Effectiveness of Exercise and Physiotherapy in Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling adverse effect of cancer treatment, affecting up to 65% of patients. It reduces quality of life, increases fall risk, and often leads to chemotherapy dose reduction or discontinuation. Because pharmacological management provides limited relief, non-pharmacological strategies such as exercise and physiotherapy have become increasingly relevant. Methods: A systematic review following the PRISMA 2020 guidelines was conducted to identify randomised controlled trials (RCTs) evaluating exercise and physiotherapy for the prevention or treatment of CIPN. PubMed, Scopus, Web of Science, and Cochrane Library were searched up to May 2025. Methodological quality was assessed with the PEDro scale, and due to heterogeneity, a narrative synthesis was performed. Outcomes included neuropathic symptoms, pain, motor and sensory function, balance, muscle strength, and quality of life. Results: Twenty-six RCTs published between 2017 and 2025 were included. Nineteen assessed exercise-based interventions (aerobic, resistance, sensorimotor, balance, yoga, or multimodal), and seven examined physiotherapy modalities (manual therapy, photobiomodulation, Scrambler therapy, ultrasound, or electrical stimulation). Both approaches improved sensory and motor symptoms, balance, muscle strength, and quality of life. Adherence ranged from 70% to 95%, and no serious adverse events were reported. However, variability in intervention design and outcome measures precluded meta-analysis. Conclusions: Exercise and physiotherapy are safe, feasible, and effective non-pharmacological strategies for managing CIPN. However, heterogeneity in intervention design highlights the need for high-quality RCTs to establish optimal protocols and standardised clinical guidelines.