Physical exercise in patients with diabetic neuropathy: systematic review and meta-analysis of randomized clinical trials

Maronesi, Caren Tais Piccoli; Cecagno-Zanini, Sheila Cristina; Oliveira, Luma Zanatta de; Bavaresco, Suzane Stella; Leguisamo, Camila Pereira

doi:10.1590/1809-2950/14649323022016

Caren Tais Piccoli Maronesi

Master in Human Aging at the University of Passo Fundo/RS; Professor of Physiotherapy at the Integrated Regional University - Erechim/RS

Sheila Cristina Cecagno-Zanini

Master in Human Aging by the University of Passo Fundo/RS.

Luma Zanatta de Oliveira

Master's Student in Human Aging at the University of Passo Fundo/RS.

Suzane Stella Bavaresco

Master's Student in Human Aging at the University of Passo Fundo/RS.

Camila Pereira Leguisamo

PhD in Health Sciences by the Institute of Cardiology of Rio Grande do Sul; Professor of the Graduate Program of Human Aging at the University of Passo Fundo/RS.

Mailing address: Sheila Cristina Cecagno-Zanini - University of Passo Fundo - Rua Sebastião Pereira dos Santos, 398, Bairro São Cristóvão - Passo Fundo (RS), Brazil EP: 99060-310 - E-mail: 99060-310 - Phone: +55 (54) 8109-0473

Conflict of interest: Nothing to declare

#1	"Diabetic Neuropathies"[Mesh]or "Diabetic Neuropathies" or "Diabetic Neuropathy" or "Neuropathies, Diabetic" or "Neuropathy, Diabetic" or "Diabetic Polyneuropathy" or "Diabetic Polyneuropathies" or "Polyneuropathies, Diabetic" or "Polyneuropathy, Diabetic" or "Asymmetric Diabetic Proximal Motor Neuropathy" or "Diabetic Asymmetric Polyneuropathy" or "Asymmetric Polyneuropathies, Diabetic" or "Asymmetric Polyneuropathy, Diabetic" or "Diabetic Asymmetric Polyneuropathies" or "Polyneuropathies, Diabetic Asymmetric" or "Polyneuropathy, Diabetic Asymmetric" or "Diabetic Autonomic Neuropathy" or "Autonomic Neuropathies, Diabetic" or "Autonomic Neuropathy, Diabetic" or "Diabetic Autonomic Neuropathies" or "Neuropathies, Diabetic Autonomic" or "Neuropathy, Diabetic Autonomic" or "Symmetric Diabetic Proximal Motor Neuropathy" or "Diabetic Amyotrophy" or "Amyotrophies, Diabetic" or "Amyotrophy, Diabetic" or "Diabetic Amyotrophies" or "Diabetic Neuralgia" or "Diabetic Neuralgias" or "Neuralgias, Diabetic" or "Diabetic Neuropathy, Painful" or "Diabetic Neuropathies, Painful" or "Neuropathies, Painful Diabetic"or "Neuropathy, Painful Diabetic" or "Painful Diabetic Neuropathies" or "Painful Diabetic Neuropathy" or "Neuralgia, Diabetic" or "Diabetic Mononeuropathy" or "Diabetic Mononeuropathies" or "Mononeuropathies, Diabetic" or "Mononeuropathy, Diabetic" or "Diabetic Mononeuropathy Simplex" or "Diabetic Mononeuropathy Simplices" or "Mononeuropathy Simplex, Diabetic" or "Mononeuropathy Simplices, Diabetic" or "Simplex, Diabetic Mononeuropathy" or "Simplices, Diabetic Mononeuropathy"
#2	"Exercise"[Mesh] or "Exercise" or "Exercises" or "Exercise, Physical" or "Exercises, Physical" or "Physical Exercise" or "Physical Exercises" or "Exercise, Isometric" or "Exercises, Isometric" or "Isometric Exercises" or "Isometric Exercise" or "Exercise, Aerobic" or "Aerobic Exercises" or "Exercises, Aerobic" or "Aerobic Exercise"
#3	Randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR ("clinical trial"[tw]) OR ((singl[tw] OR doubl[tw] OR trebl[tw] OR tripl[tw]) AND (mask[tw] OR blind[tw])) OR ("latin square"[tw]) OR placebos[mh] OR placebo[tw] OR random[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control[tw] OR prospectiv[tw] OR volunteer*[tw]
#4	#1 AND #2 AND #3

Authors	n	Average age	Group	Gender	Supervision	Modality	Exercises	Length	Outcome
				F/M			Prescription/Intensity/Frequency
^{Richardson; Sandman; Vela, 2001}8. Richardson JK, Sandman D, Vela V. A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil. 2001;82(2):205-9.	16	64.0±6.3	Intervention (n=9)	F/M	No	CE	Heating Strengthening of the triceps surae muscle, ankle invertors and evertors, and quadriceps. 1x 10 repetitions up to 3 x10. Balance.	3 weeks	Balance (ABC Scale)
		63.3±7.6	Controle (n=7)		No		Strengthen upper limbs in the sitting position. 5x each exercise.	3 weeks
^{Kruse; LeMaster; Madsen, 2010}10. Kruse RL, Lemaster JW, Madsen RW. Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: "Feet first" randomized controlled trial. Phys Ther. 2010;90(11):1568-79.	79	66.3±10.6	Intervention (n=41)	F/M	Yes	CE	Part 1: 1-3 months, 8 sessions with the physiotherapist, strengthen LL and balance, then 3x a week for one hour at home and a walking program monitored with pedometer. Part 2: 4-12 months, phone calls by nurses every two weeks, minimum length 10 minutes to encourage the LL strengthening exercises, balance and walking.	6 and 12 weeks	Muscle strength (dynamometer) Balance (Berg Balance Scale)
		64.8±9.4	Control (n=38)		Yes		Part 1: Instructions for health care. 8 physiotherapist visits Part 2: They received calls in the same frequency as the IG to report their recent activities, but did not receive the nurse's motivation.	6 and 12 weeks
^{Lee; Lee; Song, 2013}11. Lee K, Lee S, Song C. Whole-body vibration training improves balance, muscle strength, and glycosylated hemoglobin in elderly patients with diabetic neuropathy. Tohoku J Exp Med. 2013;231(4):305-14.	55	76.3±4.7	Intervention WBV (n=19)	F/M	Yes	CE	Balance exercise (vibrating platform), combined with progressive strengthening, balance and functional mobility. 60 min 2x a week	6 weeks	Balance (Berg Balance Scale) Muscle Strength (FTSTS-time)
		74.0±5.4	Intervention BE (n=18)	F/M	Yes		Balance exercise - 10 min heating, 40 min balance training, 10 min cooldown activities	6 weeks
		75.7±5.6	Control (n=18)	F/M			No activity performed
^{Dixit; Maiya; Shastry, 2014}12. Dixit S, Maiya AG, Shastry B. A. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: A single blind, parallel group randomized controlled trial. J Diabetes Complications. 2014;28(3):332-9.	87	54.0±1.16	Intervention (n=40)	F/M	Yes	AE	Moderate intensity exercise on a treadmill with 40% -60% HR. From 3-6 days a week, minimum 150 min/week and maximum 360 min/week. Diet for diabetics (instructions).	8 weeks	Gycemic index
		59.45±1.24	Control (n=47)		Yes		Lectures on diabetic foot and diet instructions with nutritionists and doctors	8 weeks
^{Sartor et al., 2014}9. Sartor CD, Hasue RH, Cacciari LP, Butugan MK, Watari R, Pássaro AC, et al. Effects of strengthening, stretching, and functional training on foot function in patients with diabetic neuropathy: Results of a randomized controlled trial. BMC Musculoskelet Disord. 2014;15(137):137-50.	55	60±12	Intervention (n=26)	F/M	Yes	CE	(a) foot and ankle ROM, (b) strengthen foot and ankle muscles, (c) increase foot and ankle performance through functional exercises, and (d) increase foot skills. The patient was exposed to progressive difficulty. 2x/week. 40-60 min per session	12 weeks	Balance (ABC Scale)
		59±4	Control (n=29)		Yes		No activity performed, the patient continued receiving drug and medical care and instructions for foot care.	12 weeks

[1] Mailing address: Sheila Cristina Cecagno-Zanini - University of Passo Fundo - Rua Sebastião Pereira dos Santos, 398, Bairro São Cristóvão - Passo Fundo (RS), Brazil EP: 99060-310 - E-mail: 99060-310 - Phone: +55 (54) 8109-0473

Brasil

Brasil

Physical exercise in patients with diabetic neuropathy: systematic review and meta-analysis of randomized clinical trials

ABSTRACT