1. Peripheral Neuropathy

About the condition:

Diabetes can cause damage to nerves, especially in the limb extremities, causing tingling, pain or loss of ability to sense pain or extreme temperatures in your toes, feet and fingers.

Dangers of exercising wrongly with the condition:

• Repetitive weight bearing exercises on insensitive feet can cause you to unknowingly develop blisters, abrasions and even fractures of the feet. Damage from diabetes reduces blood flow and oxygen flow to the limb extremities therefore making it harder for any open wounds and ulcerations to heal. These can lead to serious infections that could ultimately necessitate amputation
• Peripheral neuropathy also increases the risk of loss of balance and subsequently the increased risk of falling. In addition, the pain and burning sensation in the feet can alter your gait thus making it difficult to walk

What you can do:

Diabetes patients with mild neuropathy should be able to do light to moderate lower limb weight-bearing exercises. Those with severe peripheral neuropathy should avoid excessive lower limb weight bearing activities such as prolonged walking, or high impact lower limb activities such as running or jumping.

Recommended exercises include:

• Workout machines that let you sit back while engaging your arms and legs (such as the recumbent bike or stepper)   
• Water-based activities such as swimming or water-aerobics
• Balance exercises such as tai chi and yoga

Exercise tips:

• When engaging in any land-based exercise, be sure to wear proper footwear and check your feet daily for any skin injuries before and after your activities
• Avoid any water-based activities if you are nursing an open wound and always keep your feet clean and dry

2. Autonomic Neuropathy

About the condition:

Autonomic (central) neuropathy occurs when there is diabetes-related damage to the central nervous system and the nerves that control involuntary bodily functions. It can therefore affect blood pressure, temperature control, digestion, bladder function and even sexual function.

Dangers of exercising wrongly with the condition:

• For those with autonomic neuropathy, the usual heart rate guidelines for exercise do not apply due to the significant cardiac changes. For example, you may have an elevated heart rate at rest as well as a lesser rise in heart rate during physical exertion.
• Severe autonomic neuropathy may make it difficult to change body positions (e.g., going from sitting to standing or from lying to sitting) without experiencing postural drop in blood pressure, which can result in dizziness or fainting.
• Another concern is hyperthermia (elevated body temperature beyond normal) during physical activity due to the dysfunction in the body’s temperature regulation and sweat gland activity, therefore potentially leading to severe dehydration

What you can do:

Diabetes patients with autonomic neuropathy must approach any increase in physical activity levels with caution because of the role of the autonomic nervous system in hormonal and cardiovascular regulation during exercise.

Furthermore, exercise intensity should be monitored by means other than heart rate alone because it may no longer rise as much as expected or be the best way to monitor exercise intensity.

To know the level that you are exercising at, use the “Talk Test”:

• Light intensity exercise — you can sing or whistle while exercising
• Moderate intensity exercise — you can talk while exercising
• High intensity exercise — you are unable to talk while exercising

Recommended exercises include:   

• Light intensity aerobic exercises that do not involve rapid changes in movements or posture (such as brisk walking, line-dancing or pilates)
• Workout machines that let you sit back while you engage your arms and legs, and yet avoiding prolonged standing postures (such as the recumbent bike or seated weights machines)
• Balance exercises (such as qi gong or taichi)

Exercise tips:

• Check your blood glucose more frequently as having autonomic neuropathy means you may no longer experience the symptoms of low blood glucose (hypoglycaemia)
• Ensure adequate hydration at all times as dehydration may worsen symptoms
• Engage in longer warm-ups and cool down periods especially with more intense workouts due to significant changes in blood pressure

Ref: M19