The traditional clinical view has discouraged weight-bearing activity such as walking for people with diabetic peripheral neuropathy. The presumption was that weight-bearing activities increase the risk of foot ulcers among patients with diabetes and insensate feet. This advice forced people with diabetic neuropathy into a big dilemma: you need to exercise to stay healthy, but you also need to reduce repetitive loading on your feet.

The recognition of the overall importance of exercise for people with diabetes continues to grow. The American Diabetes Association (ADA) now makes these general recommendations for people with Type 2 diabetes:

• Get at least 150 minutes per week of moderate intensity aerobic physical activity. The ADA defines moderate intensity as 50-70% of maximum heart rate.
• Perform resistance training (weight lifting for example) 3 times a week unless a patient’s other medical conditions counsel against it.

For people with diabetes and severe peripheral neuropathy, the ADA says “it may be best to encourage non-weigh-bearing activities such as swimming, bicycling, or arm exercises.” ADA Standards of Medical Care in Diabetes – 2009.

What about this advice from the ADA? In weighing this advice, practitioners should also consider several recent studies. Two descriptive studies indicate that patients with diabetes and insensate feet who engage in daily activity decrease their risk of foot ulceration compared to those who are less active. LeMaster et al. 2003; Armstrong et al. 2004. A more recent, randomized controlled trial found that promoting weight-bearing activity did not lead to increases in foot ulcers among people with diabetic neuropathy. LeMaster et al. 2008. (follow links to get free copy of full article.)

If you have diabetic peripheral neuropathy, you should discuss this topic with your podiatrist and other health care providers. Don’t hesitate to provide them with the LeMaster article.