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5 tips to treat Diabetic Neuropathy naturally - Dr. Farida KhanDiabetic neuropathy and exercise -
The diabetic neuropathies. Neurologist 10, — Groover, A. Exercise-mediated improvements in painful neuropathy associated with prediabetes in mice. Pain , — Hashikawa-Hobara, N. The mechanism of calcitonin gene-related peptide-containing nerve innervation.
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Diabetes 51, — Weiss, U. Nature Westermark, P. Forty-five subjects with long-standing type 2 diabetes mellitus and length-dependent distal symmetric polyneuropathy were randomized to a week clinical trial conducted to determine whether a structured aerobic-, isokinetic strength-, or combined aerobic—isokinetic strength exercise intervention program, compared with sedentary controls, would alter peripheral nerve function.
Exercise, regardless of type, neither improved or impaired sensory or motor nerve electrodiagnostic findings across or within groups when analyzed parametrically. Non-parametric analyses of composite electrodiagnostic findings of individual responses supported a modest beneficial effect of exercise, however, on sensory nerve function.
Importantly, the beneficial effect of exercise on sensory nerve function was even more evident following the intervening post-intervention interval. In contrast, exercise did not elicit any detectable benefit to tibial or peroneal motor nerves. Three of six patients that had undergone exercise intervention exhibited a marked improvement in epidermal nerve fiber density.
Compared to baseline values within groups, and compared with sedentary values across groups, neither aerobic-, isokinetic strength-, or the combination of aerobic—isokinetic strength exercise intervention significantly altered metabolic or hemodynamic findings in this chronic diabetic patient population.
Patients that underwent aerobic- or the combined aerobic—isokinetic strength exercise intervention demonstrated an increase in treadmill test duration that was sustained over the week post-intervention period.
Aerobic exercise intervention alone elicited a significant and sustained improvement in overall perceived SFV physical, but not mental, component score. While many clinical trials Pan et al. Previous studies suggest that the beneficial effects of structured exercise intervention programs on diabetes management are primarily realized through improved insulin sensitivity and blood glucose control Boule et al.
Improved glycemic control, leading to lower HbA 1 c levels, is also associated with reduced onset and progression of microvascular retinopathy and nephropathy and neuropathic complications Diabetes Control and Complications Trial Research Group et al.
In our experience, a week-on week-off course of exercise, regardless of type, did not significantly alter HbA 1 c levels in well-managed glycemic controlled patients with long-standing diabetes. Given that HbA 1 c levels reflect an average glycemia over several months Sacks et al.
The acute effect of exercise on glycemic control was not, however, sustained by either a week course of structured exercise or following a week post-intervention period. The observed effect of acute exercise on blood glucose levels was therefore transient and most consistent with a rapid short-lived skeletal muscle dependent GLUT4-mediated mechanism of glycemic control Stanford and Goodyear, While short-term moderately intense structured exercise programs, such as the ones used in this study, do little to sustain acute-exercise induced effects on glycemic control, more extensive and prolonged structured programs of physical activity may be necessary to even modestly alter the progression of diabetes in patients with established disease Gregg et al.
This, however, may not necessarily be the case for diabetes associated vascular complications. Beyond glycemic control, structured exercise intervention programs are thought to improve vascular endothelial function by increasing endothelial-derived nitric oxide NO bioavailability Green et al.
Early studies have shown that a short-term 4-week program of physical activity increases agonist-induced endothelium-dependent vasodilatory capacity and average peak flow velocity in patients with stable coronary artery disease Hambrecht et al. Endothelial dysfunction culminating in macro- and microvascular damage plays a key role in the initiation of diabetes associated complications.
Peripheral nerves of long-standing diabetic patients show extensive microvascular pathology, including basement membrane thickening, loss of pericyte investment, as well as endoneurial endothelial cell hyperplasia, which strongly correlates clinically with nerve function deficits.
Secondary to reduced nerve blood flow and increased endoneurial vascular resistance, ischemia and hypoxia are considered the two most prevailing pathophysiological mechanisms by which chronic diabetes alters peripheral nerve function Nakuda, Given that exercise improves vascular endothelial function, we speculated that an increase in endoneurial blood flow elicited by exercise may afford a measure of protection against further ischemic insult to affected peripheral nerve fibers.
All subjects randomized to this study had clinical and electrodiagnostic findings consistent with length-dependent distal symmetric polyneuropathy. Marked small-fiber neurologic deficits within this patient population were evident from quantitative sensory testing studies.
In comparison to sensory nerve fibers, motor nerve fibers examined were not as affected, which perhaps contributed to the relatively positive quality of life measures indicated at baseline and throughout this study on the standardized SFV health survey questionnaire.
In those patients where electrodiagnostic responses were initially measurable, exercise, regardless of type, had no statistically significant beneficial or detrimental effects on motor nerve electrodiagnostic findings nor on sensory nerve studies as parametrically analyzed within and across experimental groups.
Similarly, exercise intervention did not significantly alter patient perceptions of vibration, cooling, or heat-pain as determined by quantitative sensory testing.
Aerobic exercise did, however, improve subject treadmill endurance times as well as overall physical component scores, supporting a modest clinical benefit for aerobic exercise in the management of the diabetic neuropathic patient.
When analyzed in this manner, a week structured exercise program was found to elicit a modest, statistically significant, beneficial effect on sensory nerve fiber function.
During the intervening week post-intervention period, even more individuals that had undergone exercise showed improvement on electrodiagnostic findings. When analyzed in an identical non-parametric manner, exercise elicited neither a beneficial or detrimental effect on motor nerve function.
In addition to these qualitative electrodiagnostic analyses, 12 randomized subjects volunteered to be biopsied for determination of epidermal nerve fiber density. These findings infer a restorative effect of exercise on this population of small sensory nerve fibers.
The selective effect of exercise on sensory nerve fiber function is not without precedence and may be related to localized increased production by sensory ganglia of numerous neurotrophic BDNF, NGF, NT-3 and related factors Cooper et al.
This program was well-tolerated by our patients with no exercise-related adverse events encountered. Despite its intensity, there were no immediate or sustained effects of aerobic-, isokinetic strength-, or the combination of aerobic—isokinetic strength training, compared to sedentary controls, on peak patient achieved oxygen uptake.
This sample of well-managed glycemic controlled chronic diabetic patients appeared rather resistant to metabolic change and neither benefited or were detrimentally harmed by performing regular-interval exercise intervention. The lack of exercise-improved cardio fitness encountered in this patient population may have limited the impact on our primary electrodiagnostic and secondary quality of life outcome measures in this study.
Subjecting diabetic individuals to a more rigorously intense exercise training program is not recommended due to elevated risk of exacerbating associated retinopathic, nephropathic, and neuropathic diabetic complications. Alternatively, extending the length of time patients are subjected to exercise lifestyle intervention beyond 12 weeks of training may prove beneficial to cardio fitness as well as allowing endoneurial vascular remodeling to alleviate ischemic damage to affected peripheral nerves.
As with all randomized clinical trials, this single-site study is not without limitations. Our small sample size coupled with variable electrodiagnostic findings with this chronic patient sample unavoidably limited the statistical power of this study.
Since it is well known that exercise improves glycemic management, this study was specifically designed to address and identify whether a specific type of exercise would improve peripheral nerve function among patients exhibiting tight glycemic control.
Enrolled patients were therefore clinically well-managed, which may have buffered or masked any exercise-dependent direct effects on peripheral nerve function. The length of time patients were subject to exercise intervention 12 weeks, Fisher et al.
Longer durations of intermittent exercise may prove more effective at improving peak metabolic parameters among chronic diabetic patients while eliciting endoneurial changes that enhance regenerative repair of distal peripheral nerve fibers.
Although our patient sample was comprised of sedentary subjects, we advocated throughout this study lifestyle modifications that included increased physical activity in compliance with recommended standard of care.
An objective measure of each patients daily physical activity level, similar to that of HbA1c, would have proved a useful means of normalization. A structured aerobic exercise program is recommended as a safe well-tolerated adjunctive therapy for the management of diabetic patients with long-standing distal symmetric polyneuropathy.
In most patients, a week course of physical exercise, regardless of type, does not appear to adversely alter sensory or motor nerve electrodiagnostic findings. In a subset of patients, a short-term structured program of exercise may selectively improve sensory nerve fiber function.
Large-scale exercise lifestyle intervention trials are warranted to further evaluate the impact of aerobic exercise on nerve function in diabetic neuropathic patients. This study was carried out in accordance with the recommendations of the Edward Hines Jr. VA Hospital human studies subcommittee with written informed consent from all subjects.
All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Edward Hines Jr. VA Hospital human studies subcommittee.
ES, MF, and EC conceived, designed, and implemented the study, participated in data analyses and data interpretation, and contributed to the writing of the original manuscript. CMM was the nurse clinical coordinator for this study.
CJ, JB, and CM was the exercise electrophysiologist technicians responsible for training subjects randomized to respective training groups. MF was the neurologist responsible for conducting and collecting all primary outcome neurological EMG data.
ES was the principal investigator responsible for overseeing and conducting all administrative aspects of this study and conducting QST measurements. This work was supported by grants [BR and BR I01 RX ] from the Department of Veterans Affairs Rehabilitation Research and Development Service.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors wish to express their sincere admiration and appreciation to the Veterans that volunteered to participate in this study. The authors are grateful to Ms. Louise Corzine and Drs. Nicholas Emanuele and Lonnie Edwards for their unwavering devotion toward providing the highest standards of care to our participating Veterans and for their invaluable insight and assistance with administrative oversight.
FIGURE S1 Exercise does not alter SFV patient self-reported subscale scores. Indicated subscale scores are expressed as a percentage of weighted score Supplementary Table S1 determined at entry into the study baseline , immediately following intervention, and again at week post-intervention, as indicated.
TABLE S3 Relative effect of exercise type on self-reported health status using the SFV questionnaire. Abbott, C. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.
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PubMed Abstract Google Scholar. Other common symptoms include:. Treatment options typically focus on pain relief and treating the underlying cause. However, studies show that exercise can also effectively preserve nerve function and promote nerve regeneration.
There are three main types of exercises ideal for people with peripheral neuropathy: aerobic, balance, and stretching. Before you start exercises, warm up your muscles with dynamic stretching like arm circles.
This promotes flexibility and increases blood flow. It will boost your energy, too, and activate your nerve signals. Aerobic exercises move large muscles and cause you to breathe deeply.
Best practices for aerobic exercising include routine activity for about 30 minutes a day, at least three days a week. Peripheral neuropathy can leave your muscles and joints feeling stiff and sometimes weak.
Balance training can build your strength and reduce feelings of tightness. Improved balance also prevents falls. Stretching increases your flexibility and warms up your body for other physical activity.
Routine stretching can also reduce your risk of developing an injury while exercising. Common techniques are calf stretches and seated hamstring stretches. Exercise can reduce pain symptoms from peripheral neuropathy. Be sure to stretch after any workout to increase your flexibility and reduce pain from muscle tightness.
Top Diabetic neuropathy and exercise the page. Precautions for ulcer prevention exercise Prescription refill service help manage your sxercise, which can reduce your risk of severe diabetic neuropsthy. If you have nerve damage, you may need to avoid certain exercises to stay safe. Talk to your doctor before you start an exercise program. Autonomic neuropathy may increase your risk of having heart, blood pressure, or body temperature problems during exercise.Diabteic Physical exercise neuropathyy an essential adjunct to the management of patients with type exeercise diabetes mellitus. Therapeutic interventions that improve blood flow to peripheral nerves, such as exercise, may slow the progression of Diqbetic in the diabetic patient.
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Advancements in clinical practice for the early detection of neuropathy, coupled with lifestyle intervention for improved glycemic control, are being intensively investigated as viable non-invasive alternatives to pharmacotherapy Fisher et al. It is well established that structured aerobic exercise improves glycemic control in type 2 diabetic patients, largely through a cumulative increase in whole-body insulin sensitivity van Dijk and van Loon, Resistance exercise has similarly been associated with improvements in insulin sensitivity and glucose tolerance Bacchi et al.
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Experimental studies suggest that aerobic exercise may delay the onset of neuropathic pain in a diabetic animal model Shankarappa et al. Alternatively, diabetic patients with painful neuropathy are reported to exhibit a heightened level of pain perception during isometric exercise Knauf and Koltyn, In healthy individuals, exercise is associated with attenuation of pain when a painful stimulus is administered during or immediately following an exercise session Koltyn, Secondary objectives were to establish whether physical exercise alters responses to quantitative sensory testing, self-reported health status using the standardized SFV, or alters peak metabolic or hemodynamic parameters in this sample patient population.
This is the first randomized, controlled trial assessing the effect of different structured exercise programs on peripheral nerve function in diabetic neuropathic patients. From topatients aged 45—80 seen at Edward Hines Jr. VA Hospital and surrounding care settings were pre-screened by chart review or in person for enrollment into ClinicalTrials.
gov NCT Figure 1. Written informed consent was obtained for one hundred six eligible patients. All consented, but not yet randomized, patients completed baseline testing that included a detailed clinical history, physical including blood pressure monitoring and foot examsneurological examination with nerve conduction studies, laboratory studies including fasting blood glucose, HbA 1clipid profile, immune testsand two incremental symptom-limited treadmill exercise sessions.
Subject randomization was blinded to staff ES and MF responsible for obtaining and analyzing data on primary and secondary study outcomes. Because of the nature of the study, patients and clinical staff not involved in data analyses were not blinded to the study group assignments.
Throughout this study, patient compliance with completing secondary outcome measures was variable. No patients experienced a study-related serious adverse event. Patients also exhibited clinical findings consistent with length-dependent sensorimotor distal symmetric polyneuropathy stage N2a as defined by positive or negative distal sensory symptoms and nerve conduction abnormalities in at least two distal nerves.
Positive sensory symptoms included aching, burning, and tingling while negative symptoms included loss of feeling with diminished ability to distinguish heat from cold in the feet. Screened patients were excluded if they presented with foot ulceration, unstable heart disease, or co-morbid conditions limiting exercise.
Patients were also excluded if they had disorders of the central nervous system causing weakness or sensory loss determined by clinical history and neurological examination, had received treatment with medications known to have neuropathy as a prominent side effect including vincristine, vinblastine, cis -platin, and paclitaxel, or had medical conditions that may be associated with neuropathies such as alcoholism ongoing heavy alcohol use by historyliver disease abnormal liver function testskidney disease elevated creatininetoxic exposure by historyvitamin deficiency by history and laboratory studies as well as clinical signs and symptomsautoimmune disorders immunoglobulin abnormalities, studies for collagen diseasescancer by history and review of medical record, laboratory studiesor hypothyroidism increased thyroid stimulating hormone, TSH.
A modified Bruce protocol developed for individuals with peripheral vascular disease and osteoarthritis was used Langbein et al. Cardiac function was monitored by lead electrocardiographic recording prior to, during, and immediately following each incremental symptom-limited treadmill stress test as detailed below.
Patients randomized to aerobic- isokinetic strength- or the combination of aerobic—isokinetic strength exercise were trained three times weekly. A min warm-up consisting of stretching and flexibility exercises preceded all training sessions.
Patients randomized to the combined exercise group received aerobic training prior to isokinetic strength training. Exercised training duration and intensity progressed as listed in the Table 1. All patients randomized to an exercise intervention received Digiwalker pedometers to serve as a motivational tool and to monitor daily physical activity.
To minimize attention and educational bias, all patients received standard of care and attended a session health promotion educational series provided by the same certified diabetes educator CMM consisting of various min skill building sessions Figure 1.
Patients access to the internet and current best source information on diabetes and related topics were demonstrated. Because physical activity lowers insulin resistance, blood glucose was monitored before and after each symptom-limited incremental treadmill stress test and exercise intervention session.
All randomized patients performed and recorded daily blood glucose levels using study-provided test strips and calibrated glucometers throughout this study. Standard of care medications were employed for all subjects and included a combination of insulin, metformin, and sulfonylureas for glucose control and statins for anti-hyperlipidemic drugs.
Cardiac performance of each randomized patient was visually monitored leads II, V1, and V5 on a continuous basis. In the event the treadmill ECG was positive, patients were referred to cardiology for appropriate follow-up.
Patients with indolent coronary artery disease, unstable angina, or other findings that made it unsafe to proceed with the exercise program were withdrawn from the study Figure 2.
Blood pressure was determined by the auscultatory technique using a sphygmomanometer, a pre-gauged adult cuff, and a stethoscope. All randomized patients received a detailed foot exam prior to, during, and after each exercise intervention session in conjunction with the bi-weekly Health Promotion classes.
To minimize the risk of foot injury, all patients randomized to exercise intervention received and wore study-provided new well-fitting supportive athletic shoes. Limb temperatures were continuously monitored using an integrated surface temperature probe to minimize variation within and between patients.
The temperature probe was placed distally on the leg at the dorsal surface of the ankle and distally on the volar surface of the forearm at the wrist crease.
Prior to neurophysiologic evaluation, patient limbs were warmed heating lamp if the surface temperature was less than 32°C in the leg or less than 33°C at the wrist. In all cases, limb surface temperatures were maintained for all sequential nerve conduction studies.
A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. All nerve conduction studies were performed with standard protocols used in the Electromyography Laboratory at the Edward Hines Jr. Veterans Affairs Hospital.
The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three baseline, weeks, weeks conduction studies. The gain was increased, as needed, for low amplitude responses.
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural antidromicmedian antidromic to second digitand ulnar nerves antidromic to fifth digit. Distal motor nerve evoked compound muscle action potential CMAP potentials were recorded from tibial and peroneal nerves.
F-waves were recorded as previously described Fisher et al. Autonomic nerve function was not quantified in this study. Normative Data Taskforce electrodiagnostic reference values for select peripheral sensory and motor nerves for adult populations were used for comparison Chen et al.
At entry into this study, 12 patients volunteered to be biopsied at baseline, and again at week post-intervention, for determination of epidermal nerve fiber density. Skin samples from the distal leg approximately 10 cm proximal to the lateral malleolus were obtained by punch biopsy 3 mm circular punch × 4 mm depth and quantified for epidermal nerve fiber density Therapath Neuropathology.
Post-intervention, three of these 12 patients one sedentary control, two combined declined to be biopsied a second time. Quantitative sensory testing QST evaluation performed by the same examiner ES using a commercially available Computer Assisted Sensory Evaluator [CASE IV System] WR Medical Electronics, Stillwater, MN, United States.
: Diabetic neuropathy and exercise| Exercise for Diabetic Neuropathy | Thank you for visiting nature. Balance training enhances knee and ankle reflexes, resulting in better balance. Gooch, C. ORIGINAL RESEARCH article Front. Effects of exercise-induced hypoalgesia and its neural mechanisms. Article Google Scholar Tryon, W. DPN symptoms were evaluated by the Brazilian version of the Michigan Neuropathy Screening Instrument MNSI |
| Our Review Process | Pettinger, L. The Foot. Cell-specific alterations of T-type calcium current in painful diabetic neuropathy enhance excitability of sensory neurons. Diabetic neuropathy. More randomized controlled trials are needed to further explore the mechanisms by which exercise reduces DNP in order to select the appropriate exercise prescription for treatment. |
| What Is Diabetic Neuropathy? | Follow these safety tips when breaking a sweat. You know that exercise is vital to leading a healthy life with diabetes, to help boost your cardiovascular health, reduce body fat levels, and better manage blood sugar. First, know that neuropathy is nerve damage to cells that can occur anywhere in the body, though the condition often exhibits in feet and hands. In people with diabetes, high blood sugar levels, or persistent hyperglycemia , can cause neuropathy, not to mention a slew of other potential diabetes complications. Meanwhile, in those people with poor circulation — a common side effect of diabetes — a lack of blood flow and oxygen to hard-to-reach nerves can cause further damage and cell death. The result of this damage includes everything from chronic pain to impaired digestive system, urinary tract, and cardiovascular function. But the most common signs of neuropathy include pain, tingling, and numbness in the extremities. When such symptoms set in, the idea of exercising can become a bit scary. If you find from checking your feet daily that you have a blister or ulcer, be sure to notify your physician to help prevent infections. Both are vital to performing your workouts safely and effectively. For instance, in one study published in September in the Journal of Diabetes and Its Complications , all it took was 10 weeks of exercise to significantly reduce pain and symptoms in men and women with diabetes-related neuropathy. Physical activity is a great way to keep your blood sugar levels in check , improve insulin sensitivity, and reduce inflammation, Machowsky says. Plus, by undoing some of the blood vessel damage that can occur with diabetes, exercise can help increase the flow of blood, oxygen, and other nutrients to nerve cells, further helping to improve neuropathic symptoms. To minimize the risks and amplify the possible rewards of exercising with neuropathy , prioritize these expert-approved workouts:. Aerobic exercise can also help reduce blood sugar and cholesterol levels , according to the American Diabetes Association ADA , which helps to further improve blood flow to your hands and feet, and improve nerve health. To boost your blood flow while preventing cuts, scrapes, and blisters, skip pounding the pavement in favor for gentler, low-impact activities, such as swimming and cycling, Machowsky recommends. Whatever workout you choose, try to perform at least 30 minutes of aerobic exercise five times per week, the ADA recommends. Meanwhile, you can perform a vast array of upper-body exercises, from bicep curls to shoulder presses, while seated on a bench. Patients who underwent an exercise program that targeted these problems achieved significant success. After exercising for 60 minutes twice a week for 12 weeks, these patients improved in all measures. For example, to work on endurance, patients repeatedly sat down and stood back up or climbed stairs. To work on balance, patients walked heel-to-toe or stood on one leg. A 6-week program of stretching, balance, and strengthening exercise focused on the lower limbs also helped patients achieve functional improvements. Alternatively, there is evidence that supports tai chi as an effective form of exercise for improving balance and diabetic neuropathy symptoms. Studies that examined the effects of tai chi in patients with diabetic neuropathy demonstrated significant increases in quality of life and improvements in glucose control, balance, and neuropathic symptoms. Patients in these studies performed tai chi 2 or 3 times per week for 12 weeks. Despite these benefits, patients who suffer from severe foot pain, numbness, or other foot complaints may remain hesitant about exercising. Although previous guidelines advised against weight-bearing physical activity to reduce the risk of ulceration, moderate walking does not increase this risk. In a recent study, patients who followed a week program of aerobic and resistance exercise experienced significant decreases in pain and neuropathic symptoms and increases in cutaneous innervation; these results demonstrate that exercise can solve the very problems that may keep patients from exercising in the first place. Non—weight-bearing exercises may be especially helpful for patients with open foot sores or those unable to tolerate their own weight. Concerns about poor balance and falls with exercise can also be ameliorated by data showing that exercise improves balance and reduces the risk of falls. In accordance with guidelines, 7 patients should seek instruction and supervision from a fitness professional when beginning an exercise program; this ensures safety and may assuage fears. Finally, review routine foot care with patients at each visit and advise them to inspect their feet regularly to detect ulcers, especially after beginning an exercise program. To assist clinicians with exercise prescription, guidelines have been established by the American College of Sports Medicine and the American Diabetes Association that apply generally to patients with diabetes Table 2. Because exercise intensity is more highly correlated with blood glucose control than exercise volume, intensity should be emphasized when constructing an exercise program. Any form of aerobic exercise that involves large muscle groups and causes elevation in heart rate is recommended. Resistance training should accompany aerobic training and should be performed at least 2 days per week at a moderate to vigorous intensity. A minimum of 5 to 10 exercises targeting major muscle groups should be performed in each session, with 3 or 4 sets of 10 to 15 repetitions performed per exercise. Patients should also seek instruction and supervision by a qualified professional when beginning an exercise program. This is particularly important for patients with diabetic neuropathy, because they are at risk for falls. Flexibility training and other modes of exercise that promote balance training, such as yoga or tai chi, should also be undertaken to help reduce the risk of falls; however, this should not replace aerobic or resistance exercise but rather be done in conjunction with them. Volume 53 - Issue 8 - August Copied to clipboard. BENEFITS OF EXERCISE Short- and long-term benefits. HOW TO ADDRESS PATIENT CONCERNS Despite these benefits, patients who suffer from severe foot pain, numbness, or other foot complaints may remain hesitant about exercising. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev. Pasnoor M, Dimachkie MM, Kluding P, Barohn RJ. Diabetic neuropathy part 1. Neurologic Clinics. Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The healthcare costs of diabetic peripheral neuropathy in the US. Diabetes Care. Praet SFE, van Loon LJC. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider. Want to stay signed on? We are unable to switch you to this area of care. Diabetic Neuropathy: Exercising Safely. Skip Navigation. Overview Regular exercise may help manage your diabetes, which can reduce your risk of severe diabetic neuropathy. Try to choose exercises that don't put stress on your feet, such as: Swimming. Seated exercises. Arm and upper-body exercises. Other non-weight-bearing exercises. Related Information Diabetic Neuropathy. Credits Current as of: October 2, Next Section: Related Information ». Previous Section: « Overview. |
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