The document outlines chemotherapy-induced peripheral neuropathy (CIPN), a condition affecting 30-90% of patients undergoing neuropathic chemotherapy, characterized by symptoms like numbness and tingling in extremities. It emphasizes the potential benefits of exercise in alleviating symptoms and reducing fall risk through strength and balance training. Additionally, it provides tips for managing foot and hand neuropathy, as well as a series of practice exercises to help improve mobility and strength.

1. Nancy Campbell, MS
Exercise Physiologist
Adult Survivorship Program
March 27, 2014

2. Agenda
 What is chemotherapy induced peripheral neuropathy
(CIPN)?
 How exercise may help with symptoms
 Practice exercises

3. What is Chemotherapy Induced Peripheral
Neuropathy (CIPN)?
 A group of neuromuscular symptoms that result from
nerve damage caused by drug therapies used during
cancer treatment
 Affects 30-90% of patients getting specific neurotoxic
chemotherapy drugs
 The most commonly used classes of drugs causing
CIPN are taxanes (Taxol and Taxotere) and platinum
based drugs (Cisplatin and Oxaliplatin)
http://www.slideshare.net/DanaFarber/chemorelated-neuropathy-managing-this-nerve-wracking-problem

4. Symptoms
 Vary from person to person based on type of treatment
and individual differences
 Numbness, tingling and discomfort in the upper or
lower extremities are the hallmark of CIPN
 Can last for months to years after chemotherapy and
sometimes is permanent
 It can interfere with the ability to perform usual
activities
http://www.slideshare.net/DanaFarber/chemorelated-neuropathy-managing-this-nerve-wracking-problem

5. Benefits of Exercise
 People with neuropathy have reduced:
 Proprioception
 Sensation in lower extremities
 Ankle strength
 This can lead to increased risk for falls
 Strength and balance training leads to fewer falls

6. How Exercise May Help
Toftagen, C et al. Strength and Balance Training for Adults with Peripheral Neuropathy and High Risk of Fall. Onc Nurs For. 39, 5,
2012.

7. Tips for Foot Neuropathy
If you have numbness in your feet you should:
 Wear comfortable, properly fitting shoes
 Avoid sandals, open toed or heeled shoes
 Inspect feet daily for injury
 Avoid walking barefoot or in socks alone
 Always check for foreign objects in shoes before
putting them on
 Change shoes in the middle of the day
 Consider making an appointment for physical or
occupational therapy

8. Tips for Hand Neuropathy
If you have numbness in your fingers you should:
 Wear warm clothing in cold weather and protect
hands from extreme cold
 Use care when washing dishes or taking a bath or
shower and do not let the water get too hot
 Use potholders when cooking
 Use gloves when washing dishes, gardening
 Inspect skin for cuts, abrasions and burns
 Consider making an appointment for physical or
occupational therapy

9. Practice Exercises

10. Finger Rolls
 Extend arms in front of you at shoulder height with
palms facing away from you
 Starting with your little finger, curl your hand into a
fist one finger at a time
 Rotate the fist to face you
 Then open up your fingers one at a time, again starting
with your little finger
 Then rotate our palm back to the front
 Repeat with your left hand
 Do 4 sets of finger rolls
Thriving After Breast Cancer. Sherry Lebed Davis and https://www.youtube.com/watch?v=KK1Uf56mNC8

11. Finger Roll with Fist
 Extend your arms in front of you at shoulder height
with palms facing ceiling
 Starting with your little finger, curl your hand into a
fist one finger at a time and make a fist
 Squeeze the fist, then open up fingers, squeeze again
 Do 4 sets of finger rolls
https://www.youtube.com/watch?v=KK1Uf56mNC8

12. Finger Taps
 Extend your arms in front of you at shoulder height
with palms facing ceiling
 Touch your little finger to your thumb, then ring
finger, then middle finger, then index
 Then unwind starting with index finger straightening,
then middle finger, then ring
 Do 4 sets of finger taps
https://www.youtube.com/watch?v=KK1Uf56mNC8

13. Finger Taps
 Place the palms of your hands in your lap
 Lift the index finger twice and tap your lap
 Repeat twice with each finger is succession
 Do 4 sets of finger taps

14. Ankle Circles
 Sit on the edge of a chair
with knees bent at 90
degrees
 Extend right leg straight
 Perform 10 clockwise
ankle circles
 Perform 10 counter-
clockwise ankle circles
 Repeat with left leg
http://thephysicaltherapysourceankle.blogspot.com/2007/01/ankle-ankle-circles.html

15. Standing Heel to Toe
 Beginner: Stand and hold on to a chair for support.
 Place right foot directly in front of left foot, eyes open,
arms at side or across chest
 Look straight ahead at stationary object
 Hold for up to 30 seconds
 Repeat with left foot in front
 Intermediate: Stand without holding on to chair
 Advanced: Repeat with eyes closed

16. Standing Side Leg
 Stand next to a chair in an upright
position, with feet together
 Maintain your balance by gently
touching the back of a chair with
your right hand.
 Raise your left leg in an outward
motion, as far as possible. Make
sure the left foot continues to point
forward.
 Hold for 2 seconds and return slowly
to the starting position.
 Make sure to keep your back straight
as you raise your left leg. Your head,
spine, and stationary leg should be
aligned.
 Keep your abdominal muscles
engaged throughout the movement.
 Repeat with the other leg.
http://www.health24.com/fitness/Exercises/16-1339-1346,20052.asp

17. Calf Raise
 Stand with your feet hip
distance apart, with a slight
bend in your knees
 While maintaining total body
alignment, raise heels off the
floor
 Lower slowly and repeat
 Lift for 3 counts, hold for 1-2
counts, lower for 4 counts
 Perform 2 sets of 10 reps
Progression:
 Perform calf raise off a step
for more range of motion
http://truly-healthy.blogspot.com/2010/10/6-simple-strength-training-exercises.html

18. Calf Stretch
 Place hands on wall at
shoulder height
 Extend one leg behind you
in a lunging position
 Make sure all 10 toes are
facing forward, toward the
wall in front of you
 Bend your front knee, but
make sure knees don’t
extend over your toes
 Stop movement when
slight tension is felt and
hold for 20-30 seconds
http://www.furnacebrookpt.com/how_physical_therapy_can_help_you/ptcanhelpyou_plantar_fasciitis.html

19. Resources
Dana-Farber Adult Survivorship Program
 Exercise consultation
 www.dana-farber.org/exercise or 617-632-4523
 Women’s Strength Class
 Tuesday 10-11, Friday 1:30-2:30
 Dana-Farber Zakim Center
 Acupuncture, massage, qi gong, yoga
 www.dana-farber.org/zakim or 617-632-3399
 http://www.dana-farber.org/research/clinical-trials/clinical-
trial.aspx?tid=4207
 Dana-Farber exercise research studies
 http://www.dana-farber.org/Research/Clinical-
Trials/Clinical-Trials-Search-Result.aspx?q=exercise

20. Resources
 www.cancer.net/survivorship/rehabilitaion
 www.livestrong.org/ymca
 www.slideshare.net/DanaFarber/chemorelated-
neuropathy-managing-this-nerve-wracking-problem
 www.gohealthysteps.com
 www.youtube.com/watch?v=KK1Uf56mNC8
 www.lbbc.org/Event-Archive/2012-05-31-Neuropathy
 www.cancercare.org/connect_workshops/281-
post_treatment_neuropathy_2012_07_17_2012-07-17
 www.cancer.net/print/24588