The effect of exercise interventions on the balance of diabetic neuropathic patients: A systematic review study

Document Type : Research Paper

Authors

1 PhD student in sport injury and corrective exercise, Faculty of Sport Sciences, Kish International Campus, University of Tehran

2 Department of Sports Sciences, Kish International Campus, University of Tehran, Kish, Iran.

3 Department of Sports Injuries and Corrective Exercises, Faculty of Sports Science, Shahid Bahonar University of Kerman, Kerman, Iran

Abstract

Background: Diabetic peripheral neuropathy (DPN) reduces the senses, proprioception, reflexes, and strength in the lower extremities and leads to balance dysfunction.
Aim: This study aimed to evaluate the effectiveness of interventions used by researchers and therapists to minimize balance dysfunction in people with DPN.
Materials and Methods: This study is a comprehensive review of exercise interventions on the balance of patients with diabetic neuropathy by searching in the PubMed Elsevier, Springer, Science Direct, Google Scholar, and Scopus databases with the combined keywords “balance”, “diabetic peripheral neuropathy”, “training interventions”, “proprioception”, “risk of diabetic fall”, “peripheral neuropathy” and also in Persian databases of Jihad Daneshgahi Scientific Information Center, MedLib (Comprehensive Database of Medical Articles), IranMedex, Iran Institute of Information Science and Technology Research Institute (IRANDOC), Iranian Publications Database (MAGIRAN) and with keywords “fall risk”, “profundity” and “postural control in diabetic neuropathic patients” from 2010 to 2021. After collecting the search results, first the title and then the summary of the pieces were studied. If the articles met the inclusion and exclusion criteria, their results would be used in the review study and otherwise discarded.
Results: Twenty-five studies published between 2010 and 2021 met the inclusion criteria. The results showed that training interventions were more effective than control conditions to improve the balance of patients with diabetic neuropathy. Also, the most training programs and rehabilitation protocols have a positive effect on the balance of patients with diabetic neuropathy.
Conclusion: The studied exercise interventions are an effective tool to improve the balance of diabetic neuropathy patients. However, given the small number of studies and their limitations, the present findings of this study should be considered.

Keywords


[1] Orlando G, Balducci S, Bazzucchi I. “Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training”. Diabetes/ Metabolism Research and Reviews. 2016; 32(1): 40-50.
[2] Suda E, Madeleine P, Hirata RP, Samani A. “Reduced complexity of force and muscle activity during low level isometric contractions of the ankle in diabetic individuals”. Clinical Biomechanics. 2017; 42: 38-46.
[3] Kiani J, Moghimbeigi A, Azizkhani H. “The prevalence and associated risk factors of peripheral diabetic neuropathy in Hamedan, Iran”. Archives of Iranian Medicine. 2013; 16(1): 17-19. [in Persion]
[4] Ghanavati T, Shaterzadeh Y, Goharpey Sh, Arastoo A. “Functional balance in diabetic neuropathy”. 11th European Congress of Endocrinology. 2009; BioScientifica. [in Persion]
[5] Tanenberg RJ. “Diabetic peripheral neuropathy: painful or painless”. Hospital Physician. 2009; 45(7): 1-8.
[6] Nardone A, Grasso M, Schieppati M. “Balance control in peripheral neuropathy: are patients equally unstable under static and dynamic conditions?”. Gait & Posture. 2006; 23(3): 364-373.
[7] Boucher PN, Teasdale R. “Courtemanche, postural stability in diabetic polyneuropathy”. Diabetes Care. 1995; 18(5): 638-645.
[8] Mustapa A, Justine M, Mohd Mustafah M. “Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review”. BioMed Research International. 2016; Article ID 9305025, 14 p.
[9] Fortaleza AC, Chagas EF. “DMA ferreira, postural control and functional balance in individuals with diabetic peripheral neuropathy”. Revista Brasileira de Cineantropometria & Desempenho Humano. 2013; 15(3): 305-314.
[10] Song CH, Petrofsky JS, Lee SW, Lee KJ. “Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies”. Diabetes Technology & Therapeutics. 2011; 13(8): 803-811.
[11] Akbari M, Jafari H, Moshashaee A, Forugh B. “Do diabetic neuropathy patients benefit  from balance training?”. Journal of Rehabilitation Research & Development. 2012; 49(2). [in Persion]
[12] Eftekhar-Sadat B, Azizi R, Aliasgharzadeh A. “Effect of balance training with Biodex Stability System on balance in diabetic neuropathy”. Therapeutic Advances in Endocrinology and Metabolism. 2015; 6(5): 233-240. [in Persion]
[13] Khushnood K, Sultan N, Mehmood R. “Does Wii Fit balance training improve balance and reduce fall risk in diabetic patients as compared to balance training exercises? A Randomized Control Trial”. Rawal Medical Journal. 2019; 44(1): 44-48. [in Persion]
[14] Akbari M, Jafari H, Moshashaee A. “Evaluation of the effects of balance exercises on balance indices in patients with diabetic neuropathy”. Journal of Rafsanjan University of Medical Sciences. 2011; 10(1): 14-24. [in Persion]
[15] Salsabili H, Bahrpeyma F, Forogh B. “Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes”. Journal of Rehabilitation Research & Development. 2011; 48(7). [in Persion]
[16] Grewal GS, Schwenk M, Lee-Eng J, Parvaneh S. “Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in experimental study”. Pak J Med Sci. 2021; 37(2): 389-392.
[17] Daud SAH, Mujeeb-Ur-Rahman A, Junaid M. “Effect of balance training with Biodex Balance System to improve balance in patients with diabetic neuropathy”. Pakistanjornal of sport medical science. 2021; 61(6): 567-574.
[18] Allet L, Armand S, De Bie RA, Golay A, Monnin D. “The gait and balance of patients with diabetes can be improved: a randomised controlled trial”. Diabetologia. 2010; 53(3): 458-466.
[19] 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”. Physical Therapy. 2010; 90(11): 1568-1579.
[20] Venkataraman K. Choo Tai B, Eric Y, Khoo H, Tavintharan S. “Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial”. Diabetologia. 2019; 62(12): 2200-2210.
[21] Hedayati A, Rashidlamir A, Hashemi Javaheri A. “The effect of eight weeks of resistance training on static and dynamic balance as well as power of the foot muscles in diabetic women with peripheral neuropathy”. The Journal of Shahid Sadoughi University of Medical Sciences. 2015; 23(9): 833-843. [In Persion]
[22] Rezaei N, Gholami F, Nader A. “Effect of resistance training on posture control components in women with diabetic peripheral neuropathy.” Medical Journal of Tabriz University of Medical Sciences and Health Services. 2021; 42(6): 764-772.
[23] Nardone A, Schieppati M. “Group II spindle fibres and afferent control of stance. Clues from diabetic neuropathy”. Clinical Neurophysiology. 2004; 115(4): 779-789.
[24] El-Wishy A, Elsayed E. “Effect of proprioceptive training program on balance in patients with diabetic neuropathy: a controlled randomized study”. Bulletin of Faculty of Physical Therapy. 2012; 17(2).
[25] Ahmad I, Noohu MM, Verma S, Singla D, Hussain MF. “Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy”. Gait & Posture. 2019; 74: 114-120.
[26] Chatchawan U, Eungpinichpong W, Plandee P. “Effects of thai foot massage  on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial”. Medical Science Monitor Basic Research. 2015; 21: 68.
[27] Hamidi H, Letafatkar A, Shojaoddin SS. “A comparison of the efficacy of the reflexology and yumeiho therapy massages on balance and proprioception in women  with diabetic neuropathy in lower limp”. Journal for Research in Sport Rehabilitation. 2015; 3(5): 9-17. [in Persion]
[28] Shourabi P, Bagheri R, Wong A, et al. “Effects of hydrotherapy with massage on serum nerve growth factor concentrations and balance in middle aged diabetic neuropathy”. Complementary Therapies in Clinical Practice. 2021; 101141.
[29] Farhan V, Abbasi A, Ghomshe FT, Tazaj MK. “Effect of combined trainings (Rom improvement, muscle strengthening, balance training, and gait training) on balance and risk for falling in older women with diabetic peripheral neuropathy”. The Scientific Journal of Rehabilitation Medicine. 2019; 8(2): 97-105. [in Persion]
[30] Khanbabazade M, Ebrahimi Atri A, Rashid Lamir A. “Comprision of the effect of aerobic and weight resistance training protocols on balance and neuron growth factor (NGF) on the neuropathy– diabetic men”. The Journal of Shahid Sadoughi University of Medical Sciences. 2015; 23(2): 1866-1877. [in Persion]
[31] Morrison S, Colberg SR, Parson HK, Vinik AI. “Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy”. Journal of Diabetes and its Complications. 2014; 28(5): 715-722.
[32] Rojhani-Shirazi Z, Barzintaj F, Salimifard MR. “Comparison the effects of two types of therapeutic exercises Frenkele vs. Swiss ball on the clinical balance measures in patients with type II diabetic neuropathy”. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017; 11: S29-S32. [in Persion]
[33] Ahn S, Song R. “Effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy”. The Journal of Alternative and Complementary Medicine. 2012; 18(12): 1172-1178.
[34] Abasgholipour A, Shahbazi M, Tahmasbi Sh. “The effects of in-water and on-land aerobic training on postural sway and balance in patients with type 2 diabetes”. Research Society for Study of Diabetes in India. 2021; 41(2): 1-7 [in Persion]
[35] Kanjirathingal J, Mullerpatan R, et al. “Effect of Yogasana intervention on standing balance performance among people with diabetic peripheral neuropathy”. International Journal of Yoga. 2021; 14(1):60-70.
[36] Najafi B, Manish B, Talal K, Armstrong DG. “Advances in balance assessment and balance training for diabetes”. Diabetes Management. 2012; 2(4): 293.
[37] Kluding PM, Pasnoor M, Singh R, Jernigan S, Farm K. “The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy”. Journal of Diabetes and its Complications. 2012; 26(5): 424-429.
[38] da Silva CA, Ribeiro JP, Canto JCAU. “High-intensity aerobic training improves endothelium-dependent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus”. Diabetes Research and Clinical Practice. 2012; 95(2): 237-245.
[39] Chae CH, Kim HT. “Forced, moderate-intensity treadmill exercise suppresses apoptosis by increasing the level of NGF and stimulating phosphatidylinositol 3-kinase signaling in the hippocampus of induced aging rats”. Neurochemistry International. 2009; 55(4): 208-213.
[40] Atlanta GA. Centers for Disease Control and Prevention. US Department of Health and Human Services, 2020.
[41] Boulton AJM, Vinik AI, Arezzo JC, Bri V. “Diabetic neuropathies: a statement by the American Diabetes Association”. Diabetes Care. 2005; 28(4): 956-96.
[42] O'Sullivan SB. Schmitz TJ. Improving Functional Outcomes in Physical Rehabilitation. FA Davis, 2016.
[43] Mark Vrabel M. “Preferred reporting items for systematic reviews and meta-analyses. in Oncology nursing forum”. Oncology Nursing Society. 2015; 42(5), 552-556.
[44] Cimbiz A, Cakir O. “Evaluation of balance and physical fitness in diabetic neuropathic patients”. Journal of Diabetes and its Complications. 2005; 19(3): 160-164.