they are wearing a glove or stockings. Other people can have trouble sensing hot and cold temperatures, which can put them at risk for skin injury. Sometimes, people have trouble picking up objects or doing daily tasks, such as buttoning a shirt. These changes can make daily activities more difficult and can increase your risk for falling.

Exercise challenges while living with peripheral neuropathy

Peripheral neuropathy might cause some unique challenges to exercise for some people. If you have numbness in your hands, for example, it may make it hard to hold weights. However, there are many other options available to modify weightlifting, like using weights with Velcro or using therapy bands. Some people also cannot fully feel the bottom of their feet, which puts them at a higher risk for falling. Therefore, it is important for them to wear supportive, well-fitting shoes in and out of the gym or during at-home exercise to help with balance. For anyone living with peripheral neuropathy, it is important to start slowly and gradually increase the intensity and duration of your exercise.

If you are experiencing symptoms of peripheral neuropathy and are having difficulty with exercise, ask your health care team for help. A physical therapist or cancer rehabilitation specialist can help design an exercise program that is appropriate for your condition and fitness level. They will assess your balance and strength and work with you to improve function and mobility, as well as decrease the impact of peripheral neuropathy on your daily life. A physical therapist might use other treatments to help relieve neuropathy in combination with exercise, including desensitization techniques to reduce pain, numbness, and tingling in your hands and feet; devices that stimulate the skin with electricity, such as transcutaneous electrical nerve stimulation (TENS); or cold therapy.

You may also work with an occupational therapist if you are experiencing peripheral neuropathy. An occupational therapist can help improve your function around the house by working with you to create strategies for your daily activities that may have been impacted by peripheral neuropathy. For example, they can work with you on arranging your home to decrease your risk of falling. This may include keeping your floors clear of obstacles and loose rugs, installing handrails in areas like the shower or stairways, using assistive devices to help with activities or movement, and keeping dark areas well-lit at night in case you need to get up and walk around.

Exercising with peripheral neuropathy

Exercise has been found to be an effective way to help manage symptoms of peripheral neuropathy. Balance exercises, in particular, can have a major impact on symptoms by improving coordination and decreasing the risk of falling.

Some simple balance exercises to help manage peripheral neuropathy are described below. However, always be sure to check with a member of your health care team before trying any new forms of exercise.

• Single Leg Balance: Stand tall with your feet hip-width apart. When you start out doing this for the first time, you can hold onto a wall or piece of furniture for stability. As you progress, you can perform this without holding on to anything. Lift 1 foot off the floor while holding yourself straight up. Hold for 10 to 15 seconds, and then slowly return your foot to the floor. Repeat on the other leg.

• Tight Rope Walk: Pick a destination to walk towards. Extend your arms out to the sides and start walking slowly in a heel-toe pattern, like you are walking on a tightrope. Count at least 5 seconds before each step. You can start out by holding onto the wall for support or have someone walk next to you for light support.

• Marching in Place: Begin by standing with your feet shoulder-width apart and have your hands lightly touching a wall or chair in front of you. Raise 1 leg up to your hip as if you were marching. Lower it and repeat on the other side. You can increase the difficulty of this exercise by increasing your speed, raising your leg higher, or doing the exercise without touching the wall or chair.

You may also consider trying strengthening exercises, which can help people with peripheral neuropathy improve their muscle strength and function, as well as build endurance. Additionally, there are exercises that can help reduce numbness, tingling, and discomfort in the hands and feet. Talk with your health care team for their recommendations on an exercise plan that is right for you.

While peripheral neuropathy can present many challenges for people with cancer and survivors, exercise can make a big impact on improving your balance, strength, sensation, and pain, and it can greatly improve your quality of life.

The author has no relevant relationships to disclose.