Mayo Clinic states that peripheral neuropathy is a condition which occurs when the nerves that are located outside of the brain and spinal cord are damaged.^[1] Peripheral neuropathy can occur as a standalone condition without any recognizable or identifiable cause; this would be known as idiopathic neuropathy. More commonly, however, it can occur as a result of other underlying medical conditions such as, but not limited to, diabetes mellitus, traumatic injuries, infections, metabolic problems, inherited causes or exposure to toxins.^{1 [2]}

For some 1-7% of the general population living with the condition, this can spell major discomfort in the various symptoms caused by this condition.¹ The most common symptoms of peripheral neuropathy include tingling or numbness, sharp jabbing pain, muscle weakness, instability, loss of coordination, increased blood pressure, digestive issues in addition to a host of many other less common presentations.

Given the frequency of these difficult-to-live-with symptoms, it can be important to seek solutions to mitigate their strength and occurrence. Amidst the recommendation of following healthy lifestyle choices, receiving medical treatment, and practicing self-care, a key defense in the battle against worsening peripheral neuropathy may be to implement a healthy exercise routine.

How Peripheral Neuropathy Affects the Body

Due to the tendency for patients with peripheral neuropathy to develop difficulty walking due to gait and imbalance issues, much of the journey in combating the condition lies in addressing these symptoms—this is where exercise comes in.

Peripheral neuropathy, particularly diabetic peripheral neuropathy (DPN), can have a debilitating effect on one's quality of life on a daily basis. To understand how exercise can be advantageous to someone with the condition, it would be helpful to first understand the physical effects that go along with it. 

Altered Gait, Steadiness, and Balance

A person afflicted with peripheral neuropathy may experience an altered ability to walk. This can be due to their loss of sensory nerve function combined with the possibility of a wasting or atrophy of lower limb muscles.^[3] The consequence of these symptoms is that patients experience inhibited proprioception, or a sense of body position and movement. This can make it difficult for those afflicted to walk alongside and follow others.

Additionally, this affected gait can result in erratic steps which can result in falls, accidents, and even a reluctance to partake in certain activities. ^{[4] [5]} An individual with peripheral neuropathy could easily be at risk around any staircase or ladder, or chaotic event with a lot of commotion, such as a fair, festival, or party. This may result in a lessened quality of life where the individual opts out of events entirely just due to the sheer risk factor involved in moving about.

DPN may also cause dynamic plantar pressure which may result in antalgic gait which is limping as a means to avoid pain.

These factors all contribute to an affected motor control for those with peripheral neuropathy. A possible means for improvement may be found in proper exercise science, rehabilitation, stretching, and balance training.

Exercise (Resistance and Aerobic) for Peripheral Neuropathy

While there seem to be no studied cases of exercising directly reversing the effects of diabetic peripheral neuropathy, there is research which suggests that exercise can have a positive effect in limiting the progression of the degenerative effects of DPN.  Neurogenic muscular atrophy can have an effect of declining a patients’ muscular strength, speed, and endurance.^[6] So combatting that atrophy with muscle building resistance workouts, especially in lower body strength, has shown an effect in reducing the advancement pace of peripheral neuropathic patients' walking disorders by up to ⅕, which may be marginal but still suggests movement in a positive direction.

There are also studies which suggest that exercise can serve to reduce diabetic neuropathic pain, decrease the symptoms of sensory loss, and can activate an anti-inflammatory mechanism which also works to suppress pain.^[7] Another study focused on the effects exercise has on elderly patients with long term type-2 diabetes found that there was an noticeable increase in patient leg strength, 6 minute walking distance, and increased walking ability, which they suggested markedly improved patient’s quality of life. ^[8]

These factors all suggest that while not a cure all prescription, exercise can only go to improve a patient’s quality of life, and limit progression of diabetic peripheral neuropathy.

Stretching / Yoga / Physical Therapy for Peripheral Neuropathy

In addition to exercise resistance or cardiovascular training, implementing a positive stretching routine or physical therapy regimen may prove beneficial to those with peripheral neuropathy. In a systematic review exploring the effects which exercise and stretching had on various forms of neuropathic pain, researchers clearly found a correlation to exercise and a clear reduction in pain.^[9] While the methods of the study were not singularly focused on stretching or yoga, the review had a clear inclusion on studies with effective stretching routines. Across the board, the results suggest that exercise, with the inclusion of stretching, reduced patient neuropathic pain intensity and was stated as endorsed by expert recommendation.

Another systematic review with meta-analysis found that active muscle stretching, alongside electrical stimulation, served to effectively increase the sensibility of plantar skin in both feet and increase walking speed in older adults with type 2 diabetes mellitus. ^[10]

Balance Training / Tai Chi for Peripheral Neuropathy

While it may be something of an understudied subject in direct relation to diabetic peripheral neuropathy, Tai Chi or generalized balance training may prove worthwhile to those with the condition. A major consequence of peripheral neuropathy is the altered gait and balance, and so an exercise science with a focus placed on reinforcing one’s ability to maintain balance seems like a reasonable supplement to a patient's physical therapy regimen.

With the emphasized slow movement and low impact training apparent to Tai Chi, it is shown as one of the most effective exercise therapies for reducing falls in the elderly, with one study reporting a 50% reduction over one year.^{[11] [12]} Tai Chi also aims to have the arms and legs work synchronously with one another, offering benefits in weight shifting, postural control, improved proprioception, boosted postural stability of the lower limbs, and improved neuromuscular function in the lower limbs. ^{11 [13] [14] [15]}

Final Thoughts

Always consult with your health care practitioner before committing to any lifestyle change or new exercise regimen. However, various sources seem to point to the conclusion that different forms of exercise science can only have a positive impact on someone suffering from peripheral neuropathy; these benefits can be found namely in the halted progression of negative symptoms, increased lower extremity strength, lessened neuropathic pain, and improved balance with a reduced risk for falls.