Depending on the cause and person, symptoms of neuropathy can include temporary or permanent numbness; tingling, pricking, or burning sensations; increased sensitivity to touch and pain; muscle weakness or wasting; paralysis or dysfunction in organs or glands; and impairment to urination and sexual function. (2,3) In addition, neuropathy can cause difficulty swallowing and gastrointestinal problems like constipation, nausea, and vomiting, according to Stanford Medicine. In the case of diabetic peripheral neuropathy, the most prevalent form, symptoms involve a progressive change in sensation, as well as pain and weakness that start in the feet (or, less commonly, the hands), and then move their way up the extremities over time. As the neuropathy progresses, it can lead to a loss of sensation in the affected areas or a loss of proprioception (the brain’s ability to sense movement and location of your limbs), which can lead to imbalance and falling. (4,5) Regular, supervised exercise can help an individual better manage blood sugar, build strength, reduce falls, lower high blood pressure (hypertension), improve blood flow to the extremities, prevent muscle wasting, reduce cramps, sleep better, and improve sexual health — all benefits that help to manage or reduce neuropathic symptoms. (3,6,7) The following are four simple steps to take to ensure you can practice fitness safely while managing neuropathy. “Pain is a protective mechanism,” says Peter Highlander, DPM, a podiatrist based in Bellevue, Ohio. “I’ve had patients walk in who are profoundly neuropathic with bad fractures, and it doesn’t hurt them. They think, I just sprained my ankle. So they just continue to walk on it, and things just get worse and worse, and then a lot of times require a major surgical reconstruction,” he explains. Likewise, if neuropathy is affecting movement in your extremities, you may need to make adjustments under the guidance of a physical therapist so that you don’t set back your progress with an injury.
2. Choose a Type of Exercise That’s Appropriate for You
Let’s assume that you have undergone a doctor’s assessment, which may include a foot examination, a neuropathy assessment, and a check of blood flow to the extremities, as well as any deformities or other risk factors for foot ulceration, as is the practice of Dr. Highlander. Perhaps you have received a referral for a physical therapist. Start with an activity that takes your condition into account. If neuropathy has affected sensation in your feet or legs or you have developed a complication such as a foot ulcer or open sore, the American Diabetes Association (ADA) recommends that you use caution with high-impact, strenuous, or prolonged weight-bearing exercise, such as walking a long distance. It recommends walking shorter distances, cycling, swimming, and chair exercises in a moderate climate over running, jumping, and lifting weights, particularly in hot or cold weather. Definitely wait until any injuries or sores have healed before doing any weight-bearing exercises. (8) “You can opt for water therapy or a stationary bicycle. Anything that works to increase the overall cardiovascular fitness of patients will help to increase the overall circulatory system and hopefully improve symptoms,” says Matthew Villani, DPM, a podiatrist based in Orange City, Florida.
3. Be Sure to Wear the Right Footwear When Exercising With Neuropathy
Make sure you have the right gear to succeed. The ADA advises wearing shoes with silica gel or air midsoles for weight-bearing activities like walking because they are designed to reduce stress on your feet and joints. Dr. Villani adds: “Make sure that your shoes are wide enough and large enough. Sometimes people with neuropathy like their shoes to be more snug so that they can still have that sensation that they can feel their shoes, but that can increase their susceptibility to pressure points.” Similarly, close-toed shoes are always preferable to properly protect your feet. With sandals you might unknowingly stub your toe or get a rock in your shoe, leading to cuts and blisters. People with peripheral neuropathy should also look for shoes with a high toe box. In cases of severe neuropathy, or if you have difficulty with shoes you’ve purchased, you may need to see an orthotist for a custom shoe. If you need to wear shoes for diabetes, Villani says don’t let the cost stop you. “Both government and private insurers pay a substantial portion, and sometimes all, of the cost for diabetic shoes if you meet the qualifications. So if your neuropathy is from diabetes and you have a higher risk of ulceration, then that is the first line of treatment — prevention.” Opt for socks that are made out of fabrics that reduce friction and pull moisture away from your skin, thereby reducing the chance of blisters and sores. Avoid cotton, and look at CoolMax, polypropylene, or acrylic, the ADA suggests. (8) And while you should be checking your feet daily for damage anyway, it’s especially imperative on days you exercise. “Do a daily inspection before and after you do exercise to make sure there are no areas of increased redness, skin breakdown,” Villani says. “We recommend that people wear white socks so that if there’s any sort of drainage or bleeding, it can be seen.” Highlander elaborates. “If you are going to go for a walk for exercise or even a stationary bike for something like that, afterward take off your socks and look at the bottoms and back of your feet. Purchase a plastic mirror that you can keep at your bedside to look at the bottoms of your feet if you are not flexible enough to see the bottoms on your own, or have a loved one check them.” Of course, once you have taken all of the necessary precautions, get as much exercise as your condition will allow.
