(Neurotoxic) Chemotherapy can have extensive negative effects at the biopsychosocial level. This secondary analysis of a randomized controlled exercise intervention study aimed to investigate whether a sensorimotor- (SMT) and resistance training (RT) may affect sleep quality and fatigue during neurotoxic chemotherapy.
170 cancer patients were randomized to SMT, RT or usual care (UC). Patients in the SMT or RT group exercised 3×/week (105 min/week) during neurotoxic chemotherapy (mean length: 20 weeks). Subjectively perceived sleep quality (PSQI), fatigue (MFI), and chemotherapy-induced peripheral neuropathy (CIPN) symptoms (EORTC CIPN20) were assessed before and three weeks after last neurotoxic chemotherapy cycle. Analysis-of-covariance models were applied on changes from baseline to post-intervention assessment (covariates: age, gender, neurotoxic chemotherapy class, baseline value of the respective dependent variable, and optional CIPN symptoms).
At baseline, 50% of patients reported good sleep quality. Overall sleep quality remained unchanged during chemotherapy, while general, physical, and mental fatigue increased in all groups (p<0.05). Intention-to-treat analyses (N=159) revealed no differences regarding analyzed outcomes. Exploratory per-protocol analyses (training attendance rate ≥67%; N=89) revealed that general and physical fatigue as well as reduced activity increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) compared to UC (p≤0.02, ES≥0.47). Inclusion of CIPN symptoms as a covariate resulted in non-significant effects for all fatigue dimensions except general fatigue.
In a cancer population at high risk for developing CIPN, sleep quality was not affected by exercise. This result is in contrast to other research findings and might be due to the type of exercise and/or a ceiling effect. However, SMT and/or RT may alleviate several fatigue dimensions, if an appropriate training stimulus is achieved. Of note, the intervention effects on fatigue appeared to be influenced by CIPN symptoms, raising the question if the MFI is a valid PRO for detecting fatigue in CIPN patients. A methodological aspect which needs to be addressed in future research.
Clinical trial identification
Legal entity responsible for the study
Heidelberg University Hospital.
This project was supported by an intramural funding programme: Proof of concept trials 3.0, National Center for Tumor Diseases, Heidelberg, Germany (G876).
All authors have declared no conflicts of interest.