Table 1.
Summary of exercise training intervention studies in individuals with diabetic peripheral neuropathy.
| Author (Year) | Participants | Primary Measures | Intervention | Key Results | ||||
|---|---|---|---|---|---|---|---|---|
| Type | Frequency | Time | Intensity | Duration | ||||
| Mueller (2013) [8] | Weight-bearing (15); non-weight-bearing (14) | 6-min walk and daily step count | Mobility and functional movement | 3 days/week | 60 min/session | 60–70% MHR | 12 weeks | Weight-bearing group: greater improvements in 6-min walk and daily step count; non-weight-bearing group: greater improvements in HbA1c. |
| El-Refay and Ali (2014) [30] | Control (15); experimental (15) | Gait | Mobility and functional movement | 3 days/week | 45–60 min/session | --- | 8 weeks | Increased walking speed, cadence, and ankle ROM; decreased step time |
| Sartor (2014) [10] | Control (29); experimental (26) | Gait | Mobility and functional movement | 2 days/week | 40–60 min/session | --- | 12 weeks | No significant change in foot rollover during gait |
| Kanchanasamut and Pensri (2017) [31] | Control (10); experimental (11) | Foot mobility, plantar pressure, and foot sensation | Mobility and functional movement | 5 days/week | --- | --- | 8 weeks | Increased ROM and decrease peak plantar pressure |
| Win (2020) [32] | Control (53); experimental (51) | Activities of daily living, DPN signs/symptoms, and pain | Mobility and functional movement | 3 sessions/day; 2–3 days/week | 10 min/session | --- | 8 weeks | Improvements in motor scores and activities of daily living |
| Monteiro (2020) [33] | Control (15); experimental (15) | Strength, PA, gait speed, ROM, DPN symptoms, and QOL | Mobility and functional movement | 2 days/week | 50 min/session | --- | 12 weeks | Improvements in toe strength, gait, DPM symptoms, and foot contact pressure |
| Dixit (2014) [34] | Control (37); experimental (29) | Neuropathy quality of life | Aerobic | 5–6 days/week | 150–360 min/week | 40–60% HRR | 8 weeks | Improved neuropathy quality of life total score |
| Dixit (2014) [35] | Control (37); experimental (29) | Nerve conduction studies and MDNS | Aerobic | 3–6 days/week | 150–360 min/week | 40–60% HRR | 8 weeks | MDNS scores decreased and NCV increased |
| Morrison (2014) [36] | Non-DPN (21); DPN (16) | Gait, reactions, fall risk, and balance | Aerobic | 3 days/week | 30–45 min/session | 50–75% HRR | 12 weeks | Reaction time decreased, gait velocity and stride/step length increased, balance and postural coordination improved |
| Zhang (2014) [37] | Control (30); experimental (30) | Plantar pressure | Aerobic | 3 days/week | 20–40 min/session | 100–120 bpm | 12 weeks | Peak plantar pressure in forefoot decreased while pressure in the medial foot increased |
| Hamed (2014) [38] | DPN (40); HIIT group (20); aerobic group (20) | Leeds Assessment of Neuropathic Symptoms/Signs Scale | Aerobic | 3 days/week | Aerobic: 50 min; HIIT: 20 min | Aerobic: 50–60% MHR; HIIT: 85–95% MHR | 15 weeks | HIIT lead to greater reductions in pain outcome compared to moderate aerobic exercise |
| Kluding (2015) [39] | Experimental (18) | Adverse events, fatigue, and 2peak | Aerobic | 3 days/week | 30–50 min/session | 50–70% 2reserve | 16 weeks | 57 nonserious adverse events occurred and improvements occurred in general fatigue, physical fatigue, and 2peak |
| Yoo (2015) [40] | Experimental (14) | Pain intensity and pain interference | Aerobic | 3 days/week | 30–50 min/session | 50–70% 2reserve | 16 weeks | Pain interference was reduced in walking, normal work, relationship with others, and sleep |
| Dixit (2016) [41] | Control (36); experimental (28) | Balance and posture stability | Aerobic | 3–6 days/week | 150–360 min/week | 40–60% HRR | 8 weeks | Moderate improvement on eyes closed sway velocity on foam |
| Billinger (2017) [42] | experimental (17) | FMD | Aerobic | 3 days/week | 30–60 min/session | 50–70% 2reserve | 16 weeks | Improvements in peak diameter and time to peak shear, but not statistically significant |
| Gholami (2018) [43] | Control (12); experimental (12) | Nerve conduction studies | Aerobic | 3 days/week | 20–45 min/session | 50–70% HRR | 12 weeks | NCV increased but potential amplitude was not different from control |
| Azizi (2019) [44] | Experimental (35) | Nerve conduction studies | Aerobic | 3 days/week | 40–45 min/session | 70–85% MHR | 8 weeks | Improvements in both action potential amplitude and conduction velocity |
| Gholami (2020) [45] | Control (15); experimental (16) | FMD, IMT, vessel diameter, and MDNS | Aerobic | 3 days/week | 30–45 min/session | 50–70% HRR | 12 weeks | Significant improvements in FMD and MDNS |
| Handsaker (2016) [46] | Control (21); non-DPN (13); DPN (9) | Speed of ankle and knee strength generation | Resistance training | 1 day/week | 60 min/session | 12 RM | 16 weeks | Ankle and knee speed of strength generation were higher in both stair ascent and descent |
| Kluding (2012) [47] | Experimental (17) | Pain, MNSI, nerve function, and intraepidermal nerve fiber | Aerobic and resistance training | 3–4 days/week | 30–50 min/session (aerobic) | 50–70% 2reserve; 7–8 RPE | 10 weeks | Reduction in pain, neuropathic symptoms, and increased intraepidermal nerve fiber branching |
| Taveggia (2014) [48] | Control (14); experimental (13) | 6-min walk and 10-m walking test | Aerobic and resistance training | 5 days/week | 60 min/session | --- | 4 weeks | Increased 6-min walk distance |
| Nadi (2017) [49] | Control (41); experimental (42) | MNSI | Aerobic and resistance training | 3 days/week | 20–60 min/session | 50–70% MHR; 50% 10RM | 12 weeks | Reduction in numbness, pain, tingling, weakness; increases in sense of touch |
| Stubbs (2019) [50] | Control (12); experimental (33) | NCS | Aerobic and resistance training | 3 days/week | >30 min/session | 60–80% 2peak | 12 weeks | No alterations in sensory/motor nerve electrodiagnostic |
| Seyedizadeh (2020) [51] | Control (10); experimental (12) | Serum kinesin-1 and physical function | Aerobic and resistance training | 3 days/week | ≥60 min | 8–12 RM; 50–65% HRR | 8 weeks | Serum kinesin-1 and aerobic endurance decreased and upper body strength increased (all non-significant) |
| Song (2011) [52] | Control (19); experimental (19) | Static/dynamic balance and trunk proprioception | Balance | 2 days/week | 60 min/session | --- | 8 weeks | Postural sway decreased, one-leg stance increased, dynamic balance improved, and trunk repositioning errors decreased |
| LeMaster (2008) [53] | Control (38); experimental (41) | Activity level | Balance | 3 days/week | 60 min/session | --- | 12 months | Increase in total daily steps |
| Allet (2010) [54] | Control (35); experimental (36) | Gait | Balance | 2 days/week | 60 min/session | --- | 12 weeks | Increased habitual walking speed; improved cadence, gait cycle time, and stance time |
| Kruse (2010) [9] | Control (38); experimental (41) | Strength, balance, and falls | Balance | 3 days/week | 60 min/session | --- | 12 months | Small time increase in 1-leg, eyes closed stand |
| Eftekhar-Sadat (2015) [55] | Control (17); experimental (17) | TUG, BBS, fall risk, and postural stability | Balance | 3 days/week | --- | --- | 4 weeks | Decrease in TUG, fall risk index, and increase overall stability index |
| Ahmed (2018) [56] | Control (15); experimental (45) | Posture stability | Balance | 3 days/week | 60 min/session | --- | 6 weeks | Increased posture stability |
| Boslego (2017) [57] | Experimental (15) | BBS, balance confidence, and occupation performance/satisfaction | Yoga | 2 days/week | 60 min/session | --- | 8 weeks | Improvements in BBS, balance confidence, and occupation performance/satisfaction |
| Kanjirathingal (2021) [58] | Yoga (11); conventional (10); control (14) | Balance, center of pressure, chair stand, and step-up test | Yoga | 3 days/week | 60 min/session | --- | 12 weeks | Improvements in balance, center of pressure, chair stand, and step-up test |
| Ahn and Song (2012) [59] | Control (19); experimental (20) | Glucose control, neuropathy score, balance, and quality of life | Tai-chi | 2 days/week | 60 min/session | --- | 12 weeks | Improved glucose control, balance, neuropathic symptoms, and quality of life |
| Handsaker (2019) [60] | Control (7); experimental (24) | Stepping accuracy | Proprioception | 1 day/week | 60 min/session | --- | 16 weeks | Increased stepping accuracy |
| Grewal (2015) [61] | Control (16); experimental (18) | Posture stability and daily physical activity | Proprioception | 2 days/week | 45 min/session | --- | 4 weeks | Reduced center of mass, ankle, and hip joint sway |
| Ahmad (2019) [62] | Control (17); experimental (20) | Balance and proprioception | Proprioception | 3 days/week | 50–60 min/session | --- | 8 weeks | Increased one-leg stance, decreased TUG, center of pressure sway, and increased proprioception |
| Hung (2019) [63] | DPN-group A (12); DPN-group B (12) | MFES, TUG, BBS, and UST | Proprioception | 3 days/week | 30 min/session | --- | 6 weeks | Improvements occurred in BBS, right-leg UST, and TUG test scores |
| Rehab and Saleh (2019) [64] | Control (15); experimental (15) | Gait and risk of falling | Proprioception | 3 days/week | 30 min/session | --- | 8 weeks | Increased step length, velocity and cadence; decreased risk of falling |
| Kessler (2013) [65] | Experimental (8) | Neuropathic pain scale and visual analog pain scale | Whole body vibration | 3 days/week | 12 min/session | 25 Hz and 5 mm amplitude | 4 weeks | Reductions in both pain scales |
| Lee (2013) [66] | WBV/balance (19); balance (18); control (18) | Balance, muscle strength, and HbA1c | Whole body vibration | 2 days/week (balance); 3×3 min/day | 60 min/session | --- | 6 weeks | Combined vibration and balance training improved static balance, muscle strength, and HbA1c |
| Kessler (2020) [67] | Control (8); experimental (12) | Visual analog pain scale | Whole body vibration | 3 days/week | 12 min/session | 25 Hz and 0.5–1.0 g | 4 weeks | Significant reductions in pain after 2 and 4 weeks |
BBS = Berg Balance Scale; DPN = diabetic peripheral neuropathy; FMD = flow-mediated dilation; HbA1c = glycated hemoglobin; HIIT = high-intensity interval training; HRR = heart rate recovery; IMT = intima media thickness; MDNS = Michigan Diabetic Neuropathy Screen; MFES = modified falls efficacy scale; MHR = maximum heart rate; MNSI = Michigan Neuropathy Screening Instrument; NCV = nerve conduction velocity; PA = physical activity; QOL = quality of life; ROM = range of motion; RPE = ratings of perceived exertion; TUG = Timed Up And Go; UST = unipedal stance test; 2 = oxygen uptake.