Sparked by poor glucose control, the condition can lead to a reduced sense of touch and a general decrease in sensation, particularly to the feet, which in turn can cause impaired balance and a higher risk of falling.
Critically, this loss of sensation in the feet can make it difficult or impossible to sense an injury from a cut on the foot or an infected wound, which may lead to a lower limb amputation.
About 60 to 70% of people with diabetes have mild to severe forms of nervous system damage that can affect sensory nerves (that carry sensory information toward the Central Nervous System (CNS), motor nerves (that send motor signals to muscles from the CNS) and automatic nerves (a system that regulates several unconscious processes in the body such as breathing and blood pressure).1
In addition to the loss of sensation, peripheral neuropathy (PN) can also spur muscle weakness, pain or the inability to sense pain, an inability to sweat normally, loss of bladder control and abnormal blood pressure during exercise, among other problems.
But while PN is not reversible, the good news is that “regular exercise may help slow the progression of the disease since exercise improves glycemic control,” says Richard Severin, PT, PhD (cc), University of Illinois at Chicago and clinical assistant professor at Baylor University. “It may not reverse the symptoms, but may prevent the condition from worsening. And for individuals at risk for PN, it may stave off the development of the condition.”
So controlling blood sugars is a must.
According to the Foundation for Peripheral Neuropathy,2 four types of exercise are useful for those with this condition: aerobic, resistance training, flexibility, and balance. Physical therapy and occupational therapy may help patients establish an exercise program and teach them to become alert to the importance of shifting weight to avoid falls or walking on uneven surfaces.
Several studies note that exercise can be performed safely in patients with type 2 diabetic neuropathies and exercise intervention produces a marked improvement in certain nerve functions.3,4 It can also help with balance issues, gait and reaction times, all of which may reduce the chance of falls. 5,6 And in a recent study, there is some suggestion that regular exercise may be able to help with the pain caused by neuropathies. 7
“Exercise can also improve quality of life and may reduce pain ratings due to some of the positive effects on the nerves and positive changes in how our brains perceive pain and movement,” says Dr. Severin. “Exercise for patients with chronic or even acute pain of various types has been shown to be beneficial if prescribed appropriately by a licensed healthcare professional such as a physical therapist.”
A mix of aerobic, strength, and balance exercises can help deal with symptoms of PN.
For those who have never exercised aerobically, Dr. Severin suggests starting out with as little as 10-minute intervals three times a day and working up to about 150 minutes a week. Moderate activities can include walking.
“The secret is to find something a person wants to do and enjoys,” says Dr. Severin. “We know from psychology and exercise physiology research that if a person enjoys an activity, there’s more chance of them doing it over the long term.”
He also recommends that people find an activity that they can scale up in intensity.
“It could be working out on an elliptical machine, salsa dancing with a partner, or even walking,” he says. “The biggest thing is to do it consistently and enjoy it.”
Since people with PN often have other neuropathies like retinopathies, Dr. Severin notes exercise can also help microvascular diseases. improve glucose control and lead to greater ease in performing everyday tasks.
Resistance training is also recommended. If you’ve never used weights before, Dr. Severin suggests visiting a physical therapist to help address any issues of balance and pain. The therapist will come up with a plan, then patients can check in once a month to make any adjustments.
“Dumbbells are useful, but you can also do a lot with calisthenics employing only body weight,” says Dr. Severin. “The goal is to make sure that the patient can do a routine forever, so if they don’t have the equipment, they don’t let that be an excuse. Calf raises, squats and bridges can all be valuable.”
In addition, balance exercises prescribed by a physical therapist “can be great to help improve balance, by teaching the body and brain new strategies to stay balanced and upright following changes to sensation and potentially vision,” says Dr. Severin.
One exercise he particularly recommends is Tai Chi, which involves slow and controlled movements that can help improve balance, by teaching the body and brain new strategies to stay balanced and upright. Tai Chi doesn’t cost much to perform and is often offered at YMCA’s or local adult school exercise classes or on many free YouTube channels.
“There are lots of slow progressive movements you can do in a group, or you can do it by yourself,” he says.
“The biggest concern in patients who develop type 2 diabetes is related to sedentary behavior,” says Dr. Severin. “Stretching is fine, but to get results you need to get the heart rate up and exercise at a moderate to vigorous intensity.”