A Moderate-Intensity Weight-Bearing Exercise Program for a Person With Type 2 Diabetes and Peripheral Neuropathy

Background and Purpose. The exercise guidelines for people with diabetes mellitus and peripheral neuropathy (DM + PN) have recently changed to allow moderate-intensity weight-bearing exercise, but there are few reports in the literature describing appropriate weight-bearing exercise for those with DM + PN. This case report describes a successful and safe progressive exercise program for an individual with DM + PN. Case Description. The patient was a 76-year-old man with a 30-year history of DM + PN. He participated in a 12-week, moderate-intensity, progressive exercise program (heart rate approximately 75% of maximum heart rate; rate of perceived exertion = 11-13; 3 times per week) involving walking on a treadmill, balance exercises, and strengthening exercises for the lower extremities using body weight resistance. Outcomes. Measurements were taken before and after the 12 weeks of exercise. The patient's Six-Minute Walk Test distance increased from 1,200 to 1,470 ft. His Physical Performance Test score did not change. His Foot and Ankle Ability Measure questionnaire score improved from 89 to 98. Dorsiflexor and plantar-flexor peak torque increased (dorsiflexor peak torque: right side = 4.5-4.6 N . m, left side = 2.8-3.8 N . m; plantar-flexor peak torque: right side = 44.7-62.4 N . m, left side = 40.8-56.0 N . m), as did his average daily step count (6,176-8,273 steps/day). Close monitoring of the plantar surface of the feet indicated that the exercise program was well tolerated and there were no adverse events. Discussion and Conclusions. This case report describes a moderate-intensity exercise program that was successful in increasing some measures of muscle strength, physical function, and activity without causing injury in an individual with DM + PN.