Physical Training and Activity in People With Diabetic Peripheral Neuropathy: A Paradigm Shift.

Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (i.e., walking and stair climbing). Although it is well-established that exercise has many beneficial effects for people with diabetes, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered a contra-indication for walking or any weight-bearing exercise due to concerns for injuring the participant’s insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people with DPN without severe foot deformity. In fact, emerging research has found positive adaptations to overload stress in these patients, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This Perspective will review this evidence for peripheral neuroplasticity in animal models and early clinical trials, and adaptation of the integumentary system and the musculoskeletal system in response to overload stress.

The authors propose these positive adaptations promote improved function in people with DPN and foster the paradigm shift of including weight-bearing exercise for people with DPN. This Perspective also will provide specific assessment and treatment recommendations for this important, high-risk group.