About the Author(s)


Joana G. Mateus Email symbol
Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

Lynn Smith symbol
Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

Clinton Swanepoel symbol
Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

Citation


Mateus JG, Smith L, Swanepoel C. Exercise, quality of life and chemotherapy-induced peripheral neuropathy in cancer patients and survivors. S. Afr. j. oncol. 2025;9(0), a304. https://doi.org/10.4102/sajo.v9i0.304

Original Research

Exercise, quality of life and chemotherapy-induced peripheral neuropathy in cancer patients and survivors

Joana G. Mateus, Lynn Smith, Clinton Swanepoel

Received: 25 Apr. 2024; Accepted: 07 Feb. 2025; Published: 08 Apr. 2025

Copyright: © 2025. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: With advances in cancer treatment, survival rates have increased, but patients are now subjected to longer and more intensive regimens. The impact of physical activity (PA) on health-related quality of life (HRQoL) in South African cancer patients and survivors with chemotherapy-induced peripheral neuropathy (CIPN) remains unclear.

Aim: This study aimed to explore the relationship between self-reported exercise participation and HRQoL in cancer patients with CIPN, including those currently undergoing treatment and survivors.

Setting: The study was conducted in oncology centres across Gauteng province, South Africa.

Methods: Self-reported questionnaires (n = 305), including the Global Physical Activity Questionnaire (GPAQ) and the Functional Assessment of Cancer Therapy and/or Gynaecologic Oncology questionnaire (FACT/GOG-Ntx) were distributed in oncology centres and online.

Results: Significant associations were found between HRQoL and PA. A negative correlation was observed between physical well-being and social (r = −0.289, p ≤ 0.000) and functional well-being (r = −0.447, p = 0.000). A positive correlation was found between physical and emotional well-being (r = 0.608, p = 0.000). Furthermore, significant correlations were identified between physical well-being and moderate-intensity exercise at work (r = −0.286, p = 0.046), exercise for leisure (r = −0.249, p = 0.009), and walking/cycling (r = −0.311, p = 0.013).

Conclusion: Physical activity is associated with improved physical well-being in cancer patients and survivors with CIPN. Exercise may enhance HRQoL and alleviate CIPN symptoms.

Keywords: chemotherapy-induced peripheral neuropathy; exercise; health-related quality of life; cancer; oncology.

Introduction

Quality of life (QoL) is a representation of the ways in which the mental, social, and physical traits of a person influence the well-being of that individual in day-to-day living.1 The term health-related quality of life (HRQoL) refers to how an illness, disability, or condition affects an individual’s well-being throughout the course of time.2 Because of advances in cancer-specific treatment such as early detection, clinical trials, immunotherapy, radiation, surgery and targeted therapy, cancer patient survival has risen. To improve survival and HRQoL, more patients are treated for longer durations with more rigorous regimens. However, it is unknown whether the symptom burden of chemotherapy-induced peripheral neuropathy (CIPN) and HRQoL decrease in cancer patients and survivors after oncological treatment.3 The prevailing consensus suggests that CIPN exerts a detrimental impact on QoL. This is primarily attributed to its potential to impose significant limitations on daily functioning.4

With the continuous expansion of the long-term cancer survivor population, the National Cancer Institute (NCI) places notable emphasis on elevating the QoL and minimising impairment stemming from the enduring repercussions of cancer treatments, which encompass conditions such as CIPN.5 An individual’s view of their physical and mental well-being, or HRQoL, considers their energy levels, mood, functional status, social support, socioeconomic situation, and health risks and conditions, among other things.6 This emphasis extends to the incorporation of functional daily exercise routines as part of the overall strategy.7 Exercise has been shown to improve physical functioning, reduce fatigue, enhance mood and psychological well-being, and promote social interaction and participation.7

Despite the widespread prevalence and considerable impact of CIPN, no therapies have been approved by the US Food and Drug Administration (FDA).8 There is a notable lack of clear data to support other therapies such as physical therapy, emphasising the critical need for further thorough study in this field.

Methods

Study design

This study used a cross-sectional correlational design to investigate the intricate dynamics surrounding CIPN and its impact on the lives of cancer survivors and patients.

Site of study and sampling

The study was conducted at 14 private hospitals and oncology centres within the Gauteng province of South Africa. The selection of these study sites was based on several factors, including specialisation in cancer care and treatment, access to experienced medical professionals, and a diverse patient population with varying ages and a variety of cancer types, as well as comorbidities.

Selection and recruitment of participants

Participants were carefully selected to include a diverse group of 305 participants. A diverse group was crucial for comprehensive insights, ensuring that the study’s findings could be broadly applicable and representative across various demographic factors. The study adhered to ethical standards in recruitment and selection by obtaining informed consent from the participants, providing comprehensive information through letters, and ensuring accessibility through both in-person and online interaction with participants.

Inclusion and exclusion criteria

Cancer patients and survivors with one or more specific metastatic cancer type, who were experiencing CIPN, currently undergoing or were a minimum of 6 months post-chemotherapy treatment were eligible for inclusion in this study. The Functional Assessment of Cancer Therapy and/or Gynaecologic Oncology Group - Neurotoxicity (FACT-GOG-NTX) scale was used as a diagnostic tool in the inclusion criteria to identify patients with CIPN. This validated scale, assesses the severity of neuropathy symptoms and their impact on QoL, ensuring consistent and reliable identification of patients with clinically significant neurotoxicity.

Participants were also included if they were treated with one or more of the following chemotherapeutic drugs listed, which are known to have the following side effects on patients9:

  • Cisplatin, oxaliplatin: ataxia, ‘coasting effect’. The coasting effect refers to the worsening of neurologic symptoms after treatment is stopped.
  • Vincristine: distal motor impairment (foot drop), autonomic symptoms, ‘coasting effect’, cranial neuropathies.
  • Paclitaxel: prominent small fibre neuropathy (‘burning’).
  • Ipilimumab, nivolumab: prominent motor involvement (weakness, muscle atrophy).

The study excluded cancer survivors who were 0–5 months post-treatment to eliminate any immediate effects of chemotherapy, which could interfere with the accurate assessment of CIPN. Moreover, the following individuals were excluded for the listed reasons:

  • Those with comorbid conditions, which are potential contributors to CIPN. These conditions include autoimmune diseases such as lupus, Sjogren’s syndrome, rheumatoid arthritis, diabetes mellitus Type 1 and 2, Guillain-Barre syndrome, Chronic inflammatory demyelinating polyneuropathy (CIDP), and/or Charcot-Marie-Tooth disease.
  • Neurology patients (in order to maintain a homogeneous sample and focus on cancer-related neuropathy rather than pre-existing neurological conditions).
  • Participants under 18 years (for ethical and consent reasons, as research involving minors often requires specific ethical considerations).
  • Participants not based in Gauteng, South Africa (so as to ensure geographical proximity for practical data collection and participant accessibility).
  • Cancer patients on hormone/radiation therapies (as possible effects of these therapies on neuropathy might interfere with the aims of the research).
Measuring tools or instruments

The research included two questionnaires, both in English. The Functional Assessment of Cancer Therapy and/or Gynaecologic Oncology questionnaire (FACT/GOG-Ntx) specifically assessed symptoms of peripheral neuropathy, including sensitivity to cold, and motor and sensory deficits. With a neurotoxicity subscale Cronbach’s alpha of 0.81 and an overall Cronbach’s alpha of 0.84, the FACT/GOG-Ntx has shown validity and reliability.10 The Global Physical Questionnaire (GPAQ) employs quantitative inquiries to identify levels of physical activity (PA) engagement in the contexts of employment, travel, and recreational pursuits. Spearman’s rho and Kappa coefficients of reliability were from 0.67 to 0.73 and 0.67 to 0.81, respectively. Overall, findings show that GPAQ is a competent and appropriate tool for tracking PA in community health surveillance systems.11 Participants were classified as active or inactive using the GPAQ. Individuals engaging in ≥ 150 min of moderate-intensity PA per week, aligning with World Health Organization (WHO) recommendations, were categorised as active, while those below this threshold were deemed inactive.

Data collection

The researcher utilised a comprehensive recruitment strategy, engaging 255 participants across oncology centres through a combination of digital and traditional methods. Study information and consent forms were made accessible electronically via iPad or in hard copy, ensuring inclusivity and participant comprehension prior to questionnaire completion. Social media platforms facilitated additional recruitment, yielding 50 participants, while printed advertisements at oncology centres provided opportunities for contact information collection and access to an online survey via Google Forms. Ethical rigour was maintained through clear communication of confidentiality measures.

Statistical analysis

The Statistical Package for Social Sciences (SPSS) version 30.0.0 was utilised for the analysis of the data. Descriptive and inferential statistics were used to analyse the data. Non-normally distributed data were treated using non-parametric tests, such as the Mann–Whitney U test and Kruskal–Wallis test, to ensure appropriate statistical analysis. The significance level was set at 95% (p < 0.05) to determine statistically significant results.

Ethical considerations

An application for full ethical approval was made to the University of Johannesburg, Faculty of Health Sciences Research Ethics Committee and ethics consent was received on 07 November 2022. The ethics approval number is REC-1817-2022.

TABLE 1a: Demographic data of the sample including age, height and weight (N = 305).
TABLE 1b: Demographic data of the sample including age range (N = 305).
TABLE 2: Demographic data of the sample including sex (N = 305).
TABLE 3: Current treatment status.

Results

Demographics

A total of 305 participants took part in the study, with a mean age of 52.56 years. The youngest and oldest participants were 19 years old and 87 years old, respectively. The mean height was 173 cm, with the shortest and tallest participants measuring 151 cm and 197 cm, respectively. The mean weight was 73.54 kg, with the heaviest and lightest participants measuring at 113 kg and 45 kg, respectively. A total of 151 (49.5%) participants were female and 150 (49.2%) were male. There were three (1.3%) participants who chose not to disclose their sex.

A total of 115 (46%) participants were in remission and 135 (54%) participants were undergoing chemotherapeutic treatment at the time of data collection. A total of 43 (37.4%) participants were within the first year of their remission status, while 184 (73.5%) participants received chemotherapeutic treatment for 12 months or less. A total of 30 participants had been in remission for 1–2 years and 54 (21.5%) participants had received chemotherapeutic treatment for 1–2 years. A total of 45 (36.7%) participants had passed their 2-year mark in remission and 12 (4.8%) participants had received chemotherapeutic treatment for longer than 2 years.

TABLE 4: Location and/or type of cancer found in the participants.
Global physical activity questionnaire

Table 5 provides an overview of the PA levels among the study participants, including the distribution of different activity types and the average durations of participation. The table highlights the range of activity intensity and the number of participants involved in each category, offering insight into the PA behaviours of the sample population.

TABLE 5: Number of participants and time spent (in min) on vigorous and moderate intensity exercise in the workplace or leisurely per week.
Correlation between different measures of well-being for health-related quality of life and Global Physical Activity Questionnaire
Physical well-being

The results (Table 6) indicate a significant, but negative, association between physical and social well-being (r = −0.289, p = 0.000), as well as between physical and functional well-being (r = −0.447, p = 0.000), with coefficients of r = −0.289 (p = 0.000). Moreover, a highly significant positive correlation was found between physical and emotional well-being (r = 0.608, p = 0.000). Regarding physical well-being and exercise, moderate intensity exercise at work, exercise for leisure, and walking and/or cycling on a typical day were examined. The results indicated significant correlations between physical well-being and moderate intensity exercise at work (r = −0.286, p = 0.046), exercise for leisure (r = −0.249, p = 0.009), and walking and/or cycling (r = −0.311, p = 0.013).

TABLE 6: Descriptive and correlational statistical analysis of (Functional Assessment of Cancer Therapy and/or Gynecologic Oncology Group- Neurotoxicity Scale), general physical, emotional, social and functional well-being dimensions and Global Physical Activity Questionnaire variables.
Social well-being

The results (Table 6) revealed significant negative correlations between social well-being and the following aspects of well-being: physical well-being (r = −0.289, p = 0.000), emotional well-being (r = −0.334, p = 0.000), and functional well-being (r = −0.476, p = 0.000). A significant positive relationship was found between social well-being and walking and/or cycling on a typical day (r = 0.255, p = 0.044). No significant relationships were observed between social well-being and additional concerns, such as handwriting, balance, gait, fine motor skills, vigorous intensity exercise at work or for leisure, or moderate intensity exercise for leisure.

Emotional well-being

The analysis revealed significant associations between social well-being and emotional well-being (r = −0.334, p = 0.000), as well as between functional well-being and emotional well-being (r = −0.370, p = 0.000). Furthermore, a highly significant positive correlation was found between physical and emotional well-being (r = 0.608, p = 0.000). However, no significant relationships were observed between emotional well-being and additional concerns, vigorous intensity exercise at work or for leisure, or moderate intensity exercise at work or for leisure.

Functional well-being

The results (Table 6) indicated significant associations between functional well-being and physical, social, and emotional well-being, with correlation coefficients of (r [235] = −0.447, p = 0.000), (r [235] = −0.476, p = 0.000), and (r [235] = −0.370, p = 0.000), respectively. Additionally, functional well-being exhibited a significant relation with walking and/or cycling on a typical day and moderate intensity exercise for leisure, with correlation coefficients of (r [235] = 0.307, p = 0.014) and (r [235] = 0.199, p = 0.039), respectively. However, no significant relationships were observed between functional well-being and additional concerns, vigorous intensity exercise at work or for leisure, as well as moderate intensity exercise at work.

Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-Neurotoxicity subscale dimensions of well-being

The study identified (Table 7) a significant association between low energy levels (p = 0.002) and nausea (p = 0.003) with physical well-being, shedding light on the factors impacting this aspect of health. However, other factors, such as difficulty meeting family needs, pain, feeling ill, and time spent in bed, did not exhibit statistically significant associations with general physical well-being.

TABLE 7: Descriptive and correlational statistical analysis of general physical, social, emotional, functional well-being of Functional Assessment of Cancer Therapy and/or Gynecologic Oncology Group-Neurotoxicity Scale.

Regarding social well-being, the analysis (Table 7) explored various aspects, including relationships with friends and family, communication about illness, and satisfaction with sex life. The study found that none of these variables showed statistically significant associations with social well-being and adherence to PA guidelines, underlining the need for further research to understand the unique social well-being challenges faced by this population.

Discussion

The concept of HRQoL encompasses the impact of mental, social, and physical factors on an individual’s well-being in day-to-day life.1 Health-related quality of life will also take into account an individual’s energy levels, mood, functional status, social support, socioeconomic situation, among other factors.6 This study aimed to investigate the association of PA on HRQoL in cancer patients and survivors, experiencing CIPN.

The study comprised 305 participants (mean age: 52.6 years; range: 19–87), (Table 1a and Table 1b) with an equal distribution of male and female individualds (Table 2). Approximately 46% were in remission, while 54% were undergoing chemotherapy, primarily within the first year of treatment or remission (Table 3). The predominant cancer types included breast (23.2%), colon (19.7%), and lung (7.7%) (Table 4).

Chemotherapy-induced peripheral neuropathy exerts a detrimental impact on QoL in cancer patients.4 This is primarily attributed to its potential to impose significant limitations on daily functioning.4 Patients with CIPN often contend with distressing symptoms such as numbness, cramps, tingling, and aching or burning pain in their hands or fingers, which can impede routine activities such as fastening a blouse, gripping a pen, or opening containers.12 These symptoms can manifest in the toes or feet, hindering actions such as standing, walking, stair-climbing, or driving. Consequently, CIPN-related symptoms, by disrupting physical well-being, may impact negatively on routines and personal enjoyment.

Using the GPAQ, participants’ activity levels were assessed to determine adherence to recommended guidelines of 150 min of moderate-intensity exercise per week for cancer survivors. A notable proportion of participants did not meet these guidelines, highlighting the need for targeted interventions to promote regular PA and improve HRQoL in this population.

Studies indicate that women with higher levels of CIPN experience diminished cognitive, physical, social, and emotional functioning, leading to an overall decline in HRQoL.13 Despite advances in cancer-specific therapies improving patient survival rates, the symptom burden in two-thirds of cancer patients has increased because of prolonged survival.3 Changes in movement patterns among cancer patients, influenced by discomfort from tumour-related procedures, significantly impact physical well-being and functional capacity.14,15

Emotional well-being is integral to the overall health and QoL of cancer patients, with emotional distress often triggered by the diagnosis and treatment of the disease.15 Emotional factors, such as depression and anxiety, are associated with cognitive function, pain perception, and overall physical well-being.16,17,18 Emotional distress may also reduce motivation for PA, potentially contributing to decline in physical well-being. Additionally, CIPN can make everyday tasks more challenging, further diminishing QoL.17 Emotional well-being was strongly associated with feelings of sadness (p = 0.008), while other factors, such as satisfaction with coping strategies, loss of hope (p = 0.168), feelings of nervousness (p = 0.988), worries about death (p = 0.268), and concerns about the condition worsening (p = 0.648), did not significantly impact emotional well-being. This study reinforces the positive association between PA and HRQoL, specifically highlighting correlations between physical and social well-being (r = −0.289, p = 0.000), physical and functional well-being (r = −0.447, p = 0.000), and physical and emotional well-being (r = 0.608, p = 0.000). The negative correlations between physical well-being and both social and functional well-being may reflect the complexities of cancer survivorship. The negative correlation between physical and social well-being may reflect reduced reliance on social support among individuals with better physical health or differing priorities, such as a greater focus on physical recovery. This finding may also be influenced by the cross-sectional design, which limits insights into the dynamic interactions between these domains. Chemotherapy-induced peripheral neuropathy-related symptoms, such as pain, numbness and motor difficulties can limit functional independence, preventing concurrent improvements in functional well-being. These findings emphasise the need for further research to better understand these relationships and the association between CIPN and multiple domains of well-being.

Moreover, findings on functional well-being revealed varying levels of ability to work, fulfilment in work, life enjoyment, acceptance of illness, sleep quality, engagement in enjoyable activities, and overall life satisfaction. These insights highlight the importance of considering individual experiences and challenges when assessing well-being. This information suggests that targeted interventions may be required to enhance the functional and emotional aspects of participants’ lives. This stems from the recognition that a one-size-fits-all approach may not be sufficient to address the diverse needs and challenges observed among the participants in terms of functional and emotional well-being.

Significant correlations between physical well-being and moderate intensity exercise at work, exercise for leisure, and walking and/or cycling were found. These results underscore the importance of considering multiple dimensions of well-being and exercise behaviours for overall physical well-being. This cross-sectional study identified a significant association between PA and physical well-being, although causation cannot be inferred, as greater well-being might facilitate increased activity.

These results are consistent with previous studies.19,20,21,22 Cancer patients with higher levels of CIPN experience were found to have poorer physical, emotional, cognitive, and social functioning, as well as overall HRQoL.13 No significant difference was found in social well-being between physically active and inactive participants, highlighting the need for further research to address the unique social challenges faced by individuals in this population. Similarly, no significant difference was observed in emotional well-being between physically active and inactive participants. However, a highly significant positive correlation was found between physical and emotional well-being, emphasising their interconnectedness.

Furthermore, analysis of the neurotoxicity scale (Table 7) indicates that significant symptoms were experienced by participants, including numbness, tingling, pain, and functional difficulties in the hands, feet, joints, and overall weakness. Hearing-related symptoms were less prevalent, while participants reported moderate challenges with certain tasks. These findings provide valuable insights into the prevalence and severity of neurotoxic symptoms, indicating the need for further research and targeted interventions.

No significant difference was found in functional well-being between physically active and inactive participants involved in this study. However, functional well-being showed significant correlations with walking and/or cycling on a typical day and moderate intensity exercise for leisure, suggesting the potential benefits of PA in promoting functional well-being. These findings correlate with a literature review,23 which found exercise to be a significantly beneficial therapy in preventing, mitigating, or improving the symptoms of CIPN and sleep disturbances in cancer patients. Seventy-one participants who filled in the functional well-being section of the FACT/GOG/NTX scale were found to have difficulty sleeping. Brett Whalen et al.23 suggest that:

Exercise is an effective intervention and should be specifically prescribed concurrently with chemotherapy to maximise potential of avoiding these debilitating side effects, which significantly and negatively impact QoL in cancer survivors.

Exercise interventions may have a substantial impact on QoL.8,21,22,24 In one Randomised Control Trial (RCT),23 QoL improved within the first 12 weeks of initiating exercise, while in another, overall health status, physical function, and emotional function ratings all improved (p = 0.033, p = 0.009, and p = 0.016, respectively).19

A systematic review12 analysing the relationship between CIPN and QoL found that ten out of eleven studies identified an association, with eight demonstrating a statistically significant correlation. Notable prospective studies24,25 revealed that higher CIPN symptoms were correlated with lower QoL scores.26,27 Kim et al.28 observed a decline in QoL among Korean lymphoma patients experiencing polyneuropathy during treatment. A negative association between QoL (measured using EORTC QLQ-C30) and neurological side effects was also found in patients with ovarian cancer receiving chemotherapy.29 Other studies12,25,30 have underscored the negative impact of cumulative oxaliplatin exposure on QoL in colorectal cancer patients.

Three studies31,32,33 did not establish a significant association between CIPN and QoL. Calhoun et al.31 found no significant differences in QoL improvements measured by FACT-G when examining the FACT/GOG-NTX subscale in ovarian cancer patients. Morita,32 from a study involving 377 Japanese patients with advanced non-small cell lung cancer, reported no impact of physician-identified CIPN on various QoL domains measured by the Quality of Life- Anticancer Drugs (QOL-ACD). These divergent findings suggest potential complexities in the relationship between CIPN and QoL, emphasising the need for nuanced assessments and interventions tailored to individual patient experiences.

Exercise has been shown to improve physical functioning, reduce fatigue, enhance mood and psychological well-being, and promote social interaction and participation. Results from this study reinforce the positive association between exercise and well-being. There were significant correlations between physical well-being and moderate intensity exercise at work (r = −0.286, p = 0.046), exercise for leisure (r = −0.249, p = 0.009), and walking and/or cycling (r = −0.311, p = 0.013), highlighting the positive association between PA and physical well-being. Additionally, a significant positive relationship was found between social well-being and walking and/or cycling on a typical day (r = 0.255, p = 0.044), indicating the social benefits of PA. Functional well-being also showed significant relations with walking and/or cycling on a typical day and moderate intensity exercise for leisure p = 0.014 and p = 0.039, respectively, further supporting the positive relationship of exercise and overall well-being. Exercise may help reduce CIPN-associated pain through improved circulation, inflammation reduction, and neuroplasticity. Furthermore, exercise can enhance mood via endorphin release, potentially alleviating pain. While this study shows an association between exercise and improved well-being, further research is needed to establish causality.

However, individuals undergoing chemotherapy may experience challenges in exercise participation and motor performance because of the side effects of treatment, including CIPN. These symptoms may limit an individual’s ability to engage in physical activities and impact their HRQoL. Notably, results from Table 6 underscore the significant associations between a lack of energy and nausea with physical well-being, emphasising how these symptoms affect patients. Additionally, feelings of sadness can significantly impact emotional well-being, suggesting the need for support and interventions. Insights into functional well-being and neurotoxicity symptoms highlight the variability in experiences, warranting tailored interventions.

Physical inactivity is a common issue among cancer patients and survivors, often resulting from activity-limiting symptoms and functional impairment, leading to a cycle of weakness and reduced QoL.12 Current research highlights the significance of regular PA as a cost-effective and safe intervention for individuals with CIPN. Exercise has shown potential in remedying functional impairments and reducing the severity of CIPN symptoms.19

Active rehabilitation programmes integrated into cancer care are vital for maintaining the physical and mental well-being of patients during treatment.3 A study34 on lymphoma patients demonstrates that exercise interventions, especially balance exercises, can alleviate sensory complaints associated with CIPN and improve physical functioning. While the number of clinical trials exploring the effects of exercise on CIPN symptoms is limited,32,35 various single-arm pre-post-test investigations4,21,24 report significant reductions in CIPN symptoms. Conflicting results are observed in studies8,26,34,36 where exercise groups Intervention Group (IG) showed varying impacts on CIPN symptoms compared to control groups (CGs). Kokkonen et al.3 found overall HRQoL benefits but inconsistent CIPN symptom relief. Reduced therapy-related side effects with varying degrees of CIPN improvement were reported.25 Enhanced functional stability was demonstrated, although CIPN symptoms were not directly measured,36 and significant alleviation of neuropathic symptoms was seen, although some patients experienced residual effects.34 Acknowledging these findings emphasises the need to explore interventions addressing CIPN to enhance overall HRQoL. The results of this study offer valuable insights into the relationship between exercise and dimensions of well-being, highlighting the potential of exercise interventions to improve HRQoL among cancer patients and survivors.

Study’s limitations

This study was limited to literate, English-proficient participants, which may have excluded individuals with lower literacy or different language backgrounds. Additionally, the sample was drawn from oncology centres in Gauteng, potentially limiting generalisability to other regions. The study may have also included a higher proportion of breast cancer patients or individuals from private healthcare, influencing the representation of different cancer types and socio-economic groups. It is possible that patients with less severe CIPN symptoms are more likely to exercise, rather than exercise directly reducing symptoms. Future studies with experimental designs are needed to clarify the direction of this relationship.

Conclusion

This study was the first to investigate the relationship between exercise participation, motor function, and HRQoL in South African cancer patients and survivors with CIPN. The findings suggest that exercise was associated with lower CIPN symptoms and improved physical well-being and QoL. While no significant differences were observed in social or emotional QoL between those who engaged in PA and those who did not, aerobic and strength training exercises show potential benefits for enhancing overall physical health in this population. These results highlight the potential role of exercise in supporting cancer survivors and patients with CIPN.

Acknowledgements

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors’ contributions

J.G.M. contributed to conceptualisation, methodology, formal analysis, investigation, writing (original draft), visualisation, project administration, validation, data curation, resources, and writing (review and editing). L.S. was involved in conceptualisation, methodology, writing (review and editing), and supervision. C.S. was responsible for conceptualisation, methodology, writing (review and editing), and supervision.

Funding information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

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

Disclaimer

The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.

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