Exercises for chemo neuropathy: numb feet and balance

Peripheral neuropathy is damage to the nerves that connect the brain and spinal cord to the rest of the body, and some chemotherapy drugs can cause it [1]. Macmillan lists platinum drugs, taxanes and vinca alkaloids, including cisplatin, carboplatin, oxaliplatin, docetaxel, paclitaxel and vincristine [1].

Macmillan describes the symptoms as "tingling, pins and needles or numbness in the affected area", "muscle weakness that makes it hard to walk, climb stairs or do other tasks" and "problems with balance, walking and co-ordination" [1]. Symptoms are usually mild to start with [1]. Because balance can be affected, balance work is a key part of exercise for this side effect.

For many people the numbness slowly improves over several months or longer, but for some people the nerve damage is permanent [1]. Macmillan also warns that symptoms "may get worse for a few weeks before they start to get better" [1].

A 2014 review pooled 31 studies covering 4,179 patients. Chemotherapy-induced peripheral neuropathy affected 68.1% of patients in the first month after chemotherapy, 60.0% at three months and 30.0% at six months or more [4]. The review authors concluded that "at 6months 30% of patients continue to suffer from CIPN" [4]. The figures vary a lot between drugs, so ask your own team what is typical for your treatment.

Exercise can help, mainly by improving balance, strength, pain and quality of life, but the evidence that exercise reverses the numbness itself is weaker [5]. Macmillan says exercising during chemotherapy "may help reduce the symptoms of peripheral neuropathy" [1].

The international exercise guidelines for cancer survivors, from the 2018 roundtable published in 2019, judged the effect of exercise on peripheral neuropathy to "remain uncertain" [7]. Since then, more trials have been published:

• A 2023 meta-analysis of 16 studies found that exercise improved quality of life, neuropathic pain, upper and lower limb strength and balance compared with usual care. It also reported "no evidence was found that exercise intervention could improve CIPN symptoms" [5].
• A 2024 German trial (STOP) randomised 158 people having oxaliplatin or vinca alkaloids. Neuropathy developed in 30.0% of the sensorimotor training group, 41.2% of the whole-body vibration group and 70.6% of the usual-care group [6]. The authors call this "initial evidence" [6].
• A 2018 multicentre trial of 355 people, 79% with breast cancer, tested a six-week home walking and resistance-band programme during chemotherapy. Hot or cold sensations in the hands and feet improved slightly; the improvement in numbness and tingling did not reach statistical significance [8].

A 2022 review of exercise to prevent neuropathy found that none of the eight included trials had a low overall risk of bias [12]. The honest summary: balance and strength training looks promising and is worth discussing with your team, but it is not a guaranteed fix.

The most useful mix is balance practice, leg strengthening and low-impact aerobic activity, started gently and built up. Macmillan says exercise for neuropathy "can include aerobic exercise and exercises to help with balance" [1].

In the STOP trial, supervised sessions ran "twice a week, each lasting approximately 15 to 30 minutes" alongside treatment [6]. The NHS advises "doing activities that improve strength and balance at least twice a week" to lower the risk of falls [9]. Cancer Research UK suggests starting "with short chunks (10 to 15 minutes) of gentle activity" [3].

Type of exercise	Examples from UK sources	What the sources say
Balance	Tai chi; "standing on one leg while brushing your teeth" [3]	Neuropathy can cause "problems with balance, walking and co-ordination", and exercise for it "can include ... exercises to help with balance" [1]
Strength	Bodyweight exercises, resistance bands, weights [3]	Lower-leg strength improved in the STOP trial [6]
Aerobic	An exercise bike or swimming [2][3]	If your feet or balance are affected, "Using an exercise bike or swimming may be more suitable" [2]

The NHS suggests doing balance exercises "near a wall or a stable chair just in case you lose your balance" [14]. If numb hands make it hard to grip weights or bands, Macmillan notes that weightlifting gloves "may help you grip the weight" [2]. For general exercise while treatment is still going on, see our guide to exercise during chemotherapy.

If your feet or balance are affected, Macmillan says some activities may not be recommended, including "running or brisk walking, especially on uneven surfaces" and "walking up and down steps" [2]. An exercise bike or swimming may be more suitable [2].

Cancer Research UK makes the same point: with numb or tingling hands and feet, "it might be better to use a stationary bike than to do other types of weight bearing exercise" [3]. If you have bone thinning or cancer in the bones, Macmillan says "you should speak to your healthcare team before doing or starting any exercise" [2].

Check your feet often, do not walk barefoot and test hot water with your elbow, so that scratches and injuries are noticed and treated early [1].

Macmillan advises [1]:

• "do not walk around barefoot, and check your feet often to treat any scratches or other injury as soon as possible";
• "wear well-fitting shoes or boots";
• "test the temperature of hot water with your elbow before baths, showers or doing the washing-up";
• "wear gloves and socks in cold weather to keep hands and feet warm".

After exercise, Macmillan's reminder is to "check your feet regularly for cuts or blisters" [2].

Good lighting, clear floors and stair rails reduce the risk of falls with numb feet. Macmillan advises: "Make sure rooms are well lit. Always put a light on if you get up during the night", keep hallways free of clutter and have rails on the stairs [1].

The NHS advises wearing "shoes or slippers that fit well, do not slip off and have a good grip" [9]. Macmillan suggests asking a physiotherapist about walking aids if your balance is affected [1]. The NHS says to see a GP if "you're worried about your balance or mobility" or "you've had a fall", and to call 999 if someone has fallen and "may have injured the head, back, neck or hip" or "cannot get up" [9].

Tell your healthcare team whenever you notice new neuropathy symptoms or your symptoms are getting worse [1]. If you have symptoms, your cancer doctor will assess how much your nerves are affected, and Macmillan says this "will help them decide whether to continue your treatment, reduce the dose or stop the drug" [1].

Do not hide symptoms to keep treatment on schedule. The ASCO guideline asks clinicians to consider delaying, reducing, substituting or stopping chemotherapy in people who develop "intolerable neuropathy and/or functional impairment" [11]. The same guideline found that "no agents are recommended for the prevention of CIPN" [11], so reporting early is one of the main tools your team has. If you start a new cancer treatment later, Macmillan says it is important to tell your doctor if you already have neuropathy [1].

Macmillan suggests getting advice from a physiotherapist about walking aids if your balance is affected [1]. The NHS says "You can make an appointment with a GP to discuss your problem and whether physiotherapy might help", and "In many areas, you may be able to get physiotherapy from NHS community musculoskeletal (MSK) services without needing a referral from a GP" [10]. Macmillan says people with advanced cancer "can ask your cancer doctor or palliative care team to refer you to a clinical exercise physiologist or physiotherapist for advice before you start any type of exercise" [2].

Clinical exercise physiologists (CEPs) are healthcare professionals who prescribe and deliver "evidence-based exercise to help patients prevent, treat and manage their long-term conditions" [13]. In oncology they work "with patients with different types of cancer and at different stages of treatment" [13]. Our guide to the cancer rehabilitation team explains who does what, and cancer rehabilitation in the UK covers how to get support, including cancer rehabilitation in London.

Request a match with a verified clinical exercise physiologist through The Health Nav.