The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy

Abstract

Although exercise can significantly reduce the prevalence and severity of diabetic complications, no studies have evaluated the impact of exercise on nerve function in people with diagnosed diabetic peripheral neuropathy (DPN). The purpose of this pilot study was to examine feasibility and effectiveness of a supervised, moderately intense aerobic and resistance exercise program in people with DPN. We hypothesize that the exercise intervention can improve neuropathic symptoms, nerve function, and cutaneous innervation. Methods A pre-test post-test design was to assess change in outcome measures following participation in a 10-week aerobic and strengthening exercise program. Seventeen subjects with diagnosed DPN (8 males/9 females; age 58.4±5.98; duration of diabetes 12.4±12.2 years) completed the study. Outcome measures included pain measures (visual analog scale), 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. Results Significant reductions in pain (−18.1±35.5 mm on a 100 mm scale, p=0.05), neuropathic symptoms (−1.24±1.8 on MNSI, p=0.01), and increased intraepidermal nerve fiber branching (+0.11±0.15 branch nodes/fiber, p=−.008) from a proximal skin biopsy were noted following the intervention. Conclusions This is the first study to describe improvements in neuropathic and cutaneous nerve fiber branching following supervised exercise in people with diabetic peripheral neuropathy. These findings are particularly promising given the short duration of the intervention, but need to be validated by comparison with a control group in future studies.

Glycemic Control, Hand Activity, and Complexity of Biological Signals in Diabetes Mellitus

“…However, if blood glucose was not controlled well, the peripheral neuropathy remained present in dominant hand. These findings were consistent with many previous observational studies [3][4][5][6][7][8][9]37].…”

Diabetic Peripheral Neuropathy: Should a Chaperone Accompany Our Therapeutic Approach?

“…The efficacy of exercise in exerting a similar effect in patients with diabetes who have signs and symptoms of DPN has yielded similar results. Patients with DPN who exercise regularly experience significant improvements in electrophysiological deficits and neuropathic symptoms, which is accompanied with increases in intraepidermal nerve fiber branching (Fisher et al, 2007;Hung et al, 2009;Kluding et al, 2012). In diabetic animals, exercise prevents myelin damage and attenuates changes in voltage-gated Ca 2ϩ channel function, thereby ameliorating electrophysiological deficits that occur in DPN (Selagzi et al, 2008;Shankarappa et al, 2011).…”

Risk Factors for Early Development of Polyneuropathy Among Type Ii Diabetic Patients.

“…22 reported that, lack of physical activity was not directly associated with peripheral neuropathy while 23,24 found that there are association between lack of physical activity and early development of peripheral neuropathy. Also [24][25][26] observed that, physical activity was associated with lower rates of PN development. One potential strategy to delay or prevent the progression of diabetes to diabetic PN is regular physical activity.…”