Does walking make neuropathy worse


Exercises for Peripheral Neuropathy

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

Aerobic exercises move large muscles and cause you to breathe deeply. This increases blood flow and releases endorphins that act as the body’s natural painkillers.

Best practices for aerobic exercising include routine activity for about 30 minutes a day, at least three days a week. If you’re just starting out, try exercising for 10 minutes a day to start.

Some examples of aerobic exercises are:

  • brisk walking
  • swimming
  • bicycling

Balance training

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.

Beginning balance training exercises include leg and calf raises.

Side leg raise

  1. Using a chair or counter, steady your balance with one hand.
  2. Stand straight with feet slightly apart.
  3. Slowly lift one leg to the side and hold for 5–10 seconds.
  4. Lower your leg at the same pace.
  5. Repeat with the other leg.
  6. As you improve balance, try this exercise without holding onto the counter.

Calf raise

  1. Using a chair or counter, steady your balance.
  2. Lift the heels of both feet off the ground so you’re standing on your toes.
  3. Slowly lower yourself down.
  4. Repeat for 10–15 reps.

Stretching exercises

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.

Calf stretch

  1. Place one leg behind you with your toe pointing forward.
  2. Take a step forward with the opposite foot and slightly bend the knee.
  3. Lean forward with the front leg while keeping the heel on your back leg planted on the floor.
  4. Hold this stretch for 15 seconds.
  5. Repeat three times per leg.

Seated hamstring stretch

  1. Sit on the edge of a chair.
  2. Extend one leg in front of you with your toe pointed upward.
  3. Bend the opposite knee with your foot flat on the floor.
  4. Position your chest over your straight leg, and straighten your back until you feel a muscle stretch.
  5. Hold this position for 15 – 20 seconds.
  6. Repeat three times per leg.

Can Exercise Help Peripheral Neuropathy?

The right exercises can be a catalyst for regaining motor control in clients sidelined with neuropathic pain. Negotiating with neuropathy when personal training has its challenges, but you can make movement possible again.

Peripheral neuropathy is a widespread and potentially incapacitating pathological condition that encompasses over 100 different forms of nerve damage. An estimated 20 million people in the United States suffer from its deleterious effects: weakness, numbness, and pain, most commonly in the hands and feet.

Menacing Manifestation

Risk factors for developing peripheral neuropathy include the following:

  • Diabetes mellitus/poorly controlled blood sugar levels
  • Alcohol abuse
  • Vitamin B deficiency
  • Infections such as Lyme disease, shingles, hepatitis C and HIV
  • Autoimmune diseases such as rheumatoid arthritis and lupus
  • Kidney/liver/thyroid disorders
  • Overexposure to toxins
  • Repetitive motion tasks
  • Family history of neuropathy

Although symptoms will vary from patient to patient, individuals living with peripheral neuropathy generally exhibit a few classic characteristics:

  • Gradual onset of numbness, prickling or tingling in hands/feet, occasionally spreading into arms/legs
  • Sharp/ throbbing/ freezing/ burning pain
  • Extreme sensitivity to touch
  • Lack of coordination/clumsiness
  • Muscle weakness or paralysis
  • Loss of balance
  • Dizziness upon standing
  • Sexual dysfunction

Often worse at night, neuropathic pain is further exacerbated by disruptive sleep patterns. Coupled with an over-sensitization of pain receptors in the skin, patients often report feeling severe pain from seemingly innocuous stimuli, such as bed sheets draped lightly over the body.

How Neuropathy Develops

The human body’s peripheral nervous system sends information from the brain and spinal cord to the rest of the body, most notably to the muscles in an effort to generate movement.

Peripheral nerves also send sensory messages back to the central nervous system. Similar to static on a telephone line, peripheral neuropathy distorts and may even interrupt this process.

Large sensory fibers register vibration and positional awareness. Damage to these fibers results in a general decrease of sensation, which patients liken to wearing gloves and stockings, as well as diminished reflex response.

Positional awareness challenges often render complex movements like walking, fastening buttons, or maintaining balance frustrating and difficult.

Small sensory fibers transmit pain and temperature sensations. Patients suffering from damage in this area of the nervous system may fail to perceive an injury such as a cut or an infected wound.

Others may not detect pain that warns of impending heart attack or other acute conditions. Loss of such sensation is a particularly serious problem for individuals with diabetes, contributing to the high rate of leg/foot amputations among this population.

Autonomic nerve damage symptoms are diverse since the parasympathetic and sympathetic nerves control nearly every organ in the body. Commonly experienced problems include an inability to sweat normally, which may lead to heat intolerance; a loss of bladder control; and an inability to control muscles that expand or contract blood vessels as they strive to regulate blood pressure.

A drop in blood pressure upon rising (a condition known as postural or orthostatic hypotension) may result in dizziness or fainting.

Can Exercise Help or Hinder?

The adoption of healthy lifestyle habits can reduce the effects of peripheral neuropathy. A balanced diet, smoking cessation, and regular exercise are all helpful.

Since many underlying causes of peripheral neuropathy cannot be fully treated, it is critical to understand that routine exercise may not only help prevent some of those causes but has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.

Paying close attention to foot care and wounds, especially when pain sensation has been greatly diminished, can greatly improve one’s quality of life. Such changes often create conditions that may even encourage nerve regeneration.

Cultivating Cardio/Strength/Balance

Research has shown that strengthening exercises for peripheral neuropathy lead to a moderate improvement in muscle mass along with a decrease in atrophy. In addition, properly chosen exercises may reduce cramping and can help control blood sugar levels. A comprehensive exercise routine should include four kinds of activities: aerobic, flexibility, balance and strength training.

In addition to what we can offer clients through personal training, physical and occupational therapy can help to improve balance and gait, fine motor skills, dexterity, and coordination.

Balance/ proprioceptive exercises challenge the receptors in the toes, ankle, and feet to send signals back to the spine. By encouraging the body to pay more attention to these receptors, tripping and falling will dissipate over time.

The more information the body receives from the joints at receptors, the more it becomes accustomed to these signals, and an improved stabilizing response develops.

Some of the activities that can be encouraged for those suffering from neuropathy include stationary cycling, semi-recumbent cycling, and water exercises. Water activities and semi-recumbent cycling are especially beneficial for those with orthostatic hypotension, since the pressure of water surrounding the body as well as the semi-recumbent posture help to maintain blood pressure.

Chair exercises are also beneficial: seated ankle circles performed while extending 1 leg at a time, and performing circles both clockwise and counter-clockwise, are easily tolerated by even the weakest of clients.

Researchers note that yoga is also helpful in reducing stress levels, blood pressure, and inflammation, all of which can affect the progression of diabetes-related neuropathy. Although yoga might feel less intense compared with cycling or strength training, it still gets the heart pumping and can facilitate the building of lean muscle mass.

Such exercises increase the supply of blood, oxygen, and glucose going to the cells’ mitochondria, allowing the production of energy in a more efficient manner. Facilitating blood flow to peripheral nerves may result in fewer neuropathic symptoms, increased strength, and improved balance.


Patients with clinically significant autonomic neuropathy typically demonstrate a lower exercise tolerance, resulting in large part from the reduced cardiac output and faulty redistribution of blood flow to the muscles.

Consequently, the duration of exercise in these clients must be determined individually. A workout may initially be tolerated for less than 30 minutes; advise clients not to increase the intensity of the exercise to compensate for a shorter session. Over time, comfort levels will allow for longer workouts.

The Role of Cancer

Chemotherapy-induced peripheral neuropathy (CIPN) is an under-addressed problem in the field of oncology. If nerves in the hands are affected, clients may have difficulty grasping dumbbells. Tubing or resistance bands with handles may be a safer, more effective option.

Peripheral neuropathy may develop at any phase of one’s cancer journey. A new study revealed that 50% of women who have undergone chemotherapy report symptoms of peripheral neuropathy long after their treatment has ended, and often present with a significantly higher incidence of altered walking patterns.

“Women with peripheral neuropathy reported significantly lower physical functioning, significantly more difficulty with tasks of daily living, and increased fall risks” says the study’s lead author, Kerri Winters-Stone.

Understanding the process and side effects of peripheral neuropathy can allow us to better serve our clients. We can offer them the chance to regain movement that they may have thought to be permanently lost. Together you can face this challenge head-on and witness the magnificent life-affirming transition.

Have you worked with a client dealing with chemotherapy-induced peripheral neuropathy?

Share your ideas with us on our Facebook Community Group.

A Healthy Body Leads to Healthy Nerves

Hurting nerves don’t exactly encourage exercise, do they? While peripheral neuropathy might not seem like the best time to get up and work out, this couldn’t be further from the truth.

You’re in pain. Peripheral neuropathy has been taking its toll on your nervous system. Depending on the specific type of neuropathy that you find yourself dealing with, your symptom set might be a little different. Either way, your limbs are likely sore and aching to at least some degree.

Exercise is not going to seem like a good idea, in other words.

But for those of us suffering from the oftentimes painful symptoms of peripheral neuropathy, this idea could not possibly be further from the truth. When it comes down to it, exercise is a damaged nerve ending’s best friend!

There are, as it turns out, a wide variety of ways to naturally boost your body’s defense systems, helping to beat back the damage of peripheral neuropathy before it gets too late. Exercise just so happens to be not only one of the most effective, but also one of the easiest and most universal methods for fighting peripheral neuropathy.

By this, what’s meant is that no matter what the specifics of your situation may be, exercise will help you to improve the health of not just your nerves, but of the rest of your body, as well.

So there’s really just no excuse! Exercise is only going to improve your condition, on both micro and macro levels. Let’s take a closer look at exactly why.

Your Nerves Love Blood (And Your Blood Loves Them Back)

In more ways than just one, your blood is kind of like a super-useful magic potion that you have flowing all throughout your body. It does so many incredible things that help your body to operate as it’s supposed to, and nourishing that nervous system of yours is a real big one of them.

Your blood functions as the delivery system for important compounds, growth factors, and nutrients that all work together to make sure your nerve endings are functioning properly at all times. In fact, the farther your nerve endings get away from the central parts of your body (where the central nerve bodies live), the more important the blood’s role becomes in keeping them healthy.

The central nerve bodies have a hard time reaching out to the nerve endings all the way down in the ends of the hands and feet with reparative nutrients, so the blood has to help out in a pretty big way. This, as it turns out, is why there is such a direct correlation between issues that impact the blood — like diabetes — and peripheral neuropathy. When your blood composition is less than ideal, the results are toxic for your nerve endings and wind up killing them off.

So how does exercise come into play?

When peripheral neuropathy is at play, this added blood flow is highly beneficial to your damaged nerve endings. It can go a long way towards stopping the damage that has begun to set in, and can even help to heal it, in many cases.

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Exercise: The Great Blood-Mover

Simply put, getting in a good round of exercise goes a very long way towards pushing all that life-giving blood around your body. A good workout does wonders for your circulation, which in turn gets more blood moving out to those extremities.

As a result, your nerve endings get to hang out with more of those nutrients that your blood carries around the body.

Stop Secondary Symptoms

One of the most troublesome things about peripheral neuropathy is that it very often leads to what can be known as “secondary issues.” This basically refers to the fact that when your nervous system is damaged, the effects don’t really stop there.

Depending on what type of peripheral neuropathy you might be experiencing, the symptoms will be different and can impact your body in a number of different ways. Sometimes, these impacts lead to secondary problems.

One example can be muscle atrophy, which happens when peripheral neuropathy is specifically impacting the motor neurons. As your muscles lose their ability to properly contract, they can start to waste away. Not only does their full use help to keep them strong, but the nerves that enable that use also deliver growth factors and hormones to the muscles.

Regular exercise directly negates this, however. Not only does it ensure that your muscles are getting regular use, but it helps to keep them pumped full of healthy vitamins and nutrients (thanks to that increased blood flow).

Another secondary problem that can come from peripheral neuropathy involves an increased risk for trips and falls. As muscle coordination weakens, the risk for injury can increase.

Regular exercise, though, helps to keep your body strong, improving your balance and coordination in concrete ways by building muscle strength. This means that you’ll be able to avoid trips and falls thanks to improved core power and better overall muscle coordination.

Happy Mind, Happy Body

Another great benefit that comes from regular exercise involves the release of endorphins into your body. These are, in effect, your happy hormones. You want more of these. And exercising is a surefire way to make sure that you’re enjoying a very steady diet of those happy little guys.

This is doubly true for those of us dealing with peripheral neuropathy. Nerve damage can be a very constant and troubling situation. After a while, all that chronic pain and consistent irritation can start to have a serious impact on one’s quality of life. When this is the case, a little bit of a mental pick-me-up can go a really long way. Working out not only helps to heal your nerves and strengthen your muscles, but it also improves your state of mind, as well.

A healthy dose of endorphins helps when you’re dealing with the near-constant aches and pains of peripheral neuropathy.

Designing Your Weekly Workouts

By now, you’re probably convinced: Exercise is good. Peripheral neuropathy is bad. It’s not complicated.

But, at the very same time, if you are dealing with the symptoms of damage to your nervous system, your motivation to get up and get moving isn’t going to be at an all-time high. In fact, many individuals with peripheral neuropathy might inadvertently wind up worsening their situation through inactivity.

While it might seem like staying still is the best way to mitigate the pain caused by peripheral nerve damage, the opposite is actually true.

But, it is also important to recognize that exercise must be undertaken cautiously when peripheral neuropathy is in play. You don’t want to inadvertently injure yourself further, which (due to things like impaired coordination and/or muscle control), can certainly be a possibility.

Household Chores? They Totally Count!

If you’re wondering whether or not all the stuff you have to get done around the house can count as exercise, the answer is yes! It can!

The rule of thumb is that you want to elevate your heart rate for 20 minutes per day, five days a week.

Do those chores get your breathing up for at least 20 minutes or more? Well then, congratulations! You did an exercise.

All you really need to do is ensure that you get your heart rate raised, your blood pumping, and your oxygen flowing. Beyond that, you’re always the best judge when it comes to how hard and how far you can push yourself.

Exercise with Caution

Good rules of thumb? Don’t push yourself harder than feels right. And talk to your doctor.

Having a handle on how far your particular case of peripheral neuropathy has progressed is going to go a long way towards determining which exercises are safe for you and which ones you might want to work your way up to.

In some cases, neuropathy specifically targets that autonomic nervous system. This means that your body’s involuntary functions will be impaired, so you must be extra vigilant as you work out. Monitoring things like your blood pressure, heart rate, and breathing become extra important, as you must be sure to compensate for your body’s elevated activity levels if it can’t naturally do so itself.

When peripheral neuropathy is particularly present in the lower limbs, you’re going to want to avoid high-impact exercises and activities. There are quite a few reasons for this.

Peripheral neuropathy in the lower limbs has a tendency to weaken muscle control. It can also lead to a loss of feeling, in many cases. Both of these conditions can make physical activity a lot more dangerous. Not only are you at an increased risk of falls, but you can potentially injure yourself in other ways, too.

Joint misalignment, stress fractures, and other problems become a lot riskier when your nerves are impaired in the lower extremities, so it’s smart to avoid higher-impact workouts like running and swap them out with lower-impact activities like rowing or swimming.

Integrate the Day, Your Way!

When it comes to getting regular exercise, time can often wind up being the big show-stopper. Think about it — how many things can you list, just off the top of your head, that you’d love to be doing regularly…if only you had the time?

But when it comes to peripheral neuropathy, free time is not really something that one has the luxury of waiting around for. Avoiding exercise is only going to prolong the healing process, so even those of us with busy schedules will want to make sure to find ways to integrate exercise into our daily routines.

It’s not nearly as impossible as it sounds!

Maybe you can take a look around the house and find some things that need accomplishing, focusing on tasks that might lend themselves to a bit of vigorous exercise. Maybe a 20-minute stroll around the neighborhood is all you can handle. Even parking farther away from the office than you normally would and giving yourself a longer walk is a great way to add some physical exertion to your day!

No matter what, managing to work in a bit of exercise to your daily routine is going to have a positive impact on your nerves. Especially if they’ve been fending off the damage done by peripheral neuropathy.

Not only will you be giving yourself a pretty significant mood boost — thanks to regular exposure to all those “happy hormone” endorphins — but you’ll be actively encouraging the regeneration of your damaged nervous system, as well.

Getting a bit of exercise every day isn’t impossible at all, but its benefits are many. The more regularly you work out, the more actively you’re working against the onset of peripheral neuropathy.

So get to it!

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Peripheral Neuropathy Exercise Precautions

  • 10-07-2019
  • By Rohit Jain

Peripheral neuropathy is a disease related to nerves. Peripheral nerves get damaged due to various underlying diseases such as diabetes. Peripheral nerves primarily control the muscles. Any disease in these nerves may lead to weak muscles. Other symptoms of peripheral neuropathy include numbness, pricking sensation, pain, and improper coordination and balance. Exercises are advised to the patients to strengthen their muscles and improve balance. However, precautions are necessary while performing exercises to reduce the risk of injury or worsening of the condition. Following are some peripheral neuropathy exercise precautions you must follow

Peripheral neuropathy is the condition characterized by pain, muscle weakness, poor balance, numbness and tickling sensation and sensitivity to touch. Although various exercises, including peripheral neuropathy rehabilitation exercises, are recommended to the patients, precautions should be taken while exercising. Doing exercise without the guidance of an expert may do more harm than good. Some of the peripheral neuropathy exercise precautions to be followed by patients, while exercising are:

  • Do not perform heavy exercises right from the beginning. Gradually increase the intensity and frequency of exercise to avoid any complications.
  • Walking should be preferred over jogging due to the latter’s increased pressure effect on the foot.
  • In the case of diabetic neuropathy, the patient should always inspect the feet for any injury after exercise.
  • Avoid doing exercise if you have a foot injury or back inflammation as it may further worsen the condition.
  • Always perform exercise under the advice and guidance of an expert.
  • Various exercises are recommended for peripheral neuropathy but you should opt for that particular exercise that best suits your condition.
  • Always wear comfortable footwear while doing exercise.
  • Avoid socks that cause friction and does not help absorbing moisture, as it may lead to tissue injury.

Exercises Recommended In Peripheral Neuropathy

Exercising with peripheral neuropathy helps reduce pain and strengthens muscles. Research has proven that exercise plays an important role in improving muscle strength and managing fatigue, two commonly found symptoms in patients with peripheral neuropathy. Exercise also helps improve blood circulation to the affected nerve, thereby enhances the process of healing and revitalization. Peripheral neuropathy exercises are broadly divided into four categories :

a) Aerobic Exercise

Neuropathic pain requires frequent use of pain killers. Taking pain killers for a longer period may cause side effects. To reduce the frequency of pain killers, it is essential that the secretion of the body’s own natural painkillers such as endorphins should be released. One of the primary aims of aerobic exercise is to increase the secretion of endorphins. Aerobic exercise increases the movement of large muscles and helps to breathe with full capacity. This improves blood circulation and increases endorphin secretion. Initially, exercise for 10 minutes, three days a week. Gradually increase the time of exercise to 30 minutes with a similar frequency of three days a week. Aerobic exercise includes swimming, stationary bicycle indoor and brisk walking (outside or on a treadmill).

b) Balance Training

Peripheral neuropathy may lead to stiff muscles because of poor nerve conduction. In such a condition, the risk of falling is significantly increased. Balance training improves balance by reducing stiffness of muscles and joints and also helps in maintain sufficient balance. Side leg raise exercise is done by raising a leg on one side while balancing the body with the help of a chair. Similarly, the steps are to be repeated with another leg. The patient should try to hold their body on one leg for 5-10 seconds. Once the patient gets successful in balancing with the support of the chair, he should try to perform without a chair. Other balancing exercises include hip extension, hip flexion, and calf raises exercise.

c) Stretching Exercise

Stretching exercises improve muscular and joint flexibility. Doing these exercises on a routine basis reduces the risk of injury. These exercises are generally done before aerobic exercises to warm up the body. Various flexibility exercises include seated hamstring stretch, calf stretch, and plantar fascia stretch. In the plantar fascia stretch, the patient stands by its face towards the door frame. The heel is placed at the closest distance from the door frame. Patient leans forward and the toe moves up on the frame while the heels slide back. The knee can also be bent on the door frame to increase the stretch.

d) Strength Training Exercise

Strength training exercises enhances the strength of muscles and helps to perform other exercises with improved strength. Strength training exercises recommended in peripheral neuropathy are Seated Dorsiflexion, Chair Squat, and Kitchen Counter Calf Raises. Seated dorsiflexion is done for peripheral neuropathy in feet. In seated dorsiflexion, the patient is seated on the front part of the chair. The feet are placed flat on the floor. The patient is advised to lift the toe and ankle as high as possible. Ankles and toes are slowly let down.


Exercising helps to increases muscle strength and improves balance in patients with peripheral neuropathy. It also helps in reducing further injuries during routine activities by enhancing muscular and joint flexibility. Exercises such as stretching, balancing and aerobic are done after consulting with peripheral neuropathy doctor. However, such exercises should be done with caution to avoid any injury.


Rohit Jain

Exercise in individuals with diabetic neuropathy

Patients with diabetes and peripheral neuropathy can benefit from participation in mild to moderate aerobic, resistance, and balance activities. But they must take precautions to ensure exercise is safe as well as effective, particularly with regard to the risk of foot ulceration.

By Steven Morrison, PhD, and Sheri R. Colberg, PhD

Throbbing pain in the feet, a burning sensation in the hands, and a loss of sensation in the toes or fingers all can be symptoms of peripheral neuropathy, a condition that develops frequently as a long-term complication of diabetes and is caused by damage to the peripheral nerves. Peripheral pain or loss of sensation in the feet or hands is common in individuals with both types of diabetes and can occur in the absence of diabetes.1 The prevalence of neuropathy in people with diabetes is staggering, and as many as 60% to 70% of adults with diabetes exhibit signs of significant damage to their peripheral nerves.2 The most common form of peripheral neuropathy, distal symmetrical polyneuropathy, usually involves both small and large diameter nerve fibers and typically becomes symptomatic after a patient experiences many years of poorly controlled diabetes. Alternatively, it may even develop shortly after the diagnosis of type 2 diabetes if elevated blood glucose levels went undetected for years prior to diagnosis.3

Neuropathy and physical function

Peripheral neuropathy can cause problems with physical function for many reasons. While a loss of peripheral sensation is not by itself life threatening, the physical consequences of this damage can be quite profound. Sensory information about the body and from the environment are used in a variety of ways, allowing individuals to gain information about texture and temperature from objects we hold or touch, giving feedback (ie, pain and burning) when there is injury or damage to a body part, and also providing awareness of where the limbs and body are in space (ie, proprioception).

When the transmission of these different forms of sensory information is impaired, a person may have difficulty with a number of everyday tasks. For example, he or she may have difficulty holding a cup of coffee, lifting or carrying heavy objects, and judging the distance between obstacles when walking, which increases the likelihood of tripping and falling.

Alterations in temperature, pain perception, and impaired position sense also frequently lead to a loss of balance and postural control,4,5 especially in dimly lit conditions and when the eyes are closed. People with diminished sensation also may not experience the normal warning signs that indicate an injury to the feet or hands has occurred. As a result, a blister or repeated trauma may go unnoticed. Over time, painless injuries can lead to undetected ulcers, gangrene, and lower extremity amputations.6

A decline in nerve function can also lead to other profound changes, such as slower reactions and reflexes, a feeling of light-headedness or dizziness, general muscle weakness, tiredness or fatigue, and changes in walking ability and balance control.3,4,7 Limb weakness may result in difficulty climbing and descending stairs, getting up from a seated or supine position, holding objects, and raising the arms above the shoulders. The combination of slower reactions and muscle weakness may lead to an inability to catch oneself when tripped and so lead to more frequent falls.8,9 In the hands, loss of sensation can lead to impaired fine hand coordination, grasping, and force control10-12 —all of which can translate to difficulty with everyday tasks like opening jars, using utensils for eating, or turning keys.

Table 1 lists some of the more common symptoms associated with peripheral neuropathy, most of which can, in many cases, lead to a decreased quality of life for the person experiencing them.

How can exercise help?

For persons with diabetes who exhibit a significant decline in sensory nerve function, the ultimate goal is to find an effective treatment that will reverse or prevent further peripheral nerve damage. Exercise is one intervention often prescribed as a somewhat effective treatment strategy for persons with nerve damage related to neuropathy. It is well known that physical activity per se is useful for all individuals, given that its benefits are widespread throughout the body, affecting all components of a person’s physiology, from cardiovascular function to respiratory, endocrine, and neuromuscular systems. This is particularly true for persons with diabetic peripheral neuropathy, in whom research has shown that maintaining a mild to moderate exercise training regimen can lead to improved sensory responses in the legs, and may help prevent the onset of peripheral neuropathy.13

Some researchers have speculated that the benefits for exercise may extend to the nerve fibers themselves, with a recent report stating that increased physical activity in patients with diabetic peripheral neuropathy can lead to increased nerve fiber branching and produce structural improvements in neural function.14 If nothing else, exercise participation can prevent worsening of the muscle strength and flexibility losses commonly experienced by those with both small and large nerve fiber damage.3 Thus, in addition to the more general improvements seen in physiological function, exercise has the potential to induce structural changes in the nervous system, which could also translate to functional benefits for everyday activities.

For older adults, neuropathy can lead to dramatic declines in their ability to maintain an optimal level of balance, leading to changes in how well they are able to perform many locomotory activities of daily living, such as walking, standing up from a seated position, and climbing stairs. Persons with neuropathy tend to walk at a slower pace, taking shorter steps with a wider stance compared with healthy persons of a similar age.5,15,16 It seems reasonable to assume that these adaptive responses are related to diminished balance control, perceptions of increased risk of falling, or both. Individuals who have compromised balance or walking ability or who have a previous history of falling may also develop a “fear of falling”—a term used to describe an individual’s heightened perception of threats to their postural control when they move.17

Currently, it is estimated that close to 13 million (36%) of American adults older than 65 years are moderately fearful of suffering a fall.18 An unfortunate consequence of any decrease in balance and walking ability coupled with a fear of falling is the increased likelihood of suffering a fall in the future,19, 20 which can lead to further injury and curtailment of physical activity.

Fortunately, research suggests that exercise and training interventions for these individuals have some significant benefits. General improvements in overall falls risk, better balance and posture, and improved speed of reactions and walking function have all been reported following implementation of exercise and training programs for older adults with type 2 diabetes.8,9,21,22

Some of the benefits of low-impact balance exercise can be seen with very little training. When both healthy older persons and older adults with type 2 diabetes and mild to moderate peripheral neuropathy engaged in resistance and balance training done thrice-weekly for only six weeks, both groups showed improvements in balance, speed of reaction time, and falls risk, along with improved postural dynamics, illustrating that this intervention can lead to reasonably rapid improvements in function.8,9 Other research has shown that six months of weekly tai chi training can improve plantar sensation and balance in both healthy elderly adults and elderly adults with diabetes and large plantar sensation losses.23

Together, these results demonstrate that structured exercise can have widespread positive effects on physiological function for individuals with neuropathy. Thus, while the use of strength and balance training for older healthy adults at risk for falls has been a common practice, the implementation of similar training interventions for those older people with peripheral neuropathy can also have profound benefits.24 This approach has recently been endorsed by the American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA), which both recommended the use of strength and balance training for persons with neuropathy.25

Safety concerns and precautions

Engaging in weight-bearing physical activities can, unfortunately, be a double-edged sword for the person with peripheral neuropathy, since doing so may increase the risk of falls and foot problems, such as ulcers. Consequently, the general recommendation is that walking and many other locomotor activities should not be prescribed in isolation without considering the increased risk of plantar injury. Ideally, walking and balance exercises should be supplemented by partial or nonweight-bearing exercises to improve physical fitness in populations with diabetes that have peripheral neuropathy or are at high risk of developing the condition.26

Safety must be the prime consideration when recommending exercise to anyone with peripheral neuropathy. A series of specific recommendations for exercise for persons with peripheral neuropathy are shown in Table 2. Of importance is the inclusion of range-of-motion exercises, strengthening and balance activities, and a variety of other exercises that include walking and some optional lower impact activities such as cycling, swimming, other aquatic exercises, and chair exercises. In general, an individual with diabetic peripheral neuropathy and an unhealed foot ulcer should avoid or limit activities requiring significant weight bearing; however, such activities do not necessarily increase the risk of reulceration after complete healing.27,28

Another way to prevent problems is to make sure that individuals with diabetes are educated about proper foot care and the need for frequent foot examinations to prevent ulcers or catch them early before they become more severe. It is recommended that individuals undertake daily inspection of their feet, either by examining their feet themselves or by having someone else assist them. For example, a mirror can be placed on the floor and used to examine the bottoms of the feet for redness, discoloration, swelling, or other areas of trauma.29 Use of proper footwear (socks and shoes that minimize trauma) is also important for prevention of sores or ulcers: silica gel or air midsoles in shoes is recommended, along with polyester or polyester-blend (cotton-polyester) socks to prevent the formation of blisters and to keep feet dry.25 Patients do not necessarily have to wear diabetic footwear for exercise as long as their conventional athletic footwear meet these criteria.

In cases in which orthoses are used, individuals can insert these in athletic shoes in place of the customary sole inserts the shoes are sold with. Individuals with neuropathy and foot deformities may need custom footwear or orthotic inserts, in particular after healing of ulcers has occurred, to redistribute and reduce plantar foot pressures and to prevent reulceration.30-32 Table 3 includes some additional physical activity considerations for individuals with peripheral neuropathy, particularly individuals who are suffering from ulcerations and lower limb amputations.

In conclusion, the development of peripheral nerve damage is common in individuals with any type of diabetes. Peripheral neuropathy, with the associated decreases in sensation, carries with it an increased risk of falling and injury, along with greater discomfort associated with painful types of neuropathy during physical activity. Although physical activity cannot fully reverse the symptoms of
peripheral neuropathy, it may improve nerve function and can prevent further loss of physical function related to the waning muscle strength and decreased flexibility commonly experienced by individuals with neuropathy.

All individuals with peripheral neuropathy can benefit from regular participation in mild to moderate aerobic, resistance, and balance activities, but they must take precautions to ensure exercise is safe and effective.

Steven Morrison, PhD, is director of research and an endowed professor of physical therapy in the School of Physical Therapy and Athletic Training at Old Dominion University in Norfolk, VA. Sheri R. Colberg, PhD, is a professor of exercise science in the Human Movement Sciences Department at Old Dominion University.

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Steps to Prevent or Delay Nerve Damage

Steps to Prevent or Delay Nerve Damage

There’s a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.

Keep your blood sugar levels in your target range

Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood sugar levels:

  • Use a blood glucose meter to help you make decisions about day-to-day care.
  • Get an A1C test (a lab test) at least twice a year to find out your average blood sugar for the past 2 to 3 months.

Checking your blood sugar levels will tell you whether your diabetes care plan is working or whether changes are needed.

  • Report symptoms of diabetic neuropathy.
  • If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
  • Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it’s hard for you to see or reach your feet, get help from a family member or foot doctor.
  • Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
  • Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
  • Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

The Health Benefits of Exercising With Neuropathy and How to Do It Safely

1. Be Sure to Consult Your Doctor Before Hitting the Gym

You should consult with a medical professional before beginning to exercise because neuropathy can affect how you respond (or don’t respond) to injury or activities that risk injury. For instance, if you have numbness or loss of sensation in your legs and feet, you might not know when you have stubbed a toe, applied too much pressure to your ankle, or gotten a blister from too-tight shoes.

“Pain is a protective mechanism,” says Peter Highlander, DPM, a podiatrist based in Sandusky, Ohio. “I’ve had patients walk in who are profoundly neuropathic with bad fractures, and it doesn’t hurt them. They think, I just sprained my ankle. So they just continue to walk on it, and things just get worse and worse, and then a lot of times require a major surgical reconstruction,” he explains.

Likewise, if neuropathy is affecting movement in your extremities, you may need to make adjustments under the guidance of a physical therapist so that you don’t set back your progress with an injury.

2. Choose a Type of Exercise That’s Appropriate for You

Let’s assume that you have undergone a doctor’s assessment, which may include a foot examination, a neuropathy assessment, and a check of blood flow to the extremities, as well as any deformities or other risk factors for foot ulceration, as is the practice of Dr. Highlander. Perhaps you have received a referral for a physical therapist.

Start with an activity that takes your condition into account. If neuropathy has affected sensation in your feet or legs or you have developed a complication such as a foot ulcer or open sore, the American Diabetes Association (ADA) recommends that you use caution with high-impact, strenuous, or prolonged weight-bearing exercise, such as walking a long distance. It recommends walking shorter distances, cycling, swimming, and chair exercises in a moderate climate over running, jumping, and lifting weights, particularly in hot or cold weather. Definitely wait until any injuries or sores have healed before doing any weight-bearing exercises. (8)

“You can opt for water therapy or a stationary bicycle. Anything that works to increase the overall cardiovascular fitness of patients will help to increase the overall circulatory system and hopefully improve symptoms,” says Matthew Villani, DPM, a podiatrist at Central Florida Regional Hospital in Sanford, Florida.

3. Be Sure to Wear the Right Footwear When Exercising With Neuropathy

Make sure you have the right gear to succeed. The ADA advises wearing shoes with silica gel or air midsoles for weight-bearing activities like walking because they are designed to reduce stress on your feet and joints. Dr. Villani adds: “Make sure that your shoes are wide enough and large enough. Sometimes people with neuropathy like their shoes to be more snug so that they can still have that sensation that they can feel their shoes, but that can increase their susceptibility to pressure points.”

If you need to wear shoes for diabetes, he says don’t let the cost stop you. “Both government and private insurers pay for a substantial portion if not completely for diabetic shoes if you meet the qualifications. So if your neuropathy is from diabetes and if you have a higher risk of ulceration, then that is the first line of treatment — prevention.”

Opt for socks that are made out of fabrics that reduce friction and pull moisture away from your skin, thereby reducing the chance of blisters and sores. Avoid cotton, and look at CoolMax, polypropylene, or acrylic, the ADA suggests. (8)

As you can imagine, a chain reaction starts where blood circulation is interrupted and the nerves deteriorate further.

As a result, the muscles stop receiving signals and any movement becomes quite painful. To understand what type of exercise works best for neuropathic patients, a study conducted by White CM, Pritchard J, and Turner-Stokes L. It was published in the Cochrane Database of Systematic Reviews.

To test functional ability, measures of mobility were taken into account such as walking, stair climbing, and running. A few other different exercises were tested for strength training for an 8-week period. The results revealed that exercise that contributed to muscle building such as walking only showed promise.

As we all know, fluctuations in blood sugar level is are a part of diabetes. Patients who suffer from peripheral neuropathy can feel extreme pain when their blood sugar level flares up. Another reason to indulge in exercise such as light walking is to control your sugar level.

In fact, according to a study published in the Diabetes Care Journal by American Diabetes Association, regular physical activity not only improves blood glucose but also delays the onset of diabetes.

Now that you know how walking can actually help with your peripheral neuropathy, let’s have a look at the four simple steps on how you can remain fit while managing never pain:

1. Consult Your Doctor First

Before hitting the gym or developing any kind of exercise routine, consult your doctor first. When you suffer from peripheral neuropathy, the body’s responses to injuries become slow. For example, if you have lost sensation in your feet or legs, you might not feel the pain when you stub your toe.

If the injury is severe, the pain can set in and cause problems later. This is why it is better to talk to a physical therapist and let him/her do a full check up. You can then ask him the therapist for an exercise routine that is more suited to the symptoms of peripheral neuropathy you have.

2. Choose Appropriate Exercise

Let’s assume that after your check up, the doctor tell that you that your nerve damage is severe in the foot. This means that you cannot perform any strenuous activities, which might force you to stand on your feet for too long. Taking into account the level of numbness and tingling in your feet, you will be more suited to short distance walks and swimming and that in a warm climate.

Try to exercise inside the house for the first few days, so that if the flares up pain increases, you have soft ground to rest on. It’s possible that the peripheral neuropathy in your feet has made you prone to falls, which can be quite dangerous when you are exercising outside.

3. Wear the Right Shoes

The American Diabetes Association recommends wearing shoes with air midsoles or silica gel. You can also try Nike’s Training shows and Adidas’s Work Out Shoes that have been specifically created for exercising. Wear socks that pull moisture away and reduce friction. This way, you won’t have to worry about sores or blisters.

4. Gradually Increase the Exercise Frequency

Always start small! Take a walk around the block and then head back home to inspect your feet. Soak them in warm water and pay special attention to how your feet feel throughout the day. Keep the same routine for a week and look for any changes. If everything iIs alright, increase your exercise time.

5. Aerobic Exercise

Here’s a light exercise routine for you to get started. As mentioned earlier, the purpose of exercising is to increase the heart rate, raise your breathing and feel a light burn in your muscles. You can achieve this in about 30 minutes, which is the ideal exercise time.

However, if you suffer from severe peripheral neuropathy, it is better start with just 5 to 10 minutes. At first, you might feel some pain if you haven’t been active for a long time but the pinching feeling will go away if you exercise regularly.

Following are some examples:

  • Join an aerobic class that teaches low-impact exercises
  • Take a walk after every meal
  • Stationary bicycle indoors
  • Swim
  • Yoga exercises

From all this, we can safely conclude that exercise such as walking can actually help dull the pain and inflammation associated with peripheral neuropathy. It prevents sensory dysfunction and improves mobility, which is achieved through light aerobic and flexing exercises.

Neuropathy (Peripheral Neuropathy)

Your peripheral nervous system is made up of the nerves outside your central nervous system. Sensory nerves carry messages to your brain. Motor nerves carry messages to your muscles.

What is neuropathy?

Neuropathy is damage or dysfunction of one or more nerves that typically results in numbness, tingling, muscle weakness and pain in the affected area. Neuropathies frequently start in your hands and feet, but other parts of your body can be affected too.

Neuropathy, often called peripheral neuropathy, indicates a problem within the peripheral nervous system. Your peripheral nervous system is the network of nerves outside your brain and spinal cord. Your brain and spinal cord make up your central nervous system. Think of the two systems working together this way: Your central nervous system is the central station. It is the control center, the hub from which all trains come and go. Your peripheral nervous system are the tracks that connect to the central station. The tracks (the network of nerves) allow the trains (information signals) to travel to and from the central station (your brain and spinal cord).

Neuropathy results when nerve cells, called neurons, are damaged or destroyed. This disrupts the way the neurons communicate with each other and with the brain. Neuropathy can affect one nerve (mononeuropathy) or nerve type, a combination of nerves in a limited area (multifocal neuropathy) or many peripheral nerves throughout the body (polyneuropathy).

What types of peripheral nerves are there and what do they do?

The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.

  • Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.
  • Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.
  • Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body’s temperature from rising too high.

The type of symptoms you feel depend on the type of nerve that is damaged.

What does neuropathy feel like?

If you have neuropathy, the most commonly described feelings are sensations of numbness, tingling (“pins and needles”), and weakness in the area of the body affected. Other sensations include sharp, lightening-like pain; or a burning, throbbing or stabbing pain.

How common is neuropathy? Who gets neuropathy?

Neuropathy is very common. It is estimated that about 25% to 30% of Americans will be affected by neuropathy. The condition affects people of all ages; however, older people are at increased risk. About 8% of adults over 65 years of age report some degree of neuropathy. Other than age, in the United States some of the more common risk factors for neuropathy include diabetes, metabolic syndrome (high blood pressure, high cholesterol, obesity, diabetes), and heavy alcohol use. People in certain professions, such as those that require repetitive motions, have a greater chance of developing mononeuropathies from trauma or compression of nerves.

Among other commonly cited statistics, neuropathy is present in:

  • 60% to 70% of people with diabetes.
  • 30% to 40% of people who receive chemotherapy to treat cancer.
  • 30% of people who have human immunodeficiency virus (HIV).

How quickly does neuropathy develop?

Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.

There are many causes of neuropathy. Diabetes is the number one cause in the United States. Other common causes include trauma, chemotherapy, alcoholism and autoimmune diseases.

What causes neuropathy?

Neuropathy is not caused by a single disease. Many conditions and events that impact health can cause neuropathy, including:

  • Diabetes: This is a leading cause of neuropathy in the United States. Some 60% to 70% of people with diabetes experience neuropathy. Diabetes is the most common cause of small fiber neuropathy, a condition that causes painful burning sensations in the hands and feet.
  • Trauma: Injuries from falls, car accidents, fractures or sports activities can result in neuropathy. Compression of the nerves due to repetitive stress or narrowing of the space through which nerves run are other causes.
  • Autoimmune disorders and infections: Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjogren’s syndrome and chronic inflammatory demyelinating polyneuropathy are autoimmune disorders that can cause neuropathy. Infections including chickenpox, shingles, human immunodeficiency virus (HIV), herpes, syphilis, Lyme disease, leprosy, West Nile virus, Epstein-Barr virus and hepatitis C can also cause neuropathy.
  • Other health conditions: Neuropathy can result from kidney disorders, liver disorders, hypothyroidism, tumors (cancer-causing or benign) that press on nerves or invade their space, myeloma, lymphoma and monoclonal gammopathy.
  • Medications and poisons: Some antibiotics, some anti-seizures medications and some HIV medications among others can cause neuropathy. Some treatments, including cancer chemotherapy and radiation, can damage peripheral nerves. Exposure to toxic substances such as heavy metals (including lead and mercury) and industrial chemicals, especially solvents, can also affect nerve function.
  • Vascular disorders: Neuropathy can occur when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.
  • Abnormal vitamin levels and alcoholism: Proper levels of vitamins E, B1, B6, B12, and niacin are important for healthy nerve function. Chronic alcoholism, which typically results in lack of a well-rounded diet, robs the body of thiamine and other essential nutrients needed for nerve function. Alcohol may also be directly toxic to peripheral nerves.
  • Inherited disorders: Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy. CMT causes weakness in the foot and lower leg muscles and can also affect the muscles in the hands. Familial amyloidosis, Fabry disease and metachromatic leukodystrophy are other examples of inherited disorders that can cause neuropathy.
  • No known cause: Some cases of neuropathy have no known cause.

What are the symptoms of neuropathy?

Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can appear suddenly, which is called acute neuropathy, or develop slowly over time, called chronic neuropathy.

Common signs and symptoms of neuropathy include:

  • Tingling (“pins and needles”) or numbness, especially in the hands and feet. Sensations can spread to the arms and legs.
  • Sharp, burning, throbbing, stabbing or electric-like pain.
  • Changes in sensation. Severe pain, especially at night. Inability to feel pain, pressure, temperature or touch. Extreme sensitivity to touch.
  • Falling, loss of coordination.
  • Not being able to feel things in your feet and hands – feeling like you’re wearing socks or gloves when you’re not.
  • Muscle weakness, difficulty walking or moving your arms or legs.
  • Muscle twitching, cramps and/or spasms.
  • Inability to move a part of the body (paralysis). Loss of muscle control, loss of muscle tone or dropping things out of your hand.
  • Low blood pressure or abnormal heart rate, which causes dizziness when standing up, fainting or lightheadedness.
  • Sweating too much or not enough in relation to the temperature or degree or exertion.
  • Problems with bladder (urination), digestion (including bloating, nausea/vomiting) and bowels (including diarrhea, constipation).
  • Sexual function problems.
  • Weight loss (unintentional).

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