Exercise With Neuropathy: What to Ask

This page is for people with numb, tingling, or weak hands and feet from cancer treatment who want to exercise safely. It covers what the nerve damage changes, how to protect your feet, and what to ask your team.

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. Cancer treatment can cause it, and NCI separates the effects into three kinds. Knowing which kind you have changes the exercise plan.

Sensory nerves carry feeling. Damage brings tingling, numbness, or a pins-and-needles feeling in the feet and hands, which may spread up the legs and arms. NCI notes it can also blunt the ability to sense temperature or pain.

Motor nerves drive muscles. Damage brings weak or achy muscles, muscle twitching, tripping, and loss of balance.

Autonomic nerves run background systems. Damage can cause dizziness from low blood pressure, plus changes in digestion and sweating. NCI advises getting up slowly after sitting or lying down, especially if you feel dizzy.

This is common and it lingers. In one trial NCI reported on, more than 40 percent of participants still had numbness and tingling in the hands or feet two years after taxane chemotherapy. In that trial, 10 percent called their symptoms severe.

NCI reported on a study of more than 500 survivors, most of them treated for breast cancer, about six years after chemotherapy. Roughly 45 percent still had numbness in the hands and feet. Those with lasting neuropathy were twice as likely to fall.

Here is the part that matters. In that study, the researchers found that neuropathy did not cause muscle weakness. It changed movement and gait patterns instead, in a way that appears neural rather than muscular. The recommendation that followed was rehabilitation that compensates for the lost sensation, focused on improving balance during movement and correcting gait.

Read that as a reason to ask about rehabilitation. The numb feet may send back poor information. The researchers pointed to retraining balance and gait, not only strength.

If you cannot fully feel your feet, you will not notice a blister, a cut, a pebble in the shoe, or a burn. Any of those can become an infection, and during chemotherapy an infection is a serious event.

NCI's advice is direct: check your feet daily for injuries, and wear sturdy shoes with soft soles.

Make it a fixed habit tied to something you already do, such as before bed.

• Look at the top, the sole, between the toes, and the heel.
• Use a mirror on the floor or ask someone if you cannot see the bottom.
• Feel inside each shoe with your hand before putting it on.
• Wear shoes, both inside and outside, as NCI advises.

The same numbness affects temperature. NCI advises using potholders in the kitchen and having someone else check bath water before you get in.

Sturdy with soft soles is the standard. Fill in the rest at a store that measures your feet.

• Closed toe and closed heel. No flip-flops, no backless clogs.
• A fastening you can tighten, such as laces or a strap.
• Enough room that nothing rubs, since a rub you cannot feel becomes a wound.
• Shoes on before you leave the bed in the morning if your balance is worst then.

Once your feet and shoes are set, the next question is how much exercise to aim for. NCI states that exercise training and testing are generally safe for cancer survivors, based on the 2018 American College of Sports Medicine roundtable. The same review looked at moderate aerobic training, resistance exercise, or both, during and after treatment. It found they can reduce anxiety, depressive symptoms, and fatigue. They can also improve quality of life and physical function. NCI also notes that the same review found insufficient evidence that exercise prevents chemotherapy-induced neuropathy or improves falls. These results were not specific to people with neuropathy.

The federal Physical Activity Guidelines for Americans set the target for adults. Aim for at least 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous activity. Add muscle-strengthening work on at least 2 days a week. Older adults are told to add balance training as part of a multicomponent routine.

The guidelines also speak directly to people who cannot hit those numbers. Adults with chronic conditions should be as physically active as their abilities allow, should avoid inactivity, and should be under the care of a health care provider. Some activity beats none.

NCI's summary of the ACSM work gives a usable starting dose: about 30 minutes of aerobic exercise three times a week, with resistance exercise twice a week. That was enough to improve anxiety, depression, fatigue, quality of life, and physical function.

Match the activity to the deficit.

• Seated or supported cardio first. A recumbent bike, an upright stationary bike, or an arm ergometer removes the balance demand. Water walking in a pool does the same, if the pool floor is not slick and you can enter safely.
• Hold on for balance work, on purpose. Standing exercises done at a kitchen counter let you train the skill without risking a fall. Progress by using fewer fingers, not by letting go all at once.
• Watch the surface. Grass, gravel, sand, and thick carpet demand ankle feedback you may not have. Smooth, level, well-lit surfaces are the place to build volume.
• Use vision to replace feeling. Keep the path lit, keep your eyes up, and avoid exercising in dim rooms. You are now relying on sight to know where your feet are.
• Grip matters too. If your hands are numb, use straps or machines rather than heavy free weights you might drop.

Bring these to the next visit:

• Is my neuropathy sensory, motor, autonomic, or a mix?
• Which drug caused it, is it still in my plan, and would a dose change or a break help?
• Will you refer me to physical therapy or a cancer rehabilitation program for balance and gait work?
• Should I have a formal fall risk assessment?
• Does my blood pressure drop when I stand, and should I be checked for that?
• Is a treadmill safe for me, or should I use a bike?
• Should I see a podiatrist about foot care and shoes?
• Do any of my medicines add to dizziness or unsteadiness?
• Is there anything in my plan, such as bone involvement or a low platelet count, that limits what I should do?

Call 911 or go straight to an emergency department for:

• New trouble breathing or new trouble swallowing.
• Fainting or blacking out.
• A fall with a head strike, above all if you take blood thinners, or if you cannot bear weight afterward.

Do not drive yourself.

Call your care team right away, at any hour, if you are on chemotherapy and a foot sore, cut or blister becomes red, warm, swollen or starts draining, or if any foot wound has redness that is spreading or red streaks (CDC; MedlinePlus).

During chemotherapy, CDC says to call immediately for a temperature of 100.4°F (38°C) or higher (CDC). Chills, a sore throat, mouth sores, or burning when you urinate also need a right-away call, day or night, even with a normal temperature (CDC).

Call your care team right away for:

• New or fast-worsening weakness, especially trouble lifting the front of your foot.
• New numbness spreading upward.

Call your care team the same day for:

• A cut, blister, sore, or ulcer on the foot that is not infected.
• Any redness, warmth, swelling, or drainage at a foot sore, if you are not on chemotherapy. If you are on chemotherapy, call right away, day or night.

Dizziness on standing that does not settle is a same-day call rather than an emergency, unless you actually pass out.

See Neuropathy During Cancer Treatment for the symptom itself and Balance and Fall Prevention After Cancer Treatment for the training detail. Also useful: Exercise During Cancer Treatment, Exercise After Cancer Treatment, Side Effects Overview, and Gentle Movement on Low Energy Days.

• Nerve Problems (Peripheral Neuropathy) and Cancer Treatment, National Cancer Institute
• Persistent Neuropathy Increases Fall Risk among Cancer Survivors, National Cancer Institute
• Nerve Damage after Chemotherapy for Breast Cancer, National Cancer Institute
• Physical Activity and Cancer Fact Sheet, National Cancer Institute
• Prescribing Exercise as Cancer Treatment, National Cancer Institute
• Benefits of Exercise for People with Cancer, National Cancer Institute
• Physical Activity Guidelines for Americans, 2nd edition (PDF), U.S. Department of Health and Human Services
• Signs and Symptoms of Infection (Preventing Infections in People With Cancer), CDC
• Watch Out for Fever (Preventing Infections in People With Cancer), CDC