**5. Summary**

comprehensive treatment plan for patients with peripheral neuropathy [3, 23, 27]. Moderate to intense strength training and aerobic exercise appears to be well tolerated by these pa‐ tients [23] and is associated with improvements in motor function and nerve conduction velocity [26, 28], as well as improved muscle reinnervation and increased axon regeneration [22]. In addition, one investigation reported that low intensity treadmill exercise promoted Schwann cell proliferation in the injured peripheral nerve [25]. In light of these findings, it is feasible to assume that an individual who has experienced a reduction in muscular strength and functional ability due to CIPN may experience similar improvements following an exercise

Those affected by CIPN typically experience large amounts of pain associated with peripher‐ al neuropathy and can be severe enough that it interferes with an individual's quality of life [13]. This type of pain has long been recognized as one of the more difficult types of pain to treat; however, exercise rehabilitation may be able to reduce the amount of pain accompany‐ ing peripheral neuropathy. In healthy individuals, studies have shown that acute exercise can temporarily decrease pain perception; a condition known as exercise-induced hypoalgesia (EIH). Specifically, there have been reported increases in pain thresholds and pain tolerance levels both during and after exercise. Even further, there appears to be a decrease in intensi‐ ty ratings of pain following exercise. To date, research in these areas has yet to determine the optimal intensity of aerobic exercise needed to produce a hypoalgesic effect [58–63]. Typically, exercising at intensities between 60 and 75% of maximum heart rate has been found to produce EIH [58, 59]. Thus far, it has been reported that women tended to experience hypoalgesia following aerobic exercise at 85% HRmax [60]. In most research that has been performed, subject has self-selected their aerobic exercise intensities in which they reported EIH following the exercise bout [61, 62]. EIH has also been observed following resistance exercise training, though reports are limited in this area. In a study conducted by Koltyn and Arbogast [63], it was shown that following 45 min of resistance exercise at 75% of the subject's 1-RM, increases in pain

Exercise rehabilitation programs should be designed in order to help patients familiarize themselves to changes in physical functioning. Further, goals of the program should target three main areas: maximize functional capacities, prolong or maintain independent function, and improve quality of life. For example, studies performed using populations with heredi‐ tary motor and sensory neuropathy have shown that a minimum of 12 weeks of low to moderate resistance training (approximately 30% overload) resulted in strength gains [64–66] that improved function ability [67]. An important area of concern for resistance training is watching for signs that indicate the muscles are being over-worked or exhausted. Symptoms of muscle exhaustion include, but are not limited to, muscle weakness within a half hour of completion of the exercise and excessive muscle soreness between 24 and 48 h after exercise [76, 77]. Training programs should also target aerobic exercise due to its associated benefits with cardiovascular performance and pain tolerance as well as decreased fatigue and depression scores. Currently, research suggests that endurance-based programs should be low impact or utilize approximately 50% of the patient's heart rate reserve [68, 69]. Studies in this

area also suggest including a proper warm up and cool down component.

program.

440 Neurooncology - Newer Developments

thresholds were observed.

In closing, CIPN is a dose-limiting effect of cancer therapy that has negative implications on a patient's quality of life. While much effort has been made to explore pharmacological therapies aimed at cancer patients. However, exercise rehabilitation is one lifestyle modification that positively impacts the lives of patients with CIPN.
