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Exercise Intervention Studies in Patients with Peripheral Neuropathy: A Systematic Review

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Abstract

Introduction

Peripheral neuropathies (PNPs) encompass a large group of disorders of heterogeneous origin which can manifest themselves with sensory and/or motor deficits depending on the predominantly affected nerve fiber modality. It represents a highly prevalent disease group which can be associated with significant disability and poor recovery. Exercise has the potential to improve side effects of PNP.

Objective

Our objective in this systematic review was to analyze exercise interventions for neuropathic patients in order to evaluate the possible benefits of exercise.

Methods

Three independent reviewers used PubMed, MEDPILOT® (MEDLINE), Cochrane, and relevant reference lists to obtain the data. Relevant studies were graded according to the Oxford Levels of Evidence.

Results

Eighteen studies (ten randomized controlled trials and eight controlled clinical trials) met all inclusion criteria. Three (diabetic) studies were ranked very high quality [1b (A)], nine high quality (four diabetes, one cancer, four others) [2b (B)], while six (four diabetes, two others) showed low quality (4/C). Current data suggests that exercise is a feasible, safe, and promising supportive measure for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN), suggesting that endurance training has the potential to prevent the onset of and reduce the progression of DPN. In general, balance exercises showed the highest effect on the motor as well as sensory symptoms in all types of PNP.

Conclusion

Overall, balance training appears to be the most effective exercise intervention. Studies focusing exclusively on strength, or a combination of endurance and strength, appear to have a lower impact. For metabolically-induced neuropathies, endurance training also plays an important role. Further research with high methodological quality needs to be conducted in order to establish evidence-based clinical recommendations for neuropathic patients.

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Acknowledgments

Fiona Streckmann, Eva M. Zopf, Helmar C. Lehmann, Kathrin May, Julia Rizza, Philipp Zimmer, Albert Gollhofer, Wilhelm Bloch, and Freerk T. Baumann have no conflicts of interest to declare. No sources of funding were used to assist in the preparation of this manuscript. We acknowledge the advisory support of C. Brinkmann.

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Authors and Affiliations

  1. Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany

    Fiona Streckmann, Eva M. Zopf, Kathrin May, Julia Rizza, Philipp Zimmer, Wilhelm Bloch & Freerk T. Baumann

  2. Department of Neurology, University Hospital Cologne, Cologne, Germany

    Helmar C. Lehmann

  3. Department of Sport Science, University of Freiburg, Freiburg im Breisgau, Germany

    Albert Gollhofer

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  1. Fiona Streckmann
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Streckmann, F., Zopf, E.M., Lehmann, H.C. et al. Exercise Intervention Studies in Patients with Peripheral Neuropathy: A Systematic Review. Sports Med 44, 1289–1304 (2014). https://doi.org/10.1007/s40279-014-0207-5

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