¶ … Reduce Neuropathic Symptoms Kluding, P, Pasnoor, M., Singh, R., Jernigan, S. Farmer, K., Rucker, J. Sharma, N. & Wright, D.

The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 26 (2012) 424-429.

Exercise is frequently prescribed to patients with diabetes or pre-diabetes as a method of controlling blood sugar and weight reduction. However, the effects of exercise on diabetic peripheral neuropathy (DPN) have been less well-documented. This pilot study attempted to determine if the hypothesis that exercise could improve symptoms and nerve function was correct.

Research conducted

The pilot study involved a pre-test post-test design to assess seventeen subjects with DPN (split between 8 males/9 females). Subjects were asked to rate their pain and were also assessed according to the "Michigan Neuropathy Screening Instrument (MNSI) questionnaire of neuropathic symptoms, nerve function measures, and intraepidermal nerve fiber (IENF) density and branching in distal and proximal lower extremity skin biopsies" (Kluding et al. 2012, p. 424). Significant reductions in both pain and neuropathic symptoms were reported after a mild-to-moderate aerobic exercise program of 10 weeks. Glycemic control and resting heart rate also improved (Kluding et al. 2012, p. 427).

Value of Work

The study indicated that non-drug interventions could significantly improve the quality of life of individuals with this chronic condition.

Shortcomings

The study was extremely small and the health of the subjects was extremely poor, with low aerobic fitness at onset. Whether this mild an intervention would be equally beneficial for more fit diabetic subjects is uncertain.

Conclusion

Overall, the study offers a promising prognosis for the value of exercise for these at-risk patients.

Streckmann, F., Zopf, E. M., Lehmann, H. C., May, K., Rizza, J., Zimmer, P. . . . Baumann, F.

T. (2012). Exercise intervention studies in patients with peripheral neuropathy: A systematic review. Physical Therapy, 92:133-141.

Main Purpose

The main purpose of this article was to provide a systematic review of existing studies of the value of exercise programs for patients with peripheral neuropathy. Studies were evaluated in terms of their relative rigor and quality.

Research Conducted

Using PubMed, MEDPILOT_ (MEDLINE), Cochrane, and other databases, researchers compiled a list of studies meeting set criteria according to the Oxford Levels of Evidence (Streckmann, et al. 2013...

Of the eighteen studies of peripheral neuropathy on a variety of patients (diabetes, cancer, and other), three seemed to be of very high quality, nine were deemed high quality, and six were deemed of low quality.
Value of Work

By assessing a diverse range of studies, the researchers were able to come to a conclusion about the relative benefits of exercise for patients suffering peripheral neuropathy due to a wide range of conditions. Overall, studies which focused purely on strength training showed the least benefit. Endurance training for metabolic-based PN showed the greatest benefit while balance training for non-metabolic PN showed the greatest training. Even studies with combined endurance and strength training components did not show as much benefit as those which focused exclusively on the particular needs and origin of the patients' condition. Supervised exercise was more beneficial than home-based.

Shortcomings

The number of studies found to be of high quality was extremely small and because different patient types were involved in each study (diabetes versus cancer), the studies were difficult to compare. The researchers admitted "the recommendations generated are based on rather low evidence and very heterogeneous studies and can thus only present a preliminary direction" (Streckmann et al., 2013, p. 1301).

Tuttle, L. J., Hastings, M. K., & Mueller, M. J. (2012). A moderate-intensity weight-bearing exercise program for a person with type 2 diabetes and peripheral neuropathy. Physical Therapy, 92:133-141.

Main Purpose

This article provided a qualitative case study of a man prescribed aerobic and weight-bearing exercise to alleviate the symptoms of peripheral neuropathy caused by type 2 diabetes.

Research Conducted

The subject was a 76-year-old man with a history of diabetes and peripheral neuropathy. The exercise program involved keeping his heart rate at 75% of the maximum with cardiovascular and weight-bearing activities. Evaluation of his overall physical fitness was conducted after the 12-week study and found no adverse effects and improved functioning.

Value of work

Significant improvement in the patient's health benchmarks were found, including the patient's Six-Minute Walk Test and scores on the Foot and Ankle Ability Measure questionnaire. This holds promise for other sufferers and counteracts previous warnings about skin damage caused by exercise for patients with the condition.

Shortcomings

A case study by definition is only performed on a single patient and therefore findings may not be generalizable to a larger population. Also, the study was only 12 weeks…