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Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift

Patricia M. Kluding, Sonja K. Bareiss, Mary Hastings, Robin L. Marcus, David R. Sinacore, Michael J. Mueller
DOI: 10.2522/ptj.20160124 Published 19 October 2016
Patricia M. Kluding
P.M. Kluding, PT, PhD, Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, 3901 Rainbow St, MS 3051, Kansas City, KS 66160 (USA).
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  • For correspondence: pkluding@kumc.edu
Sonja K. Bareiss
S.K. Bareiss, PT, PhD, Physical Therapy Program, Bellarmine University, Louisville, Kentucky.
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Mary Hastings
M. Hastings, PT, DPT, Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri.
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Robin L. Marcus
R.L. Marcus, PT, PhD, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah.
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David R. Sinacore
D.R. Sinacore, PT, PhD, FAPTA, Program in Physical Therapy, Washington University School of Medicine in St Louis.
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Michael J. Mueller
M.J. Mueller, PT, PhD, FAPTA, Program in Physical Therapy, Washington University School of Medicine in St Louis.
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Abstract

Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person's insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group.

  • Received March 20, 2016.
  • Accepted July 11, 2016.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 12 Table of Contents
Physical Therapy: 96 (12)

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  • myMoves Program: Feasibility and Acceptability Study of a Remotely Delivered Self-Management Program for Increasing Physical Activity Among Adults With Acquired Brain Injury Living in the Community
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Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift
Patricia M. Kluding, Sonja K. Bareiss, Mary Hastings, Robin L. Marcus, David R. Sinacore, Michael J. Mueller
Physical Therapy Oct 2016, DOI: 10.2522/ptj.20160124

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Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift
Patricia M. Kluding, Sonja K. Bareiss, Mary Hastings, Robin L. Marcus, David R. Sinacore, Michael J. Mueller
Physical Therapy Oct 2016, DOI: 10.2522/ptj.20160124
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Subjects

  • Perspectives
  • Intervention
    • Therapeutic Exercise
  • Neurology/Neuromuscular System
    • Neurology/Neuromuscular System: Other
  • Diabetes

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