The Application of Exercise Training For Diabetic Peripheral Neuropathy

A number of experimental studies have utilized exercise training to treat various impairments associated with diabetic peripheral neuropathy, such as nerve conduction velocity, pain tolerance, and balance.

Chronic diabetes can cause neurological, vascular, and lymphatic disorders, including radiculopathy, plexopathy, and mononeuropathy. However, the most common complication of diabetes is the development of diabetic peripheral neuropathy (DPN), which affects somatosensory and motor nerves and autonomic nerves. DPN, defined as “the presence of symptoms and signs of peripheral nerve dysfunction in diabetic patients after exclusion of other causes,” is associated with damage to sensory and motor nerves in the feet, legs, hands, and arms due to increased blood sugar. The main concern for DPN patients is accelerated deterioration of the leg and leg muscles. Calf and foot muscle dysfunction contribute to foot deformities, which increases the risk of disability, ulcers, and amputations. It has been hypothesized that improving balance, stability, and lower body strengthening in DPN patients may improve gait and physical fitness while reducing the risk of disability, foot deformity, and amputation.

The exact mechanism behind the etiology of DPN is still unknown due to the multifactorial nature of the disease. However, chronic hyperglycemia with significantly reduced insulin sensitivity appears to be the primary cause of DPN [18]. Muscle-specific glucose uptake, microvascular perfusion, and nerve drive appear to be critical components in developing DPN and essential mediators of the response to exercise intervention in patients with type 2 diabetes (T2D). As insulin resistance increases, blood sugar levels remain elevated, gradually causing a series of physiological effects that damage peripheral nerves and blood vessels. Ultimately, an attack on motor neurons and general muscle activation lead to disability in DPN patients. Leaving it validated without treatment can raise more clinical severe concerns. One of the most common is diabetic foot syndrome, in which patients may experience foot ulcers, infections, and the possibility of surgery.

Exercise is defined as “planned, structured, repetitive, targeted physical activity in the sense that the goal is to improve or maintain one or more elements of physical fitness. In addition, “physical fitness” means “doing daily work with energy and vigilance, without excessive fatigue, with enough energy to enjoy leisure activities and deal with unexpected emergencies.” It is defined as “ability” [28,29]. Health-related factors of physical fitness are (1) cardiopulmonary endurance, (2) muscular endurance, (3) muscular strength, (4) body composition, and (5) flexibility.

The idea of ​​prescribing weight training has not been widely accepted for many years because doctors believed it was not safe for people with DPN. However, many studies are conducted to test the benefit of these different exercises on DPN. Twenty-nine DPN patients completed either weight-bearing or non-weight-bearing interventions. It consisted of progressive balance, flexibility, strengthening, and aerobic exercise, performed three times a week for 12 weeks. The weight-bearing group showed more significant improvement with a 6-minute walk distance (378 ± 72 to 404 ± 78 m) and an average daily number of steps (4909 ± 1398 to 5393 ± 1449 steps) without increasing side effects. The group showed a significant improvement in HbA1c. Twenty-six DPNs completed 40-60-minute treatment sessions twice a week for 12 weeks.

The intervention consisted of flexibility, muscle strengthening, and functional training to improve the foot rolling process during walking. No significant changes were observed in sole pressure, sole pressure distribution, or active status of the ankle-foot complex below the 6-foot area. A study with 11 DPN patients completed an 8-week home weight-bearing exercise program using a mini-trampoline. There was a trend for peak plantar pressure at the medial forefoot to decrease in the exercise group but not in the control group. After reviewing the literature, there is the support that exercise-based interventions are beneficial for 4-week DPN patients. This conclusion is based on other recent literature reviews examining the effects of exercise on improving gait function [156], reducing neuropathic pain, and improving posture and balance in patients with peripheral neuropathy matches. However, as a result of this review, various training modalities are beneficial.

 

Practice Pearls:

• A variety of biochemical disorders causes diabetic peripheral neuropathy. It is classified as extensive damage to peripheral nerve fibers, including pain, ulcers in the legs, poor mobility, poor quality of life, and severe
• Traditional balance, proprioceptive, yoga, and Tai chi-based training interventions can improve several measurements of static and dynamic balance performance, posture control, and strength, reducing the risk of falls. Is shown.
• Resistance exercise training has many potential benefits for individuals with DPN and has demonstrated its effectiveness when combined with aerobic exercise.

References

Holmes, Clifton J., and Mary K. Hastings. “The Application of Exercise Training for Diabetic Peripheral Neuropathy.” Journal of Clinical Medicine, vol. 10, no. 21, 2021, p. 5042., https://doi.org/10.3390/jcm10215042. link

Saeedi, Pouya et al. “Mortality attributable to diabetes in 20-79 years old adults, 2019 estimates: Results from the International Diabetes Federation Diabetes Atlas, 9^th edition.” Diabetes research and clinical practice vol. 162 (2020): 108086. doi:10.1016/j.diabres.2020.108086 link

Kmeone Kingdom, MPH, PharmD Candidate, South College School of Pharmacy