A Focused Exercise Regimen Improves Clinical Measures of Balance in Patients With Peripheral Neuropathy.

A Focused Exercise Regimen Improves Clinical Measures of Balance in Patients With Peripheral Neuropathy Richardson JK, Sandman D, Vela S (Department of Physical Medicine and Rehabilitation and University of Michigan Ann Arbor, Mich), Arch Phys Med Rehabil. 2001;82:205-209.

This prospective, controlled, single-blind study was conducted to determine if a specific exercise regimen had an effect on clinical measures of postural stability and confidence in a patient population with peripheral neuropathy (PN).

Twenty subjects with diabetes mellitus and PN that was verified by electrodiagnostic evidence participated in the study. The first 10 subjects were placed in the intervention group (9 completed the study; 8 men, 1 woman; mean age=64.0 [+ or -] 6.3years) and the second 10 formed the control group (7 completed the study; 4 men, 3 women; mean age=63.3 [+ or -] 7.6 years). Before the start of the intervention period, all subjects received a physical examination and electrodiagnostic testing, and the severity of their PN was assessed using the Michigan Diabetes Neuropathy Score (MDNS). The outcome measures in this study were timed tandem stance, functional reach, timed unipedal stance, and scores on the Activities-specific Balance Confidence (ABC) Scale.

The intervention exercises were performed daily for 3 weeks and consisted of a warm-up of active range-of-motion (ROM) exercises for the ankle; bipedal and unipedal closed-chain toe raises, heel raises, and ankle inversion and eversion; wall slides; and unipedal balance for time. Subjects were encouraged to perform the movement as rapidly as possible to develop maximal torque with each repetition. The exercises for the control group were performed at least 5 times per week for 3 weeks and consisted of seated cervical active ROM and upper-extremity exercises with a resistive band.

At baseline, the intervention group demonstrated a trend toward more severe PN than the control group, as measured by the MDNS; however, there were no differences between the groups at baseline with respect to tandem stance, functional reach, unipedal stance, and ABC scores. After completion of the exercise regimens, the intervention group demonstrated statistically significant improvements in tandem stance (17.5 [+ or -] 13.4 seconds pre-exercise versus 23.5 [+ or -] 10.9 seconds postexercise), functional reach (10.5 [+ or -] 2.1 inches versus 11.5 [+ or -] 2.2 inches), and unipedal stance (5.4 [+ or -] 4.7 seconds versus 11.6 [+ or -] 10.2 seconds). In contrast, the control group did not demonstrate improvements in any of the measurements.

The authors concluded that the intervention group tolerated a brief, intense exercise regimen designed to rapidly increase available distal lower-extremity strength and that the exercise improved 3 clinical measures of balance. They also concluded that these improvements develop relatively quickly. Although they did not know whether these improvements translate into decreased fall risk, the authors recommended that clinicians consider prescribing these exercises to patients with postural instability related to PN, given the minimal risk from the intervention exercises and the potentially high benefit of preventing falls in this population.

Michael J Shoemaker, PT, DPT
Spectrum Health
Grand Rapids, Mich