Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy

Handsaker, Joseph C.; Brown, Steven J; Petrović, Miloš; Bowling, Frank L.; Rajbhandari, Satyan; Marple‐Horvat, D. E.; Boulton, Andrew J.M.

doi:10.1016/j.jdiacomp.2019.07.001

Cited by 6 publications

(13 citation statements)

References 26 publications

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“…The above studies suggest that aerobic exercise in particular can improve the symptoms of DPN as well as reduce pain, [10] improve gait accuracy [11] and lower limb strength [12] and generally affect the quality of daily lives of patients [1] . There is also evidence that exercise in diabetic patients may either prevent or delay the onset of peripheral neuropathy [1] .…”

Section: Discussionmentioning

confidence: 94%

“…In reference to change, the combined exercise program caused small adjustments, which can prove beneficial due to DPN being a progressive condition. In the study of Handsacer et al, [11] the authors report that patients with diabetes and DPN place their feet less accurately while walking, which may contribute to an increased risk of falling. In a clinical study, they examined the efficacy of a combined exercise program in the gait accuracy of patients with diabetes and DPN.…”

Section: Literature Reviewmentioning

confidence: 99%

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The effect of therapeutic exercise on the treatment of symptoms and the delay of foot degeneration in patients with diabetic peripheral neuropathy: An evidenced-based physiotherapy review

Aronis¹,

Iakovidis²,

Lytras³

et al. 2021

Int. J. Adv. Res. Med.

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Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes. It presents with a symmetrical peripheral degeneration of peripheral nerves. Pain is a major complaint in about 1/3 of people with DPN and DPN-related sensory loss contributes to impaired balance, gait problems, and increased sensitivity to injury. Recent research has shown that a combination of aerobic exercise and resistance training improves fitness, glycemic control and insulin sensitivity in older adults and people with diabetes. The aim of this review was to investigate the effect of exercise on improving the symptoms of patients with DPN and delaying the onset of foot degeneration. The PubMed and Science Direct databases were searched with the following keywords: Diabetic neuropathy, therapeutic exercise, physiotherapy, rehabilitation. The results of this review suggest that exercise can improve the symptoms of DPN by reducing pain as well as improving gait accuracy, enhancing lower limb strength and improving the quality of daily life of patients. Aerobic exercise seems to be the type of training that provides the most benefits. There is also evidence that exercise in diabetic patients may either prevent or delay the onset of peripheral neuropathy. However, further clinical trials are required.

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Section: Discussionmentioning

confidence: 94%

Section: Literature Reviewmentioning

confidence: 99%

The effect of therapeutic exercise on the treatment of symptoms and the delay of foot degeneration in patients with diabetic peripheral neuropathy: An evidenced-based physiotherapy review

Aronis¹,

Iakovidis²,

Lytras³

et al. 2021

Int. J. Adv. Res. Med.

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“…Of the five RCTs, one article ( Khan et al, 2022 ) scored 23 points (good). For the remaining four RCTs ( Lindeman et al, 1995 ; Handsaker et al, 2016 ; Handsaker et al, 2019 ; Seyedizadeh et al, 2020 ) the score ranged from 9 to 15 points (fair-poor). The two case-series ( Lindberg et al, 2020 ; Hackett et al, 2021 ) and one cross-over-trial ( Markvardsen et al, 2018 ) were also assessed using Downs and Blacks checklist, with scores ranging from 13 to 18 points (fair-poor).…”

Section: Resultsmentioning

confidence: 99%

Effect of strength training on functional outcomes and strength in patients with polyneuropathy: A scoping review

et al. 2023

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Introduction: Polyneuropathy (PNP) is a chronic progressive disease that over time can lead to damage of sensory, motor and/or autonomic peripheral nerves. Symptoms vary from predominantly sensory to severe sensorimotor affection both proximally and distally. This can result in considerable functional impairments that affect activities of daily living. In other neurological patients, strength training has shown to improve strength and functional outcomes. Since medical treatment only exists for very few percentages of the underlying causes it is obvious to consider if strength training could be a potential treatment for functional impairments. To date little is known on the effect of strength training in patients with PNP.Aim: The aim of this scoping review was to summarize research on strength training and outcomes on physical function in patients with PNP.Methods: We systematically searched five data bases; Pubmed, Embase, Cinahl, Cochrane library and Web of science. Studies on strength training (load ≥70% of 1RM) in patients with PNP were included. The search was carried out in November 2022.Results: 362 articles were screened by title and abstract, 101 articles were full text screened. Eight studies were included. Patients with Charcot-Marie-Tooth (CMT), chronic inflammatory polyneuropathy (CIDP) and diabetic polyneuropathy (DPN) were represented in the studies (five RCTs, two case-series, and one cross-over trial). The methodological quality ranged from fair-poor in seven studies, one study reached good quality. Results from the studies indicated that strength training in CMT, CIDP and DPN may improve strength. However, various outcomes were used to evaluate strength training, so direct comparisons were difficult.Discussion: In this scoping review we summarized research on strength training and outcomes evaluated in interventions in patients with PNP. Eight studies were included, they indicated that strength training may be beneficial for patients with PNP. However, due to low methodological strength of most studies a recommendation for patients with PNP cannot be made. Thus, the low number of studies with relatively low quality, where various functional outcomes were used, underscores the importance of future studies to evaluate the effect of strength training on relevant functional outcomes and strength in patients with PNP.

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“…Falls prevention strategies have primarily focussed on the motor system component through increasing the strength of lower limb muscles [ 68 , 82 , 83 ]. A recent study has targeted both motor and sensory components through the combination of exercise and visual gaze training [ 84 ]. This is based on the concept that visual gaze behaviour directs movement and therefore improving eye movements can help to improve gait and reduce the risk of falls [ 68 , 84 ].…”

Section: Diabetic Peripheral Neuropathy and Falls Riskmentioning

confidence: 99%

“…A recent study has targeted both motor and sensory components through the combination of exercise and visual gaze training [ 84 ]. This is based on the concept that visual gaze behaviour directs movement and therefore improving eye movements can help to improve gait and reduce the risk of falls [ 68 , 84 ]. Given the important role of insensate feet due to DPN in falls risk, future falls prevention strategies might seek to explore interventions that can help enhance detection of foot–ground contact during walking.…”

Section: Diabetic Peripheral Neuropathy and Falls Riskmentioning

confidence: 99%

Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

Reeves

Orlando

2021

Medicina

Self Cite

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Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.

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Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy

Cited by 6 publications

References 26 publications

The effect of therapeutic exercise on the treatment of symptoms and the delay of foot degeneration in patients with diabetic peripheral neuropathy: An evidenced-based physiotherapy review

The effect of therapeutic exercise on the treatment of symptoms and the delay of foot degeneration in patients with diabetic peripheral neuropathy: An evidenced-based physiotherapy review

Effect of strength training on functional outcomes and strength in patients with polyneuropathy: A scoping review

Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

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