A Review of Beneficial Low-Intensity Exercises in Diabetic Peripheral Neuropathy Patients

Carley E Johnson1, Jody K Takemoto2

1Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler
2Ben and Maytee Fisch College of Pharmacy and Department of Pharmaceutical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler


The American Diabetic Association standards of medical care for diabetic patients recommends moderate intensity exercise to help manage diabetes; however, this recommendation may be unmanageable for patients who have become inactive or unable to reach this intensity. The purpose of this review is to determine if low-intensity exercises demonstrate improvement in diabetic peripheral neuropathy symptoms in order to utilize these exercises as a starting point for inactive patients. Studies in low-intensity exercises from 2013 to May 2018 were systematically searched in PubMed, SCOPUS, and Cochrane Library databases. The studies in this research have shown that low-intensity resistance exercises have promising outcomes such as improvements in pain interference with daily activities, pain thresholds, and reductions in neuropathy symptoms. Low-intensity aerobic therapy adds to the quality of life of the patient, and increases in strength of the lower limbs show an improvement in foot sensation and a reduction in pain and tingling symptoms. 

J Pharm Pharm Sci, 22 (1): 22-27, 2019

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Javed, S., Alam, U. and Malik, R.A. 2015. Treating diabetic neuropathy: present strategies and emerging solutions. The review of diabetic studies : RDS 12(1–2), pp. 63–83.

Juster-Switlyk, K. and Smith, A.G. 2016. Updates in diabetic peripheral neuropathy. [version 1; referees: 3 approved]. F1000Research 5.

Singleton, J.R., Marcus, R.L., Jackson, J.E., K Lessard, M., Graham, T.E. and Smith, A.G. 2014. Exercise increases cutaneous nerve density in diabetic patients without neuropathy. Annals of clinical and translational neurology 1(10), pp. 844–849.

Singleton, J.R., Marcus, R.L., Lessard, M.K., Jackson, J.E. and Smith, A.G. 2015. Supervised exercise improves cutaneous reinnervation capacity in metabolic syndrome patients. Annals of Neurology 77(1), pp. 146–153.

American Diabetes Association 2018. 4. Lifestyle Management: Standards of Medical Care in Diabetes-2018. Diabetes Care 41(Suppl 1), pp. S38–S50.

Edwards, J.L., Vincent, A.M., Cheng, H.T. and Feldman, E.L. 2008. Diabetic neuropathy: mechanisms to management. Pharmacology & Therapeutics 120(1), pp. 1–34.

President's Council on Sports, Fitness & Nutrition. (2017, January) Physical Activity Guidelines for Americans.Retrieved from https://www.hhs.gov/fitness/be-active/physical-activty-guidelines-for-americans/index.html.

Office of Disease Prevention and Health Promotion. (2018, May) Chapter 4: Active Adults. Retrieved from https://health.gov/paguidelines/guidelines/chapter4.aspx

Yoo, M., D’Silva, L.J., Martin, K., Sharma, N.K., Pasnoor, M., LeMaster, J.W. and Kluding, P.M. 2015. Pilot study of exercise therapy on painful diabetic peripheral neuropathy. Pain Medicine 16(8), pp. 1482–1489.

Kanchanasamut, W. and Pensri, P. 2017. Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study. Diabetic foot & ankle 8(1), p. 1287239.

Zivi, I., Maffia, S., Ferrari, V., Zarucchi, A., Molatore, K., Maestri, R. and Frazzitta, G. 2017. Effectiveness of aquatic versus land physiotherapy in the treatment of peripheral neuropathies: a randomized controlled trial. Clinical Rehabilitation, p. 269215517746716.

Herman, W.H., Pop-Busui, R., Braffett, B.H., Martin, C.L., Cleary, P.A., Albers, J.W., Feldman, E.L. and DCCT/EDIC Research Group 2012. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabetic Medicine 29(7), pp. 937–944.

Nadi, M., Marandi, S.M., Esfarjani, F., Saleki, M. and Mohammadi, M. 2017. The Comparison between Effects of 12 weeks Combined Training and Vitamin D Supplement on Improvement of Sensory-motor Neuropathy in type 2 Diabetic Women. Advanced biomedical research 6, p. 55.

Rojhani-Shirzi, Z., Barzintaj, F., and Salimifard, M. Comparison the effects of two types of therapeutic exercises vs. Swiss ball on the clinical balance measures in patients with diabetic neuropathy. Diabetes and Metabolic Syndromes: Clinical Research and Reviews. 11S pp S29-S32.

Powell-Cope, G., Quigley, P.A., Besterman-Dahan, K. and Lind, J.D. 2014. Perceived benefits of group exercise among individuals with peripheral neuropathy. Western journal of nursing research 36(7), pp. 855–874.

Manor, B., Lipsitz, L.A., Wayne, P.M., Peng, C.K. and Li, L. 2013. Complexity-based measures inform Tai Chi’s impact on standing postural control in older adults with peripheral neuropathy. BMC complementary and alternative medicine 13, p. 87.

Crews, R.T., Schneider, K.L., Yalla, S.V., Reeves, N.D. and Vileikyte, L. 2016. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes/Metabolism Research and Reviews 32(8), pp. 791–804.

Alsubiheen, A., Petrofsky, J., Daher, N., Lohman, E. and Balbas, E. 2015. Effect of Tai Chi Exercise Combined with Mental Imagery Theory in Improving Balance in a Diabetic and Elderly Population. Medical Science Monitor 21, pp. 3054–3061.

DOI: http://dx.doi.org/10.18433/jpps30151