Autonomic neuropathy is characterized by progressive loss of nerve fiber function that may lead to imbalances in sympathetic and parasympathetic nerve fibers. These fibers innervate the entire body and these innervations to heart and blood vessels in patients with autonomic neuropathy can lead to heart rate abnormalities and vascular dynamics that may affect patients exercising ability. It is important to prescribe or participate in exercises for health benefits; however, in autonomic neuropathy, it becomes really important what obstacles can be encountered in exercising due to the neuropathy.(1)
Best Exercises/Activities For Autonomic Neuropathy
The health benefits of exercise and physical activity on diabetics include improvements in glucose control, lipid profile, insulin sensitivity, blood pressure, body composition, coagulation profile, and psychological health. Non-participation in physical activity can lead to disuse syndrome, which leads to decreased physical work capacity, muscle atrophy, cardiovascular deconditioning, negative nitrogen and protein balance, pulmonary restrictions and depression.(2)
Patients with autonomic neuropathy, especially those with cardiac autonomic neuropathy should be advised to avoid high-intensity physical activities unless they have been cleared by their health care professional to do so. Patients with cardiac risk should first undergo stress testing to rule out any cardiac abnormalities before exercising. Patients should be advised to avoid physical exertion in hot and cold environments due to a risk of dehydration as these patients have thermoregulation problems.
Hypotension is important sequelae to vigorous and high-intensity exercises, so these should be avoided. Monitoring of exercise intensity should be carried out by using a measured maximal heart rate to measure heart rate reserve or perceived exertion can also be used. If the patient suffers from gastroparesis, then exercise regimen should be planned such that exercises should be done to avoid potential hypoglycemia during exercise after meals.(1)
Low to moderate intensity exercises such as recumbent cycling and water aerobics are safer exercises for orthostatic hypotension patients. In patients with peripheral neuropathy, walking exercises can be supplemented with partial or Nonparticipation bearing exercises to improve the physical fitness of patients with diabetes mellitus. the range of motion exercises can be adapted to minimizing shortening of connective tissue. Other mild to moderate weight-bearing exercises and low impact activities include swimming, aquatic and chair exercises. Patients with decreased sensations in feet can engage in balance training exercises along with some lower body and core strengthening exercises to minimize fall risk. Chair exercises can improve flexibility and strength in individuals with limited mobility. The risk of falls can be reduced in elderly people by making changes in exercises, such as using a small rubber ball to do repeated contractions of the hand or using a rubber band as resistance for strengthening dorsal flexion response of the foot. Simple balance training and strength training can also reduce the risk of falling. It is important to avoid jogging and it increases the pressure in feet three times as compared to walking.(1)
Effects Of Exercise Risk On Autonomic Neuropathy
Since the autonomic nervous system is responsible for regulating all the involuntary functions of the body, it can affect any system including cardiovascular, respiratory, gastrointestinal, genitourinary, neuroendocrine, and ocular or sudomotor. Therefore, the risks of exercise in patients with autonomic neuropathy should be carefully evaluated. These risks include silent myocardial ischemia, decreased heart rate variability, orthostatic hypotension with exercise, resting tachycardia and decreased maximal responsiveness, exaggerated blood pressure responses with supine position and exercise, poor exercise tolerance, loss of diurnal blood pressure variation, failure of pupil adaptation to darkness, gastroparesis and diabetic diarrhea, hypoglycemia, heat intolerance, prone to dehydration, susceptibility to foot ulcers, and incontinence. These exercise risks should be kept in mind before engaging in an exercise regimen. Although, most of the patients derive health benefits of an exercise regimen, when a patient has autonomic neuropathy, the benefits and risk of exercise should be considered carefully for maximizing benefits and safety of the patient.(2)
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