Exercise and Manual Therapy for Diabetic Peripheral Neuropathy: A Systematic Review

Abstract

(1) Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). Control of hyperglycaemia as well as surgical decompression are effective treatments for these patients. However, surgery is not indicated for all candidates. Manual therapy and physical exercise have been shown to be effective for peripheral neuropathies, and exercise for DM. The aim is to review the effectiveness of manual therapy and/or exercise in patients with DPN. (2) Methods: Randomised controlled clinical trials comparing the effects of manual therapy and/or exercise on pain, function and/or balance were selected. The search strategy was performed in PubMed, PEDro, Scopus, Cochrane and Web of Science databases. The PRISMA statement was followed. (3) Results: A total of 656 articles were registered, and 29 were selected. There was little consensus on DPN criteria selection. Aerobic, strength and balance exercises are beneficial for DPN. Sessions of 30–60 min, three times per week for 8 weeks seems to be the most used dose. Manual therapy is effective in the short term. A combination of both modalities was more beneficial than alone in one study. (4) Conclusions: Exercise and manual therapy are beneficial for patients with DPN. More studies should be carried out for analysing the potential effect of combining manual therapy and exercise.

The Association Between Physical Activity and Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Multicenter Study From Saudi Arabia

“…This study found a significant association between DNS and physical activity, in which the severity of DN decreases as physical activity increases. A recent meta-analysis study that included 29 clinical trials reported that exercise is useful for patients with PDN [7].…”

“…These signs and symptoms worsen at night [4]. It has been established that insulin resistance plays an important role in the development of peripheral neuropathy along with metabolic syndrome [5][6][7]. Previous studies reported that physical activity improved diabetes in general and prevented complications, such as PDN, by enhancing insulin sensitivity and increasing glucose uptake by the cells [6][7][8].…”

“…It has been established that insulin resistance plays an important role in the development of peripheral neuropathy along with metabolic syndrome [5][6][7]. Previous studies reported that physical activity improved diabetes in general and prevented complications, such as PDN, by enhancing insulin sensitivity and increasing glucose uptake by the cells [6][7][8]. In addition, physical activity ameliorates the structure and function of muscles and nerves by renewing small sensory nerve damage [9].…”

“…In addition, physical activity ameliorates the structure and function of muscles and nerves by renewing small sensory nerve damage [9]. Physical activity can prevent DN through a variety of mechanisms, including maintaining healthy blood glucose levels, increasing nerve blood flow, promoting axonal renewing, boosting neurotransmitter concentrations, and Na/K-ATPase, which plays a crucial role in nerve conduction velocity [7]. A recent systematic review reported that physical activity provided symptomatic relief in PDN, and its effects depend on the severity of the disease [8].…”

Complementary Approaches to Retinal Health Focusing on Diabetic Retinopathy

“…ex. Willd., Lavandula angustifolia L., Eucalyptus globulus Labyll., and Matricaria recutita Rauschert, have been shown to relieve neuropathic pain [107,108]. In India, Ayurvedic oil reflexology foot massages (Padabhyanga) have a long tradition of being used as a supplement to ophthalmic therapies, although thier effectiveness has not been proven through evidence-based research [109].…”