Safety of aerobic exercise in people with diabetic peripheral neuropathy: single-group clinical trial

• Published in: Physical therapy Vol. 95; no. 2; pp. 223 - 234
• Main Authors: Kluding, Patricia M, Pasnoor, Mamatha, Singh, Rupali, D'Silva, Linda J, Yoo, Min, Billinger, Sandra A, LeMaster, Joseph W, Dimachkie, Mazen M, Herbelin, Laura, Wright, Douglas E
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-02-2015; American Physical Therapy Association
• Subjects: Adult; Aerobic exercises; Biomarkers - blood; Body Composition; Brachial Artery - physiology; Care and treatment; Causes of; Clinical trials; Complications and side effects; Consent; Diabetes; Diabetic Neuropathies - physiopathology; Diabetic Neuropathies - rehabilitation; Exercise; Fatigue; Fatigue - physiopathology; Female; Health aspects; Humans; Intervention; Male; Middle Aged; Older people; Oxygen Consumption - physiology; Pain; Physical fitness; Polyneuropathies; Registries; Research Reports; Science; Sedentary Lifestyle; Sleep - physiology; Studies; Surveys and Questionnaires; Type 2 diabetes; United States
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20140108

Exercise is recommended for people with diabetes, but little is known about exercise in people with diabetic peripheral neuropathy (DPN).
The primary purpose of this preliminary study was to examine adverse events (AEs) during moderate-intensity, supervised aerobic exercise in people with DPN. The secondary purpose was to examine changes in fatigue, aerobic fitness, and other outcomes after intervention.
This was a single-group preliminary study.
The setting was an academic medical center.
Participants were 18 people who were sedentary and had type 2 diabetes and peripheral neuropathy (mean age=58.1 years, SD=5).
The intervention was a supervised 16-week aerobic exercise program (3 times per week at 50% to >70% oxygen uptake reserve).
Adverse events were categorized as related or unrelated to the study, anticipated or unanticipated, and serious or not serious. Outcomes included fatigue (Multidimensional Fatigue Inventory), cardiovascular fitness (peak oxygen uptake), body composition (dual-energy x-ray absorptiometry), sleep quality, plasma metabolic markers, and peripheral vascular function.
During the study, 57 nonserious AEs occurred. Improvements were found in general fatigue (mean change=-3.5; 95% confidence interval [95% CI]=-1.3, -5.3), physical fatigue (mean change=-3.1; 95% CI=-1.2, -5.0), peak oxygen uptake (mean change=1.1 mL·kg(-1)·min(-1); 95% CI=0.2, 1.9), total body fat (mean change=-1%; 95% CI=-0.3, -1.7), fat mass (mean change=-1,780 g; 95% CI=-616.2, -2,938.7), and peripheral blood flow (mean change=2.27%; 95% CI=0.6, 4.0).
This was a small-scale, uncontrolled study. A future randomized controlled trial is needed to fully assess the effects of exercise on the outcomes.
This study provides new support for supervised aerobic exercise in people with DPN. However, it is important for physical therapists to carefully prescribe initial exercise intensity and provide close monitoring and education to address the anticipated AEs as people who are sedentary and have DPN begin an exercise program.