Exercise and Peripheral Neuropathy: What's Right for You
There is nothing close to a one-size-fits-all exercise program for those with diabetic peripheral neuropathy.
The best general advice is to consult with your doctor, use common sense, invest in well-fitting comfortable shoes and socks, check your feet for injury after exercising, and for best results engage in a variety of activities – preferably those you enjoy.
No Good Excuses
Although physical activity can be uncomfortable with DPN, it is impossible to escape the importance of engaging in it.
Most neuropathy experts agree that symptoms will likely worsen without exercise and that symptoms may improve with exercise. Even if the pain, tingling, or numbness of DPN does not lessen with physical activity, human bodies deteriorate when sedentary. We all need to move.
Covering the Four Exercise Bases
The ideal exercise program for someone with peripheral neuropathy includes four types of activities: aerobic, stretching, strengthening, and balance.
Aerobic or cardio exercises increase the heart rate, expand lung capacity, and tone our muscles. Fortunately, the workouts do not have to be intense to be effective.
Many individuals with neuropathy enjoy water aerobics or swimming, riding a stationary bike, rowing, and tai chi. These activities are gentle on the feet and generally safe for those with some muscle weakness or balance impairment. For those with adequate balance and strength, walking and biking are options.
High-impact aerobic exercises such as jumping rope, jogging, or step aerobics put a threefold increase of pressure on our feet compared to walking. However, if your doctor okays these activities and you can tolerate them, they may decrease your neuropathy sensitivity.
Strength training is important because it counteracts the reduction of balance and muscle tone common with DPN, and it builds strong bones. Increased muscle tone also makes daily tasks such as making a bed or taking our the garbage easier.
One option is to use circuit-training machines. Besides offering muscle resistance, the machines' steady movements provide stability. Joining a class that utilizes weights, plastic tubes, or elastic bands can boost exercise motivation.
In 2012, the first research study to examine the effects of exercise on DPN showed that participants engaging in 10 weeks of aerobic and strength training exercises experienced improvements. There was a significant reduction in symptoms including pain severity, and a healthy increase in intra-epidermal nerve fiber branching.
Flexibility or stretching activities are important not only for keeping joints and muscles pliable, they also enhance blood circulation. Plus, adequate stretching lowers our risk of injury when doing other types of exercise and our everyday activities.
Those who are especially stiff in the joints and muscles may benefit greatly from gentle yoga poses. Many of them can be done sitting in a chair.
Balance exercises help with the loss of stability that may occur with pain or numbness in the feet. They can be done within reach of a stable chair or table for support. Both yoga and tai chi are excellent exercises for increasing balance.
Start Where You Are
About half of individuals diagnosed with diabetes develop neuropathy. If you have diabetes, regular exercise can delay, and possibly prevent, the onset of DPN.
People with mild to moderate DPN are encouraged to engage in stretching, strengthening, balancing, and aerobic activities – with their doctor’s permission. The type and amount of exercise you do will depend on several things such as overall health, glucose management needs, and the intensity of your DPN symptoms.
Those who are out of shape, have severe DPN symptoms, foot sores or ulcers, other medical conditions, or are elderly may find chair (sitting) exercises work the best, or possibly aquatic activities. Your physician may recommend you start exercising with the help of a physical therapist.
Photo credit: Mike Baird