Elsevier

Journal of Diabetes and its Complications

Volume 26, Issue 5, September–October 2012, Pages 424-429
Journal of Diabetes and its Complications

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

https://doi.org/10.1016/j.jdiacomp.2012.05.007Get rights and content

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 hypothesized that the exercise intervention can improve neuropathic symptoms, nerve function, and cutaneous innervation.

Methods

A pre-test post-test design was used 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 = .05), neuropathic symptoms (− 1.24 ± 1.8 on MNSI, P = .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.

Section snippets

Research design and methods

A pre-test post-test design was used for this pilot study, with all subjects participating in the intervention. This study was approved by the Human Subjects Committee/Institutional Review Board of the University of Kansas Medical Center.

Subjects

Informed consent forms were signed by 30 individuals, and 19 subjects completed the intervention. Three subjects were disqualified during baseline testing because of health issues that prevented participation in the exercise test (n = 2) or the absence of neuropathic signs or symptoms (n = 1). Six subjects withdrew before starting the intervention because of schedule conflicts or transportation issues. Two subjects withdrew because of the onset of medical issues that interfered with exercise

Conclusions

This is the first study to describe improvements in outcomes related to neuropathic symptoms and cutaneous nerve fiber branching following supervised exercise in people with diabetic peripheral neuropathy. The exercise intervention was feasible for the subject participants screened using the study criteria, as the study was completed by 63.3% of subjects who signed the consent form, and no serious unanticipated adverse events occurred with maximal or submaximal levels of exercise.

Despite the

Acknowledgments

The authors thank the following individuals who assisted with supervising the exercise intervention: Benjamin Tseng, Rachel Moses, Kayla Buehler, and Jennifer Jones, University of Kansas Medical Center. We would also like to thank Janelle Ryals, University of Kansas Medical Center, who processed and quantified the skin biopsy tissue, and Laura Herbelin, University of Kansas Medical Center, who assisted with the nerve conduction studies and quantitative sensory testing. Dr. Mazen DiMachkie,

References (30)

  • S. Balducci et al.

    Exercise training can modify the natural history of diabetic peripheral neuropathy

    Journal of Diabetes and Its Complications

    (2006)
  • A. Maiorana et al.

    The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes

    Journal of the American College of Cardiology

    (2001)
  • Y. Agrawal et al.

    Diabetes, vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey

    Otology and Neurotology

    (2010)
  • American College of Sports Medicine

    ACSM's guidelines for exercise testing and prescription

    (2010)
  • A.J.M. Boulton et al.

    Diabetic neuropathies: a statement by the American Diabetes Association

    Diabetes Care

    (2005)
  • M. daCosta DiBonaventura et al.

    A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost

    Pain Medicine

    (2011)
  • L.E. Davidson et al.

    Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial

    Archives of Internal Medicine

    (2009)
  • P.J. Dyck et al.

    Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity

    Diabetes/Metabolism Research and Reviews

    (2011)
  • E.L. Feldman et al.

    New insights into the pathogenesis of diabetic neuropathy

    Current Opinion in Neurology

    (1999)
  • A. Hennigan et al.

    Neurotrophins and their receptors: roles in plasticity, neurodegeneration and neuroprotection

    Biochemical Society Transactions

    (2007)
  • N. Kadoglou et al.

    The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus

    European Journal of Cardiovascular Prevention & Rehabilitation

    (2007)
  • W.C. Knowler et al.

    Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

    New England Journal of Medicine

    (2002)
  • J. Larose et al.

    Effect of exercise training on physical fitness in type II diabetes mellitus

    Medince and Science in Sports and Exercise

    (2010)
  • G. Lauria et al.

    Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study

    Journal of the Peripheral Nervous System

    (2010)
  • S.J. Mandrekar et al.

    Are our data symmetric?

    Statistical Methods in Medical Research

    (2003)
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    Conflict of Interest: The authors have no conflict of interest to disclosure.

    ☆☆

    NCT00970060, ClinicalTrials.gov.

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