Diabetic neuropathy is the presence of signs and/or symptoms of peripheral nerve dysfunction in diabetics after ruling out other causes. It affects as many as 50% of patients of type 1 and type 2 diabetes mellitus and is often the most common complication of diabetes mellitus. Neuropathies lead to a gradual loss of nerve fiber function. Diabetic neuropathy can either affect the sensory, motor or autonomic nerve fibers or may affect a combination of these or all of these. Increased blood sugar levels along with elevated lipids, blood pressure, smoking, alcohol, tall height, long duration of diabetes mellitus, and advanced age increase the risk of diabetic neuropathy.(1)
The loss of sensation in diabetics with neuropathy is thought to lead to balance problems, changes in gait and an increase in the risk of falling. When diabetic peripheral neuropathy is present in older individuals, they are more prone to a reduced level of activity per day. Furthermore, abnormal sensations along with arterial diseases can cause an increased likelihood of lower extremity injury and infections, which can ultimately lead to diabetic amputations. However, diabetes and its associated complications can be managed with strict dietary blood glucose control, medications, and exercise.(2)
Best Exercise/Activities For Diabetic Neuropathy
Various studies have demonstrated the benefits of aerobic exercise and physical fitness in controlling glucose levels and insulin sensitivity in diabetics. Therefore, exercise and physical activity is an active part of the diabetes management program to keep the complications of diabetes at bay. Diabetics with peripheral neuropathy have always been told to check their physical activity levels. Before 2009, American Diabetes Association (ADA) also recommended that people with severe peripheral neuropathy should incorporate non-weight bearing exercises, such as swimming, arm exercises and bicycling due to increased risk of infection, skin breakdown and joint destruction. However, a study noted that weight-bearing exercises do not increase the risk of foot ulcers. This changed the thought process of the medical community and ADA reinstated that people with diabetic peripheral neuropathy can do weight-bearing exercises. However, they should be cautious about proper footwear and should inspect their feet daily for any lesions. Furthermore, people with a foot injury or open sores should avoid doing weight-bearing exercises.(2)
Exercise has various nerve protective and recovery benefits including reducing oxidative stress, restoring neurotrophin levels, reducing inflammation, preventing myelin damage and improving nerve function and it can ultimately help in regeneration of the nerve. There is a growing body of evidence that suggests that people with less physical activity are more likely to have skin breakdown that those who are more physically active. People with diabetic peripheral neuropathy can also increase their weight-bearing activities without any increase in injuring themselves.(2)
The low-intensity exercises for diabetic neuropathy include aerobic exercises, resistance training, balance training and resistance, balance and flexibility therapy. Aerobic exercises include walking, aquatic exercises, and mini-trampoline. Resistance training includes weight machines, such as leg extension, leg press, and others. Balance therapy includes Swiss ball and Frenkel training, while resistance, balance and flexibility training include tai chi and yoga. Aerobic exercises decrease pain (by increasing pain intensity) and risk of foot ulcers; and increase the aerobic intensity, social benefits, balance, muscle strength, and balance and gait. Resistance training increases the quality of life by decreases the risk of foot ulcers and increasing muscle strength. Balance training increases balance by improving knee and ankle reflexes. Resistance, balance and flexibility training increase balance, heightened awareness, balance tricks, social benefits, sensations, leg strength, and flexibility.(3)
Once patients can perform low-intensity exercises they can further incorporate moderate-intensity exercises to their exercise regimen to manage pain and diabetes.
However, it is very important to understand the individual needs of a patient and help in preventing and managing diabetic neuropathy and its associated complications to improve the quality of life of a patient. This can be achieved by a combination of medication, dietary control of glucose and regular exercise.(3)
Also Read:
