Effects of exercise therapy on diabetic neuropathy: A systematic review and meta-analysis

Abstract

Objective: To evaluate the effects of exercise therapy on neuropathic symptoms, signs, psychosocial aspects, and physical function in people with diabetic neuropathy (DN). Methods: A search in PubMed, Web of Science, Physiotherapy Evidence (PEDro), and Cochrane databases was performed from inception to 24th February 2023. Randomized clinical trials (RCTs) were selected in patients with DN comparing exercise therapy with a control group. The studies’ methodological quality was assessed with the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality. Results: Eleven RCTs (n=517 participants) were included. Nine studies showed high methodological quality. Mean (MD) and standardized mean differences (SMD) were observed in favor of exercise therapy for symptoms (MD= -1.05; confidence interval 95%= -1.90 to -0.20), signs (SMD= -0.66; confidence interval 95%= -1 to -0.32), and physical function (SMD= -0.45; confidence interval 95%= -0.66 to -0.24). No changes were found in psychosocial aspects (SMD= -0.37; confidence interval 95%= -0.92 to 0.18). The overall quality of evidence was very low. Conclusion: The quality of evidence suggesting that exercise therapy provides short-term benefits in neuropathic symptoms, signs, and physical function in patients with DN is very low. Furthermore, there were no effects found on psychosocial aspects.