Streckmann, F., Zopf, E., Lehmann, H., May, K., Rizza, J., Zimmer, P., . . . Baumann, F. (2014). Exercise intervention studies in patients with peripheral neuropathy: A systematic review. Sports Medicine, 44, 1289–1304. 

DOI Link

Purpose

STUDY PURPOSE: To analyze exercise interventions for patients with peripheral neuropathy (PNP) to evaluate the possible benefits of exercise
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, MEDLINE, Cochrane database, and relevant reference lists
 
KEYWORDS: Peripheral neuropathy, PNP, CIPN, chemotherapy-induced peripheral neuropathy, diabetic neuropathy, physical activity, physical exercise, physical fitness, exercise, exercise program, exercise intervention, moving therapy, sports therapy, sport, endurance, aerobic training, resistance training, strength training, strength, balance, balance training, balance exercise, coordination, coordination exercise, gait, postural stability, postural control, proprioception 
 
INCLUSION CRITERIA: Had to have examined the effects of an exercise intervention in patients with PNP
 
EXCLUSION CRITERIA: Animal studies, expert opinions without critical appraisal, studies with less than 10 patients, studies with no control group, studies that combined exercise and nutrition, studies evaluating therapeutic footwear, studies evaluating medication for PNP. Reviews were not included in analysis but were analyzed for possibly relevant literature.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 8,701 in PubMed, 959 in MEDLINE and Cochrane, and 177 in relevant reference lists
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Literature reviewed and graded according to the Oxford Levels of Evidence

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 18
  • TOTAL PATIENTS INCLUDED IN REVIEW = 841 total patients in 10 randomized, controlled trials (RCTs) and 8 controlled clinical trials (CCTs)
  • KEY SAMPLE CHARACTERISTICS: 11 studies in diabetic neuropathy, 1 study in chemotherapy-induced PNP, 6 studies with PNP of other derivations, 12 high quality studies (levels 1 and 2), 6 poor quality studies (level 4)

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results

Five studies assessed the influence of balance training on the side effects of PNP and showed a significant impact on balance control. Two studies also showed improved gait parameters. Improved motor, sensory, and metabolic symptoms was observed with tai chi. Combinations of endurance, balance, and strengthening exercises showed a positive effect on motor performance only if exercises were performed standing or walking. One RCT in chemotherapy-induced PNP showed that exercise (sensorimotor, endurance, and resistance training) can reduce quality of life, level of activity, and sensitivity. Only three studies in the cohort of those with PNP from various causes showed they were able to achieve improvements through the exercise regimen. The other three studies in this group showed no significant changes after intervention. None of the studies reported serious adverse effects, although one of the diabetic neuropathy studies reported one calf strain from treadmill walking.

Conclusions

Evidence for exercise interventions in those with PNP has improved, although study quality is diverse. Overall, the quality of studies included in this review was 2b with the best evidence in those with diabetes and PNP. Current data suggest that exercise is feasible, safe, and beneficial.  Exercise compliance was overall good, and only mild adverse events were reported. Specific treatment for nerve damage was not available, and the efficacy of pharmaceutical interventions is questionable.

Limitations

Patient cohorts were very heterogeneous. Because of the heterogeneity, the results are not very generalizable. Eighteen studies were included (small sample).

Nursing Implications

More research is needed on exercise interventions, particularly in regard to the patients with cancer who have other symptoms to contend with as well. Nurses should educate patients about PNP and encourage enrollment in clinical trials if available.

Legacy ID

6247