Home-based exercise for chemotherapy-induced peripheral neuropathy: a feasibility study

Abstract

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy that affects the sensory, motor, and autonomic nerves. CIPN often leads to extremity dysfunction and reduced quality of life (QOL). Pharmacological therapies, such as duloxetine, have demonstrated efficacy in managing CIPN, and rehabilitation has emerged as a promising non-pharmacological treatment; however, the optimal exercise protocol remains unclear. Recent studies have suggested that home-based rehabilitation is feasible and safe for patients with cancer. This study aimed to evaluate the feasibility and safety of a 12-week hybrid intervention, combining outpatient supervision with home-based self-exercise in patients with CIPN.

Methods

This prospective observational study included 25 patients (17 women; mean age, 65.0 ± 9.3 years) with CIPN, 88% of whom had advanced or recurrent cancer. The intervention encompassed supervised outpatient rehabilitation sessions led by physical and occupational therapists and self-exercises at home. Primary outcomes included rehabilitation program completion and training adherence rates. Secondary outcomes included sensory nerve function, physical function, manual dexterity, QOL, and chemotherapy adherence. Descriptive statistics were used to summarize adherence rates. For the analysis of continuous variables, missing data were assumed to be missing at random and were handled using multiple imputation (MI), followed by generalized linear models (GLM). A total of 100 imputations were generated to ensure the stability and reliability of the estimates.

Results

The study completion rate was 76.0%, with an 88% adherence rate for both supervised and self-exercise components. The MI-based analysis showed significant improvements in physical function from T1 to T3, as measured by the Cancer Functional Assessment Set (β = 6.65, 95% CI: 0.2–13.0, p < 0.05), whereas sensory nerve function, manual dexterity, and QOL remained unchanged. Chemotherapy adherence remained favorable throughout the program.

Conclusion

The present study demonstrated the feasibility and safety of a combined outpatient-supervised and home-based exercise intervention for patients with CIPN. These findings highlight the practicability of incorporating an exercise regimen into a CIPN management protocol to support ongoing chemotherapy.

Trial registration

This study was retrospectively registered in the University Hospital Medical Information Network Clinical Trials Registry on 19/11/2024 (UMIN-CTR ID: UMIN 000056201).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-025-01223-1.

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy, with a prevalence ranging from 19% to over 85% and 30–58% at 6 months post-treatment [1–3]. CIPN, caused by agents such as platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, and angiogenesis inhibitors [1, 4], affects the sensory, motor, and autonomic nerves [1]. Symptoms include numbness, pain, paresthesia, motor paralysis, and orthostatic hypotension [1–4], often leading to upper-extremity dysfunction [5–7], gait instability [8, 9], and limitations in daily activities [5]. These impairments elevate the risk of falls [10–12] and fear of falling [13], collectively reducing the quality of life (QOL) [5, 6, 14, 15]. The lack of established treatment and prevention methods underscore the urgent need for the development of strategies addressing CIPN, with a particular focus on improving cancer treatment adherence and enhancing QOL [4].

Rehabilitation is a promising non-pharmacological approach [4, 16]. Exercise interventions alleviate CIPN symptoms [17–29], improve survival through better treatment adherence [26], and enhance physical function [18, 20–22, 24, 26, 27]. However, most studies on exercise interventions for CIPN have focused on the early-phase of neurotoxic chemotherapy [17, 19, 21–23, 26, 27], with limited research addressing exercise interventions after the onset of CIPN in patients experiencing impairments in activities of daily living (ADL) [20, 28]. Furthermore, studies specifically targeting manual dexterity are scarce. While many exercise programs involve supervised training [17, 18, 20–22, 24, 26, 27], the increasing prevalence of outpatient chemotherapy in Japan [30] presents challenges to the feasibility of frequent supervised sessions, particularly for patients with time or transportation constraints [31, 32]. Recently, Su et al. [33] reported that home-based rehabilitation is both feasible and safe. Several studies have also described home-based exercise programs for CIPN [19, 23, 25, 28, 29]. Although Stubblefield et al. emphasized the importance of regular functional assessments by physical therapists before and during chemotherapy as part of a cancer rehabilitation monitoring model [34], most of these programs lack direct involvement of rehabilitation specialists [19, 23, 28, 29]. Among them, only the study by Cao et al. incorporated professional input in the form of telephone counseling by cancer trainers [25].

Given that this study targeted patients already experiencing CIPN-related impairments in ADL, a home-based program was adopted to reduce the burden of frequent hospital visits, which can act as a barrier to exercise adherence. Concurrently, because CIPN can worsen during ongoing chemotherapy [7], the intervention incorporated outpatient supervised sessions to monitor impairments and appropriately adjust the intensity to self-directed exercise, ensuring both efficacy and safety. Furthermore, considering that manual dexterity is commonly affected in patients with established CIPN, occupational therapists were involved in the supervised sessions. Additionally, the home-based program targeted upper limb function. This study aimed to evaluate the feasibility and effectiveness of a 12-week hybrid intervention, combining outpatient supervision with home-based self-exercise, including upper limb exercises, for patients with cancer and CIPN.

Patients and methods

This prospective, observational, survey study involved outpatients participating in a 12–week rehabilitation program for CIPN between October 2022 and December 2024. Participants were required to meet the following criteria: patients with cancer aged 20 years or older who received outpatient care at the NHO Tokyo Medical Center during the study period; those who developed CIPN and were referred to the rehabilitation clinic, regardless of sex, initial cancer diagnosis, or recurrence status; and patients capable of undergoing physical function assessments. Participants were excluded if they met any of the following conditions: communication difficulties such as inability to understand the purpose of the study; history or presence of central nervous system disorders or psychiatric illnesses; received only speech-language therapy; and cases wherein the attending physician deemed the patient inappropriate for inclusion.

The clinical trial protocol was approved by the Clinical Research Ethics Committee of the NHO Tokyo Medical Center on 14/04/2022 (ID: R21-140). The trial was conducted in accordance with the Declaration of Helsinki. All the participants were informed of the experimental details, and written informed consent was obtained from all the participants. This study was retrospectively registered in the University Hospital Medical Information Network Clinical Trials Registry on 19/11/2024 (UMIN-CTR ID: UMIN 000056201).

Rehabilitation program

The exercise program consisted of two components: (1) “supervised rehabilitation conducted by physical and occupational therapists in outpatient settings” and (2) “self-exercise at home.”

Supervised rehabilitation

The supervised sessions were scheduled at a frequency of once every 4 weeks (± 2 weeks) to reduce the burden of hospital visits for patients while allowing coordination with outpatient consultations and medical examinations. These sessions were designed to maintain physical function while ensuring training adherence and were conducted in the conditioning room of an outpatient cancer center. A standardized intervention manual was developed to ensure consistency, and the therapists received training on its use. The intervention included the following steps:

• A.Monitoring and feedback on the execution of self-exercises.
• B.Counseling regarding physical activity and ADL.
• C.Revision and re-instruction of self-exercise programs.
• D.Addressing individual issues, such as balance training, additional muscle-strengthening exercises, and selection of walking aids or orthoses.

Self-exercise

The self-exercise program included resistance training, sensorimotor training, upper limb training, and aerobic exercise. The exercise program encompassed three intensity levels, with 10–20 repetitions per set and 1–3 sets per exercise. The levels were assigned by physical therapists based on individual assessment. For participants with greater impairments, a low-load program with simplified exercises in supine positions was provided. The participants adjusted their exercise regimen based on their physical condition, and the intensity was monitored using a modified Borg scale (3–5) [35]. The participants were instructed to perform the prescribed exercises at their convenience, either in a single session or multiple sessions. They were also encouraged to modify the regimen according to their physical condition and any side effects experienced from chemotherapy. All instructions, including progression strategies and frequency adjustment, were detailed in a brochure (see Supplementary Material 1). The participants were provided with a self-reported exercise diary to document their exercise status and physical condition.

The program consisted of the following components:

• A.Upper limb exercises: This component included exercises and stretches for the fingers, wrists, and shoulders. Grasping tasks were performed with eyes open and closed using balls with different surfaces (smooth, rough, and sharp), types of materials, softness levels, sizes, and weights. Occupational therapists selected the exercises according to each participant’s symptoms and functional status, and detailed instructions were provided using pamphlets.
• B.Lower limb and balance exercises: This component included hip flexion, knee extension, and toe-grasping training [36] while seated on a chair; bipedal heel raise; alternating unipedal hip abduction training while standing; sit-to-stand exercise; and other individualized exercises. These were categorized into three levels of intensity, with appropriate levels assigned by physical therapists and detailed instructions provided using pamphlets.
• C.Walking: This component included 20 min of walking three times per week, with the duration adjusted according to physical condition.

Outcomes and measures

Primary outcomes

The primary outcomes were training adherence and safety. Adherence to the intervention was assessed using two metrics: completion rate of the 12-week rehabilitation program and participation rate in supervised sessions (number of attended sessions/planned sessions). Adherence to self-exercise was determined according to the exercise records documented in self-reported exercise diaries. Reasons for missed exercises and program dropouts were also recorded.

Secondary outcomes

Sensory nerve function, physical function, manual dexterity, QOL, and chemotherapy compliance were recorded as secondary outcomes. The Semmes–Weinstein monofilament test (SWMT) [37] was used to evaluate the static tactile threshold as an indicator of sensory nerve function. This test was performed on 5 distinct areas of the hand—the thenar and hypothenar regions, as well as the fingertips of the first, second, and fifth digits (SOT-DM05A, Sakai Medical Co., Ltd., Japan). The SWMT score ranged from 0 to 5 at each site, with higher scores indicating better function, resulting in a total score of up to 25 points across the five sites [38]. Physical function was assessed using the Cancer Functional Assessment Set (cFAS) [39]. The cFAS consists of 24 items, including basic movement ability, muscle strength, balance, range of joint motion, and range of activity, with lower scores indicating more severe disability. Manual dexterity was subsequently assessed using the Purdue Pegboard test (A929-1; Sakai Medical Co., Ltd., Japan), comprising four subsets: right hand, left hand, both hands, and assembly [40]. QOL was assessed using the Functional Assessment of Cancer Therapy–General (FACT–G) [41] and Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity (FACT/GOG–Ntx) questionnaires [42]. The FACT-G includes four subscales: physical, social/family, emotional, and functional well-being. The FACT/GOG-Ntx extends the FACT–G by incorporating an additional neurotoxicity subscale. Chemotherapy adherence was evaluated using the relative dose intensity (RDI), which was calculated according to the Japan Clinical Oncology Group Protocol Manual, version 3.5 [43]. Additionally, the reasons for chemotherapy dose reduction and delay were documented.

Assessment schedule

Baseline parameters (T1) were assessed at study entry and initiation of chemotherapy. Subsequent assessments were performed at 6 weeks (T2) and 12 weeks (T3) post-T1. QOL were assessed at T1 and T3, Chemotherapy adherence was assessed at T3, and other parameters were assessed at T1, T2, and T3.

Statistical analyses

Sample size calculation was based on the methods reported in prior studies demonstrating that participants demonstrate adherence levels of almost 80% [17, 18]. The required sample size was estimated based on a projected participation rate of 80% and a threshold of 45%. Given the exploratory nature of this feasibility study, a slightly relaxed significance level (α = 0.10, two-sided) was adopted to improve statistical power while maintaining the feasibility of the sample size. Assuming β = 0.20 (power = 80%), the required sample size was calculated to be 21 participants. To account for potential dropouts, the target enrollment was set at 25 participants.

The participation, completion, and dropout rates are summarized using descriptive statistics. For the analysis of continuous variables, missing data were assumed to be missing at random and were addressed using multiple imputation (MI), with 100 imputations performed to ensure the stability and reliability of the estimates. Generalized linear models (GLMs) were subsequently applied, as they are well-suited for analyzing multiply imputed data with repeated measures and do not require the assumption of normality. Statistical analyses were performed using SPSS Statistics software (version 30.0; IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05.

Results

Participant characteristics

The baseline characteristics are presented in Table 1. Twenty-five patients (women: 17, age: 65.0 ± 9.3 years, mean ± SD) were recruited. The study cohort included patients with breast, gynecological, colon, and other cancer types. Most patients had advanced (stage III/IV) or recurrent cancer (n = 22, 88%). The most prevalent causative agent identified was paclitaxel (n = 15, 60%), followed by oxaliplatin (n = 6, 24%). The duration of CIPN in participants was 4.9 ± 7.7 months (range, 1.5–12 months).

Table 1.

Baseline characteristics of participants in this study (N = 25)

Age, mean years (SDa)	65	(9.3)
Sex
Men, n (%)	8	(32.0)
Women, n (%)	17	(68.0)
Cancer type, n (%)
Breast	8	(32.0)
Gynecological	7	(28.0)
Colon	3	(12.0)
Esophageal	2	(8.0)
Urological	2	(8.0)
Others	3	(12.0)
Stage of illness, n (%)
Stage I/II	3	(12.0)
Stage III/IV	15	(60.0)
Recurrent	7	(28.0)
Bone metastasis, n (%)	3	(12.0)
Comorbidity
Diabetes, n (%)	2	(8.0)
Dizziness, n (%)	0	(0.0)
Body Weight, kg, mean (SDa)	55.5	(10.0)
Body Mass Index, kg/m2, mean (SDa)	21.6	(3.6)
Underweight (Below 18.5)	5	(20.0)
Healthy Weight (18.5–24.9)	16	(64.0)
Overweight (25–29.9)	4	(16.0)
ECOG–PSb, mean (SDa)	0.92	(1.7)
Previous cancer treatment, n (%)
Surgery	10	(40.0)
Radiotherapy	3	(12.0)
Anticancer Agents	14	(56.0)
Current chemotherapy status, n (%)
First line	8	(32.0)
Second line or more	14	(56.0)
Completed	3	(12.0)
Number of chemotherapy cycles during study period, (SDa)	4.6	(1.6)
CIPNc–causative drugs, n (%)
Paclitaxel	15	(60.0)
Oxaliplatin	6	(24.0)
Cisplatin	2	(8.0)
Docetaxel	1	(4.0)
Cemiplimab	1	(4.0)
Duration of CIPNc, mean months (SDa)	4.9	(7.7)
CIPNc–CTCAE v4.0d, n (%)
Grade 1	0	(0.0)
Grade 2	22	(88.0)
Grade 3	3	(12.0)
Grade 4	0	(0.0)

Abbreviations: ^aSD, standard deviation; ^bECOG–PS, Eastern Cooperative Oncology Group–Performance Status; ^cCIPN, chemotherapy-induced peripheral neuropathy; ^dCTCAE v4.0, Common Terminology Criteria for Adverse Events version 4.0

Training adherence and safety

Figure 1 shows the patient flowchart. The study completion rate was 76.0%, excluding three patients who withdrew due to the disease exacerbation and three participants who did not complete the T3 assessment because of fatigue (n = 1), time constraints (n = 1), or hospital admission (n = 1). The rehabilitation program completion rate was 88%, excluding the three patients who withdrew due to disease exacerbation. The mean number of supervised exercise sessions was 8.0 ± 10.9. With the exception of the four participants who withdrew, the remaining participants completed 202 of the 228 scheduled supervised exercise sessions, resulting in an exercise participation rate of 88.6%. Twelve participants missed the supervised sessions because of hospital admissions (n = 4), time constraints (n = 4), a poor general condition (n = 3), and economic costs (n = 1). Self-exercise participation was 88.0%, with poor health—fatigue or fever—cited as the main barrier to participation. No adverse events were directly attributable to rehabilitation.

Fig. 1.

Patient flowchart of recruitment, attrition, and compliance

Physical function, manual dexterity, sensory thresholds, and QOL

Table 2 presents the changes in physical function, manual dexterity, sensory thresholds, and QOL over the study period. The observed mean cFAS score was 79.8 (SD: 11.7) at T1. The MI-based GLM analysis revealed a significant improvement from T1 to T3 (β = 6.65, 95% CI: 0.2–13.0, p < 0.05), whereas the change from T2 to T3 was insignificant (β = 0.88, 95% CI: -5.9–7.5, p = 0.794). No statistically significant changes were observed in the MI-based analyses throughout the study period for sensory function assessed using the SWMT, manual dexterity assessed using the Purdue Pegboard test, and QOL assessed using the FACT-G and FACT/GOG-Ntx questionnaires.

Table 2.

Changes over time in physical function, manual dexterity, static tactile threshold, and QOL

Variable		Observed Mean (SDa)	β (Pooled Estimate)	SEb	95% CI	p-value
cFASc total score (range; 0–102)	T1	79.8 (11.7)
	T2	85.8 (10.8)	0.88	0.3	-5.9, 7.5,	0.794
	T3	86.7 (11.6)	6.63	2.0	0.2, 13.1	0.044*
Purdue Pegboard test (number of pins)
Right hand	T1	9.5 (3.3)
	T2	9.9 (2.7)	0.9	0.9	-0.4, 3.2	0.133
	T3	10.9 (2.8)	1.4	0.9	-0.9, 2.8	0.311
Left hand	T1	9.0 (3.3)
	T2	9.4 (2.6)	1.29	0.93	-0.5, 3.1	0.164
	T3	10.7 (0.5)	1.66	0.87	-0.5, 3.4	0.057
Both hands	T1	7.4 (4.3)
	T2	7.3 (2.3)	0.9	1.0	-1.2, 2.9	0.399
	T3	8.1 (2.0)	0.7	1.0	-1.2, 2.7	0.477
Assembly	T1	15.2 (8.9)
	T2	16.6 (7.8)	3.0	2.7	-2.3, 8.3	0.262
	T3	19.6 (8.6)	4.1	2.6	-0.9, 9.5	0.104
Semmes–Weinstein monofilament set (range: 0–25)	T1	16.7 (3.8)
	T2	15.9 (3.6)	0.9	1.8	-2.6, 4.3	0.628
	T3	17.4 (5.1)	0.6	1.5	-2.4, 3.6,	0.690
FACT-Gd total score (range; 0–108)	T1	67.4 (8.1)
	T3	65.6 (11.8)	-1.8	3.1	-7.8, 4.3	0.568
FACT/GOG-Ntxe total score (range; 0–152)	T1	91.5 (10.9)
	T3	89.0 (16.2)	-2.5	4.1	-10.6, 5.6	0.540

Abbreviations: ^aSD, standard deviation; ^bSE, standard error; ^ccFAS, Cancer Functional Assessment Set; ^dFACT-G, Functional Assessment of Cancer Therapy-General; ^eFACT/GOG-Ntx, Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity. *p < 0.05

Treatment adherence

Table 3 presents data on chemotherapy adherence during the study period. As 8 of the 25 participants had already completed chemotherapy with CIPN-causative drugs, the RDI was evaluated in the data obtained from the remaining 17 participants. The mean (SD) RDI was 92.2% (18.7%). During the study period, dose were reduced in five participants owing to the development of peripheral neuropathy (n = 2), pancytopenia (n = 1), anemia (n = 1), hypertension (n = 1), renal abscess (n = 1), and deep vein thrombosis (n = 1).

Table 3.

Treatment status, relative dose intensity, and reasons for changes in treatment plan

Variable	n (%) or mean ± SDa
Treatment status during study period (n = 25)
Chemotherapy with CIPNb–causative drugs	17 (68.0)
Chemotherapy with non–CIPNb-related drugs	5 (20.0)
No chemotherapy	3 (12.0)
RDIc of CIPNb-causative drugs during study period (n = 17)	92.2 ± 18.7
less than 80%	2 (11.8)
80% to less than 85%	1 (5.9)
85% to less than 90%	0 (0.0)
90% to less than 95%	2 (11.8)
95% to less than 100%	0 (0.0)
100%	12 (70.6)
Reasons for treatment plan modification during study period (n = 17)
Peripheral neuropathy	2 (11.0)
Pancytopenia	1 (5.5)
Anemia	1 (5.5)
Renal abscess	1 (5.5)
Hypertension	1 (5.5)
Deep vein thrombosis	1 (5.5)

Abbreviations: ^aSD, standard deviation; ^bCIPN, chemotherapy-induced peripheral neuropathy; ^cRDI, Relative Dose Intensity

Discussion

This study demonstrated high adherence to and safety of the exercise program, alongside favorable chemotherapy adherence. The intervention improved physical function, highlighting the effectiveness of a hybrid intervention combining outpatient supervision with home-based self-exercise.

In this study, the overall completion rate was 76.0%, with an 88% adherence rate for both supervised and self-exercise components. Müller et al. reported that adherence rates ≥ 67% are linked to improved outcomes [21], indicating that the current program exceeded this benchmark. Previous studies of home-based exercise for CIPN have reported adherence rates ranging from 61.5 to 83.8% [19, 25, 28, 29]. The adherence rate observed in this study aligns with this range, indicating favorable outcomes. Home-based exercises without direct intervention by rehabilitation professionals have shown adherence rates ranging from 61.5 to 77% [19, 28, 29]. In contrast, the program by Cao et al., which incorporated regular telephone counseling by a oncology rehabilitation specialist, achieved a high adherence rate of 83.8% [25]. These findings, along with our results, align with the results of a previous study [34], suggesting that structured interventions by rehabilitation professionals are crucial for ensuring high adherence rates in home-based rehabilitation.

In the present study, the participants exhibited impaired physical function at baseline, supporting previous findings regarding the impact of CIPN on functional mobility [5, 8–12]. The baseline SWMT score (16.7/25, 66.8%) indicated sensory dysfunction; manual dexterity was also impaired, consistent with previously reported findings [5–7]. In addition, participants’ QOL was reduced in a manner comparable to that observed in prior studies [5, 6, 14, 15].

The 12-week exercise program led to significant improvements in overall physical function—including balance—as assessed by the cFAS total score, whereas no statistically significant changes were observed in objective neurological function measures such as the Purdue Pegboard test and SWMT scores. Previous studies have demonstrated that exercise can improve physical function in patients with CIPN [18, 20–22, 24, 26, 27, 44–47] and that during chemotherapy, it may reduce the regression of manual dexterity and incidence of neurological symptoms, including pain and numbness, when compared with usual care [6, 17, 19–23, 26]. Similarly, in our study, 68% of participants received active neurotoxic chemotherapy, and the improvements in physical function alongside maintained neurological function support these findings.

Streckmann et al. reported that sensorimotor training modulated stretch reflex responses and peripheral deep sensation [44]. Moreover, systematic reviews have shown that long-term combination of sensorimotor training with resistance and/or aerobic exercises is effective in improving neurological symptoms, including pain, numbness, and balance disturbances [45–47]. These findings are only partially consistent with our results, possibly owing to differences in study design, including intervention timing (after chemotherapy completion or earlier phases of chemotherapy), the duration of interventions, and participant age. Additionally, unlike prior studies that primarily assessed subjective symptoms, we used objective, function-based outcome measures, which may differ in their sensitivity to changes in sensory symptoms [29]. Taken together, these findings suggest that the exercise program contributed to the prevention of CIPN-related functional decline.

However, unlike previous studies that reported improvements in QOL [21, 28], no significant changes were observed in this study. This discrepancy may be attributed to differences in treatment phases and patient characteristics. Müller et al. [21] focused on those in the early stages of chemotherapy initiation. In contrast, 88% of our participants were actively undergoing chemotherapy, with 56% receiving second-line or later treatment. Additionally, while Dhawan et al. [28] investigated patients undergoing an average of two cycles of taxane-based chemotherapy, our cohort received a diverse range of agents over an average of 4.6 cycles. The longer exposure to CIPN-inducing agents and more advanced disease stage may have influenced the QOL outcomes. Despite this, adherence to chemotherapy remained favorable throughout the study. These findings suggest that incorporating exercise into cancer treatment regimens may support treatment adherence and survival, even in patients with advanced-stage cancer and prolonged exposure to chemotherapy agents inducing PN.

Nevertheless, this study has several limitations that warrant consideration. First, adherence to the self-exercise regimen was assessed solely through self-reported diaries, which may be subject to recall bias or social desirability bias, potentially leading to overestimation. Second, the study had a relatively small sample size, and several participants were unable to complete the final evaluation (T3) owing to health deterioration, resulting in a reduced dataset for longitudinal analyses. Third, the limited sample size and study duration (12 weeks) precluded subgroup analyses based on cancer type, stage, or specific causative agents. In addition, treatment adherence assessed using RDI should be interpreted cautiously, as the monitoring period was relatively short. These limitations underscore the need for cautious interpretation of our findings.

Despite these limitations, this study provides preliminary evidence supporting the feasibility of a hybrid intervention that combines outpatient supervision with home-based, self-directed exercise for patients undergoing chemotherapy. Future research should explore the long-term effects of such hybrid interventions through larger randomized controlled trials. Recently, several studies have investigated the effectiveness of home-based exercise programs for patients with cancer, including both those actively undergoing treatment and survivors [19, 23, 25, 28, 29, 48, 49]. While the efficacy and safety of such programs among survivors have often been explored through telerehabilitation [25, 48, 49], our study focused on patients actively receiving chemotherapy, who may face higher risks of CIPN exacerbation [7] and fluctuations in overall health status. In this setting, in-person supervision was integrated to help ensure the safety and appropriateness of the exercise program. These findings may provide preliminary insights for adapting home-based exercise protocols to patient-specific needs and contribute to the discussion on developing future clinical guidelines in oncology care.

Conclusion

The exercise program was associated with high adherence and safety, along with favorable chemotherapy adherence. Significant improvements in physical function were observed. In conclusion, this study provides valuable insights into the design and implementation of rehabilitation tailored to the unique challenges of CIPN. These findings may also contribute to the development of structured guidelines for integrating a hybrid intervention combining outpatient supervision and home-based self-exercise programs into routine cancer care.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

All authors contributed to the conception and design of this study. H. F., K. M., Y. H. were responsible for developing the self-exercise program, creating the pamphlet and self-reported exercise diary, and providing guidance to therapists. Y.N. was in responsible for the survey on the implementation of chemotherapy. Data collection, and analysis were performed by C. M. The first draft of the manuscript was written by C. M., and all authors commented on previous versions of the manuscript. All the authors have read and approved the final version of the manuscript.

Funding

This work was supported by JSPS KAKENHI (grant number 21K17505).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The clinical trial protocol was approved by the Clinical Research Ethics Committee of the NHO Tokyo Medical Center on April 14, 2022 (ID: R21-140). The trial was conducted in accordance with the Declaration of Helsinki. All the participants were informed of the experimental details, and written informed consent was obtained from all the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.