The impact of exercise interventions in diabetic patients with peripheral neuropathy

Abstract

Globally, diabetic peripheral neuropathy (DPN) has been recognised as the most prevalent and pressing microvascular complication of diabetes mellitus (DM). Exercise and physical activity are thought to be key components in managing symptoms of DPN. Research questions: ‘Which exercise interventions are ideal for DPN when compared to no intervention and/or advice?’ and ‘What are the effects of exercise interventions on patients with DPN?’. Through the PICO framework the following elements were formulated: (P) Type 2 diabetics affected by mild to moderate diabetic peripheral neuropathy, (I) exercise, (C) no intervention and/or advice, (O) minimisation of neuropathic pain and symptoms, improvement in blood glucose levels, physical fitness, and quality of life. Inclusion criteria: Type 2 diabetics, exercise therapy as an intervention, control group/advice as a comparison. Exclusion criteria: Type 1 diabetics, no control group, other types of neuropathy, articles not written in English or Maltese, studies that do not report the impact of exercise on DPN patients, or other forms of treatment which is not exercise. Methods of Appraisal used: A thorough literature search is carried out in this systematic review to identify relevant articles for this study with the use of PICO components, their synonyms, and Boolean operators. With the use of the PRISMA checklist and Critical Appraisal Skills Programme (CASP), irrelevant articles are excluded, and the chosen articles are critically appraised. Main results and conclusion: The selected studies, comprising 6 randomised controlled trials and 1 quasi-experiment, conclude that aerobic exercise alleviates symptoms of neuropathy and increases nerve conduction velocity. Moreover, a combination of resistance, flexibility, balance, and proprioceptive exercises improves mobility, gait patterns, and balance, ultimately enhancing quality of life for DPN patients. In conclusion, the evidence advocates for incorporating these exercise interventions in the management of DPN. Implications and Recommendations: More extensive research with larger sample sizes and direct comparisons of exercise interventions is recommended to bolster the conclusions drawn from this review. Additionally, further investigation into the intensity, frequency, duration, and mode of exercise is needed to provide better evidence for exercise recommendations.