A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy: a randomized clinical trial. The effects of a home exercise program on impairment and health-related quality of life in persons with chronic peripheral neuropathies.
To determine the effect of a specific exercise regimen on clinical measures of postural stability and confidence in a population with peripheral neuropathy (PN).
                Prospective, controlled, single blind study.
                Outpatient clinic of a university hospital.
                Twenty subjects with diabetes mellitus and electrodiagnostically confirmed PN.
                Ten subjects underwent a 3-week intervention exercise regimen designed to increase rapidly available distal strength and balance. The other 10 subjects performed a control exercise regimen.
                Unipedal stance time, functional reach, tandem stance time, and score on the activities-specific balance and confidence (ABC) scale.
                The intervention subjects, but not the control subjects, showed significant improvement in all 3 clinical measures of balance and nonsignificant improvement on the ABC scale.
                A brief, specific exercise regimen improved clinical measures of balance in patients with diabetic PN. Further studies are needed to determine if this result translates into a lower fall frequency in this high-risk population. A randomized clinical trial on the effects of strength training was performed in myotonic dystrophy (MyD) patients and patients with hereditary motor and sensory neuropathy (HMSN). Training and most measurement tools involved the proximal lower extremity muscles. The participants trained 3 times a week for 24 weeks with weights adapted to their force. Strength was evaluated by isokinetically measured knee torque. Fatiguability was assessed by the time an isometric contraction could be sustained. Functional performance was measured by timed motor performance and by questionnaires on functional performance. Serum myoglobin (Mb) levels were determined to detect changes in muscle fiber membrane permeability. The MyD group included 33 participants, and the HMSN group included 29 participants. Within each diagnostic group, patients were individually matched and subsequently randomized for treatment allocation. In the MyD patients, none of the measurement techniques showed any training effect. Neither were there signs of deterioration caused by the training. In the HMSN group, knee torques increased. Timed motor performance did not change, although the questionnaires showed an improvement on items related to upper-leg function. Mb levels did not change significantly as a result of the training. In conclusion, the MyD group showed neither positive nor negative effects of the training protocol, whereas the training produced a moderate increase in strength and leg-related functional performance in the HMSN group. The effects of a home exercise program for persons with chronic peripheral neuropathies (CPN) have not been documented. We compared changes in impairment and health-related quality of life (HRQL) between exercise and control groups, investigated the relationship between HRQL and measures of impairment, and contrasted the HRQL of individuals with CPN to that previously described for the general population.
                Twenty-eight subjects with CPN, aged 23 to 84 years (mean = 56.2, SD = 14.9), completed the study.
                Impairment measures included average muscle score (AMS), handgrip force, walking time, and forced vital capacity. The HRQL instrument measured the eight scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the component scales. The exercise group (n = 14) completed a 6-week home exercise program. The control group (n = 14) did not participate in a home exercise program.
                There was an increase in the AMS in the exercise group compared with the control group. No other between-group differences were found. The exercise group improved in scores on the role limitation scales of the SF-36. The AMS and walking time were moderately correlated with the physical function scale of the SF-36 (r = .55 and -.62, respectively). The SF-36 scores of individuals with CPN were lower than scores previously described for the general population.
                The home exercise program appears to be an important component of the treatment of persons with CPN. Compared with the general population, patients with CPN appear to have a lower HRQL, but some areas appear to improve following a home exercise program.
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.