A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy

doi:10.1053/apmr.2001.19742

Archives of Physical Medicine and Rehabilitation

Volume 82, Issue 2, February 2001, Pages 205-209

https://doi.org/10.1053/apmr.2001.19742 Get rights and content

Abstract

Richardson JK, Sandman D, Vela S. A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 2001;82:205-9. Objective: To determine the effect of a specific exercise regimen on clinical measures of postural stability and confidence in a population with peripheral neuropathy (PN). Design: Prospective, controlled, single blind study. Setting: Outpatient clinic of a university hospital. Participants: Twenty subjects with diabetes mellitus and electrodiagnostically confirmed PN. Intervention: Ten subjects underwent a 3-week intervention exercise regimen designed to increase rapidly available distal strength and balance. The other 10 subjects performed a control exercise regimen. Main Outcome Measures: Unipedal stance time, functional reach, tandem stance time, and score on the activities-specific balance and confidence (ABC) scale. Results: The intervention subjects, but not the control subjects, showed significant improvement in all 3 clinical measures of balance and nonsignificant improvement on the ABC scale. Conclusion: A brief, specific exercise regimen improved clinical measures of balance in patients with diabetic PN. Further studies are needed to determine if this result translates into a lower fall frequency in this high-risk population.

Section snippets

Subjects

The study was approved by the institution's review board. All subjects gave written and verbal consent.

Inclusion criteria included: (1) being between 50 and 80 years old; (2) a known history of diabetes mellitus treated by diet, oral hypoglycemic, or insulin therapy; (3) lower extremity symptoms consistent with PN; (4) ability to walk household distances without assistance or an assistive device (though subjects may use a cane intermittently in the community); (5) willingness to participate in

Results

Nine of the 10 intervention subjects and 7 of the 10 control subjects completed the study. The intervention subject dropped out because of foot-ankle pain, which was attributed to the exercise regimen aggravating an underlying arthritis. One of the 3 control subjects developed an illness and 2 dropped out without specifying a reason. Subject characteristics of gender and age are listed in table 1.There was a trend toward an increased MDNS score, representing more severe PN, among the

Discussion

The data from this study showed that an exercise regimen designed to increase rapidly available ankle strength improved 3 commonly used clinical measures of balance (functional reach, tandem stance, unipedal stance) among older persons with mild to moderate PN. The study further showed that these improvements develop in a relatively short period of time and that the exercise regimen is well tolerated. The data also suggested, but did not confirm, that the exercise regimen is associated with

Conclusion

A brief, intense exercise regimen designed to improve distal lower extremity strength was well tolerated and improved 3 clinical parameters of balance in a group of older persons with PN. Although increased confidence or distal lower extremity strength may be responsible for these findings, the study provided no clear insight into the mechanism of the improvements seen in the intervention group. Whether the improvements in clinical balance noted in the intervention subjects translate into

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^☆: Supported by the University of Michigan Department of Physical Medicine, Public Health Service (grant no. AG-08808), and the University of Michigan Geriatrics Research and Training Center.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

^★: Reprint requests to James K. Richardson, Dept of Physical Medicine and Rehabilitation, 1500 E Medical Center Dr, D5200, University of Michigan Health Systems, Ann Arbor, MI 48109-0718, e-mail: [email protected].

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ArticlesA focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy☆,☆☆,★

Abstract

Section snippets

Subjects

Results

Discussion

Conclusion

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Exp Neurol

Arch Phys Med Rehabil

The relationship between electromyographically documented peripheral neuropathy and falls

J Am Geriatr Soc

Peripheral neuropathy: a true risk factor for falls

J Gerontol A Biol Sci Med Sci

Problems with gait and posture in neuropathic patients with insulin-dependent diabetes mellitus

Diabetic Med

A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population

Diabetologia

Peripheral neuropathy effect on ankle inversion and eversion thresholds

Arch Phys Med Rehabil

A practical two-step quantitative clinical and eletrophysiological assessment for the diagnosis and staging of diabetic neuropathy

Diabetes Care

Measuring balance in the elderly: validation of an instrument

Can J Public Health

Articles
A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy☆,☆☆,★