title: Exercise intervention studies in patients with peripheral neuropathy: a systematic review.
abstract: BACKGROUND
  Peripheral neuropathies (PNPs) encompass a large group of disorders of heterogeneous origin which can manifest themselves with sensory and/or motor deficits depending on the predominantly affected nerve fiber modality. It represents a highly prevalent disease group which can be associated with significant disability and poor recovery. Exercise has the potential to improve side effects of PNP.
  
  
  OBJECTIVE
  Our objective in this systematic review was to analyze exercise interventions for neuropathic patients in order to evaluate the possible benefits of exercise.
  
  
  METHODS
  Three independent reviewers used PubMed, MEDPILOT (MEDLINE), Cochrane, and relevant reference lists to obtain the data. Relevant studies were graded according to the Oxford Levels of Evidence.
  
  
  RESULTS
  Eighteen studies (ten randomized controlled trials and eight controlled clinical trials) met all inclusion criteria. Three (diabetic) studies were ranked very high quality [1b (A)], nine high quality (four diabetes, one cancer, four others) [2b (B)], while six (four diabetes, two others) showed low quality (4/C). Current data suggests that exercise is a feasible, safe, and promising supportive measure for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN), suggesting that endurance training has the potential to prevent the onset of and reduce the progression of DPN. In general, balance exercises showed the highest effect on the motor as well as sensory symptoms in all types of PNP.
  
  
  CONCLUSIONS
  Overall, balance training appears to be the most effective exercise intervention. Studies focusing exclusively on strength, or a combination of endurance and strength, appear to have a lower impact. For metabolically-induced neuropathies, endurance training also plays an important role. Further research with high methodological quality needs to be conducted in order to establish evidence-based clinical recommendations for neuropathic patients.
authors.affiliation: Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany, f.streckmann@dshs-koeln.de.
authors.forename: Fiona
authors.initials: F
authors.lastname: Streckmann
authors.forename: Eva M
authors.initials: EM
authors.lastname: Zopf
authors.forename: Helmar C
authors.initials: HC
authors.lastname: Lehmann
authors.forename: Kathrin
authors.initials: K
authors.lastname: May
authors.forename: Julia
authors.initials: J
authors.lastname: Rizza
authors.forename: Philipp
authors.initials: P
authors.lastname: Zimmer
authors.forename: Albert
authors.initials: A
authors.lastname: Gollhofer
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Bloch
authors.forename: Freerk T
authors.initials: FT
authors.lastname: Baumann
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D048909:Diabetes Complications / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000534:rehabilitation*; D011788:Quality of Life
chemical_list: D000970:Antineoplastic Agents