Exercise for people with peripheral neuropathy (Cochrane Review)

Physiotherapy Division, GKT School of Biomedical Sciences, Kings College London, Shepherds House, Guy's Campus, London Bridge, London, UK, SE1 1UL.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2004; 4(4):CD003904. DOI: 10.1002/14651858.CD003904.pub2
Source: PubMed


Peripheral neuropathies are a wide range of diseases affecting the peripheral nerves. Demyelination or axonal degeneration gives rise to a variety of symptoms including reduced or altered sensation, pain, muscle weakness and fatigue. Secondary disability arises and this may result in adjustments to psychological and social function. Exercise therapy, with a view to developing strength and stamina, forms part of the treatment for people with peripheral neuropathy, particularly in the later stages of recovery from acute neuropathy and in chronic neuropathies.
The primary objective was to examine the effect of exercise therapy on functional ability in the treatment of people with peripheral neuropathy. In addition, secondary outcomes of muscle strength, endurance, broader measures of health and well being, as well as unfavourable outcomes were examined.
We searched the Cochrane Neuromuscular Disease Group register (July 2002 and updated February 2004) and MEDLINE (from January 1966 to June 2004), EMBASE (from January 1980 to June 2004), CINAHL (from January 1982 to July 2002) and LILACS (from January 1982 to July 2002) electronic databases. Bibliographies of all selected randomised controlled trials were checked and authors contacted to identify additional published or unpublished data.
Any randomised or quasi-randomised controlled trial comparing the effect of exercise therapy with no exercise therapy or drugs or an alternative non-drug treatment on functional ability (or disability) in people with peripheral neuropathy at least eight weeks after randomisation was included.
Two reviewers independently selected eligible studies, rated the methodological quality and extracted data.
Only one trial fully met the inclusion criteria. An additional two trials assessed outcomes less than eight weeks after randomisation and were also included. Methodological quality was poor for several criteria in each study. Data used in the three studies could not be pooled due to heterogeneity of diagnostic groups and outcome measures. The results of the included trials failed to show any effect of strengthening and endurance exercise programmes on functional ability in people with peripheral neuropathy. However, there is some evidence that strengthening exercise programmes were moderately effective in increasing the strength of tested muscles.
There is inadequate evidence to evaluate the effect of exercise on functional ability in people with peripheral neuropathy. The results suggest that progressive resisted exercise may improve muscle strength in affected muscles.

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Available from: Lynne Turner-Stokes, Aug 13, 2014
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    • "There have been few systematic studies on the efficacy of rehabilitation, including physical therapy for patients with GBS. In 2004, a Cochrane Systematic Review was published on exercise in peripheral neuropathy [8] "
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    • "Whether this extrapolation is valid remains to be seen but it is an important issue as exercise training to improve strength in CMT is a growing area of research. The few studies, at present, do not show any harmful effects of exercise on CMT and may show some subtle improvements [6] [19]. However, it is important to note that strengthening exercises in these studies concentrate on proximal muscles whereas the distal muscles are more affected in CMT [20]. "
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    • "It has been observed that the strength of the lower limb muscles can be improved through a specific muscles-strengthening program in healthy adults, by progressively increasing resistance [52]. When we consider DPN patients, the review published by White et al. [53] points out that there is not sufficient evidence to support the effects of lower limb strengthening and cardiovascular training on the improvement of their quality of life. However, all the rehabilitation protocols of this review accomplished generalised muscle strengthening, without the specificity of selecting the most impaired muscle groups due to the neuropathy: the ankle and foot intrinsic muscles. "
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