2012年9月11日 星期二

Potential Benefits of Weight-Bearing Exercise For People With Diabetes and Peripheral Neuropathy


The traditional clinical belief has been that weight-bearing activity such as walking should be discouraged among people with diabetic peripheral neuropathy (diabetes and insensate feet due to nerve damage). The presumption was that weight-bearing activities increased the risk of foot ulcers among patients with diabetes and insensate feet. This advice forced people with diabetic neuropathy into a big dilemma: you need to exercise to stay healthy, but you also need to reduce repetitive loading on your feet.

The recognition of the overall importance of exercise for people with diabetes continues to grow. The American Diabetes Association (ADA) now makes these general recommendations for people with Type 2 diabetes:


Get at least 150 minutes per week of moderate intensity aerobic physical activity. The ADA defines moderate intensity as 50-70% of maximum heart rate.
Perform resistance training (weight lifting for example) 3 times a week unless a patient's other medical conditions counsel against it.

For people with diabetes and severe peripheral neuropathy, the ADA says "it may be best to encourage non-weigh-bearing activities such as swimming, bicycling, or arm exercises."

What about this advice from the ADA? Recent studies raise questions about whether the ADA's advice to people with insensate feet might be too conservative. Two descriptive studies indicate that patients with diabetes and insensate feet who engage in daily activity decrease their risk of foot ulceration compared to those who are less active. LeMaster et al. 2003; Armstrong et al. 2004. A more recent, randomized controlled trial found that promoting weight-bearing activity did not lead to increases in foot ulcers among people with diabetic neuropathy. LeMaster et al. 2008. A free copy of this article is available via the federal government website pubmed.gov if you search "lemaster reiber mehr."

Summary: Exercise and particularly weight-bearing activities such as walking are highly beneficial to the overall health of people with diabetes. Recent studies suggest weight-bearing activity may have an overall beneficial even for people with diabetic peripheral neuropathy. If you have diabetic peripheral neuropathy, discuss this is a topic with your podiatrist and other health care providers. Provide them with the LeMaster article mentioned above.




John K. Lampe is the President of Tamarack Habilitation Technologies, Inc. Tamarack is a privately held, research and development company. Tamarack specializes in ankle-foot biomechanics and friction management technology. Tamarack's ShearBan® is a patented product that reduces the damaging effects of friction on the human body. It is used by professional clinicians to prevent and treat diabetic foot ulcers, excessive callusing, blisters, and other hotspots. [http://www.tamarackhti.com/]





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