Staying Active with Peripheral Neuropathy

Peripheral Neuropathy and Exercise

Peripheral nerves are responsible for sending motor signals from our brain and spine to the muscles, as well as, sending sensory signals back to the brain and spine for interpretation. When these nerves become damaged, a person can develop weakness, numbness, and pain in a process called ‘peripheral neuropathy’¹. Peripheral neuropathy happens as the result of another disease process or condition. The most common cause in the United States is diabetes with approximately 60-70% of those with diabetes experiencing symptoms of peripheral neuropathy². The damage to these peripheral nerves can make it challenging to perform fine motor tasks, maintain balance when standing or walking, and even tolerate fluctuations in heat. With the diversity of these symptoms, it can be tough to know how to stay active while still being safe and not cause undue harm. The focus of this article will be to understand the benefits exercise can have related to peripheral neuropathy and identify some general concepts to be mindful when starting a new exercise routine.

How Much Exercise is Recommended?

Exercise can have a variety of far-reaching benefits when done appropriately. According to the Centers for Disease Control and Prevention, maintaining a healthy, active lifestyle is to aim for at least 150 minutes of moderate activity throughout the week³. This may seem daunting and unrealistic, especially in a condition that has a multitude of symptoms or mobility limitations but is very manageable when broken into 30 minute segments. Furthermore, you may have been told to stop exercising or overtaxing yourself as could worsen your symptoms. Studies have found that an exercise program of moderate intensity is safe and feasible for individuals with a peripheral neuropathy. Exercise has also been found to improve balance, strength, walking speed, mobility confidence with reduced fear of falling⁴, and increasing endurance⁵. Furthermore, exercise can improve neuropathic pain and sensory disturbances that often accompany peripheral neuropathies⁶. This is where approaching your exercises in a submaximal manner can play a crucial role in you, your symptom management, and participation in day-to-day life.

Recommended Programs

The clinical definition of submaximal exercise is exercising at a level where your heart rate is 85% of your maximal predicted heart rate (220-age)⁷. This is not reliable in individuals who have chronic conditions or taking medications that may alter heart rate, as your body may not respond appropriately to additional work and will not be a true, or safe, measure of how hard you are working. That is where when you are exercising, it is strongly recommended to exercise at a level that is just below your maximum effort, this is what is called “submaximal” exercise. The following are submaximal exercise principles to help guide your routine and activity:

• The program should consist of flexibility, endurance, strength, and balance exercises.

• • • Daily stretching, endurance, and balance exercises.
    • Strengthening exercises should be performed on an every other day basis to allow optimal recovery time.

• The duration of exercise should range between to 30-45 minutes. If you are unable to tolerate this, then distribute exercises throughout your day into 3, 10-minute bouts for improved tolerance and participation.
• Perform exercises in a slow, low-intensity manner. Limit or avoid high-intensity exercises. You can still perform these options but, at a slower rate.
• Use light weight or body weight.
• Use simple, yet reliable, self-assessment tools to best gauge your intensity without having to calculate your heart rate. Aiming for “light to somewhat hard” on the BORG Rating of Perceived Exertion Scale© and/or “moderate intensity” on the Talk Test© will ensure you are exercising at an appropriate speed and workload.
• Incorporate purposeful seated rests between each exercise or sit when standing is not necessary, such as when completing upper body exercises.
• Join community-based group programs or seek at home options, such as videos. Common programs that are beneficial in peripheral neuropathy are tai chi, aquatic exercise, and gentle yoga.
• If at any point of your exercise session you experience lightheadedness, dizziness, feeling as if you may faint, chest pain, heart palpitations or feeling of “skipped beats,” unusual amount of shortness of breath, then discontinue and seek medical attention.

Monitoring Your Intensity and Your Symptoms

Just as it is important to monitor your intensity while exercising, it is equally important to monitor symptoms immediately after exercising, later that evening, and into the next day. This will best dictate whether you are exercising at “just the right” amount. Use these principles to monitor your symptoms after exercising:

• You should have a similar amount of energy at the end of your workout at which you started with.
• If you experience any of the following, then your exercise session was too hard and you should adjust your routine:

• • • Unusual or persistent fatigue despite 15-30 minutes of resting after.
    • Increasing muscle soreness or pain.
    • Greater severity or more frequent episodes of muscle cramping.
    • Change in your same or next day function, such as feeling more unsteady, or navigating stairs is harder and more exertional than before, or you feel more unstable at your ankles/knees with greater foot drop or knee buckling.
    • If you wake up the next day and continue to feel exhausted or need “several days to recover.”

• If you found that the exercise session was too hard, adjust one of the following next time until you have no adverse effects or excessive fatigue:

• • • Duration of the exercise session.
    • Exercise dosage in one session, whether reducing number of repetitions or number of exercises performed.
    • Exercise intensity, specifically reducing speed or resistance.

Finding a Program Right for YOU

Exercise can be thought of as a prescription. It will be different between each person and exercises should be chosen based on an individual’s functional capacity and also, their fall risk. It is highly recommended to seek professional evaluation by a physical and/or occupational therapist to assist in developing a specific routine for you. If you, or your underlying condition changes, you can request to return to your rehabilitation team to modify your activity plan accordingly. Seeking care from a neurologic-based rehabilitation provider versus an orthopedic-based, such as those who care for back or shoulder pain, is most appropriate and will be able to better address the multitude of symptoms you experience and how this impacts your function, safety, and participation in what you want or hope to do. Hopefully with advancement of professional and public resources, such as this newsletter, confidence grows and you can feel all of your needs and care are met and understood by your entire healthcare team and you feel more confident in managing your own symptoms and living your life as well as you can.

References:

1. Mayo Clinic. Peripheral Neuropathy. 2019, May 22.
   https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
2. National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy Fact Sheet. 2019, Aug 13. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet
3. Centers for Disease Control and Prevention. Physical Activity Recommendations for Different Age Groups. 2020 Jan 31. https://www.cdc.gov/physicalactivity/basics/age-chart.htmlStreckmann F, Zopf EM, Lehmann HC, et al.
4. Exercise Intervention Studies in Patients with Peripheral Neuropathy: A Systematic Review. Sports Medicine. 2014;44(9):1289-1304. doi:10.1007/s40279-014-0207-5
5. Saberi S, Wheeler M, Bragg-Gresham J, et al. Effect of Moderate-Intensity Exercise Training on Peak Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy: A Randomized Clinical Trial. JAMA. 2017;317(13):1349–1357. doi:10.1001/jama.2017.2503
6. Dobson JL, McMillan J, Li L. Benefits of exercise intervention in reducing neuropathic pain. Front Cell Neurosci. 2014;8:102. doi:10.3389/fncel.2014.00102
7. What is Submaximal Graded Exercise? Strong, PV. LiveStrong. https://www.livestrong.com/article/534772-what-is-submaximal-graded-exercise/.

For more recommendations on exercising with peripheral neuropathy click here.

Written by Sarah Dahlhauser, OTR/L, OTD and Sarah Boyd, PT, DPT

About the Authors:

Sarah Dahlhauser, OTR/L, OTD and Sarah Boyd, PT, DPT are with the Mayo Clinic, Department of Physical Medicine and Rehabilitation in Rochester, MN.