Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Exercise and Diabetic Neuropathy

Implications for Exercise Participation and Prescription for Patients with Insulin-Dependent and Non-Insulin-Dependent Diabetes Mellitus

  • Chapter
Clinical Management of Diabetic Neuropathy

Part of the book series: Contemporary Endocrinology ((COE,volume 7))

Abstract

Diabetes mellitus affects nearly 15 million Americans and is associated with debilitating complications that include, retinopathy, coronary artery disease, peripheral vascular disease, nephropathy, and autonomic and peripheral neuropathy (1). Recent evidence suggests that programs designed to increase physical activity may be useful in the treatment and prevention of diabetes and diabetic complications. In addition, all of the resultant complications of diabetes may have effects on exercise capacity and physical function. The purpose of the present chapter will be to review the metabolic effects of exercise and physical activity on carbohydrate metabolism and insulin sensitivity with specific reference to the metabolic responses to exercise in patients with insulindependent (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). Secondly, peripheral and autonomic neuropathy in diabetes will be discussed in reference to their influence on exercise capacity and function. The final section of this review will concentrate on exercise recommendations for the diabetic patient (with and without neuropathy) to promote health and encourage an active lifestyle.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. National Institutes of Health. Diabetes in America, 2nd ed. National Institutes of Health, Bethesda, 1995.

    Google Scholar 

  2. Taylor HL, Buskirk E, Henschel A. Maximal oxygen uptake as an objective measure of cardiorespiratory performance. Am J Physiol 1955;8:73–80.

    CAS  Google Scholar 

  3. Kemmer F, Berger M. Therapy and better quality of life: the dichotomous role of exercise in diabetes mellitus. Diabetes/Metab Rev 1986;2:53–68.

    Article  CAS  Google Scholar 

  4. Katz A, Broberg S, Sahlin K, Wahren J. Leg glucose uptake during maximal dynamic exercise in humans. Am J Physiol 1986;251:E65–E70.

    PubMed  CAS  Google Scholar 

  5. Galbo H, Richter E, Hilsted J, Holst J, Christensen N, Henrickson J. Hormonal regulation during prolonged exercise. Ann NY Acad Sci 1977;301:72–80.

    Article  PubMed  CAS  Google Scholar 

  6. Wasserman DH. Control of glucose fluxes in the post-absorptive state. Ann Rev Physiol 1995;191–218.

    Google Scholar 

  7. Vranic M, Kawamori R, Pek S, Kovacevic N, Wrenshall GA. The essentially of insulin and the role of glucagon in regulating glucose utilization and production during strenuous exercise in dogs. J Clin Invest 1976;57:245–255.

    Article  PubMed  CAS  Google Scholar 

  8. Hermansen L, Hultman E, Saltin B. Muscle glycogen during prolonged severe exercise. Acta Physiol Scand 1967;71:129–137.

    Article  PubMed  CAS  Google Scholar 

  9. Newsholme EA, Start C. In: Regulation in Metabolism. Wiley, New York, 1979, pp. 255.

    Google Scholar 

  10. Zinman B, Murray F, Vranic M, Albisser A, Leibel B. McLean P, Marliss E. Glucoregulation during moderate exercise in insulin treated diabetics. J Clin Endocrinol 1977;45:641–652.

    Article  CAS  Google Scholar 

  11. Richter E, Turcotte L, Hespel P, Kiens B. Metabolic responses to exercise: effects of endurance training and implications for diabetes. Diabetes Care 1992;15:1767–1776.

    Article  PubMed  CAS  Google Scholar 

  12. Sorrentino E, Stump D, Potter BJ, et al. Oleate uptake by cardiac myocytes is carrier mediated and involves a 40-kD plasma membrane fatty acid binding protein similar to that of liver, adipose tissue, and gut. J Clin Invest 1988;82:928–935.

    Article  PubMed  CAS  Google Scholar 

  13. Stremmel W. Fatty acid uptake by isolated rat heart myocytes represents a carrier-mediated transport process. J Clin Invest 1988;81:844–852.

    Article  PubMed  CAS  Google Scholar 

  14. Rennie MJ, Edwards RHT, Krywawych S, Davies CTM, Halliday D, Waterlow JC, Milward DJ. Effect of exercise on protein turnover in man. Clin Sci 1981;62:627–639.

    Google Scholar 

  15. Meredith CN, Zackin MJ, Frontera WR, Evans WJ. Dietary protein requirements and body protein metabolism in endurance-trained men. J Appl Physiol 1989;66:2850–2856.

    PubMed  CAS  Google Scholar 

  16. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Appl Physiol 1992;73:1986–1995.

    PubMed  CAS  Google Scholar 

  17. Vitug A, Schneider S, Ruderman N. Exercise and type I diabetes mellitus. 1988;16:285–304

    CAS  Google Scholar 

  18. Zinman B, Zuniga-Guajardo S, Kelly D. Comparison of the acute and long term effects of exercise on glucose control in type I diabetes. Diabetes Care 1984;7:515–519.

    Article  PubMed  CAS  Google Scholar 

  19. Arvill A. Relationship between the effects of contraction and insulin on the metabolism of the isolated levator ani muscle of the rat. Acta Endocr 1967;56:27.

    PubMed  CAS  Google Scholar 

  20. Helmreich E, Cori CF. The distribution of pentoses between plasma and muscle. J Biol Chem 1957;224:663.

    PubMed  CAS  Google Scholar 

  21. Wallberg-Henriksson H. Interaction of exercise and insulin in type II diabetes mellitus. Diabetes Care 1992;15:1777–1782.

    Article  PubMed  CAS  Google Scholar 

  22. Douen AG, Ramlal T, Cartee GD, Klip A. Exercise modulates the insulin-induced translocation of glucose transporters in rat skeletal muscle. FEBS Lett 1990;261:256–260.

    Article  PubMed  CAS  Google Scholar 

  23. Fushiki T, Wells JA, Tapscott EB, Dohm GL. Changes in glucose transporters in muscle in response to exercise. Am J Physiol 1989;256:E580–E587.

    PubMed  CAS  Google Scholar 

  24. Klip A, Ramlal T, Young DA, Holloszy JO. Insulin induced translocation of glucose transporters in rat hindlimb muscles. FEBS Lett 1987;224:224–230.

    Article  PubMed  CAS  Google Scholar 

  25. Holloszy JO, Constable SH, Young DA. Activation of glucose transport in muscle by exercise. Diabetes /Metab Rev 1986;1:409–423.

    Article  CAS  Google Scholar 

  26. Ivy J. In: Pando KB, ed. Exercise and Sports Sciences Review, vol. 15, Macmillan, New York, 1987, pp. 29–51.

    Google Scholar 

  27. Wallberg-Henriksson H, Holloszy JO. Activation of glucose transport in diabetic muscle: responses to contraction and insulin. Am J Physiol 1985;249:C233–C237.

    PubMed  CAS  Google Scholar 

  28. Constable SH, Favier RJ, Carter GD, Young DA, Holloszy JO. Muscle glucose transport: interactions of in vitro contractions, insulin, and exercise. J Appl Physiol 1988;64:2329–2332.

    PubMed  CAS  Google Scholar 

  29. Wallberg-Henriksson H, Constable SH, Young DA, Holloszy JO. Glucose transport into rat skeletal muscle: interaction between exercise and insulin. J Appl Physiol 1988;65:909–913.

    PubMed  CAS  Google Scholar 

  30. Galbo H. Hormonal and Metabolic Adaptations to Exercise. Thieme, New York, 1983, pp. 1–116.

    Google Scholar 

  31. Vranic M, Wrenshall G. Exercise, insulin and glucose turnover in dogs. Endocrinology 1969;85: 165–171.

    Article  PubMed  CAS  Google Scholar 

  32. Kawamori R, Vranic M. Mechanism of exercise-induced hypoglycemia in depancreatized dogs maintained on long-acting insulin. J Clin Invest 1977;59:331–337.

    Article  PubMed  CAS  Google Scholar 

  33. Hilsted J. Pathophysiology in diabetic autonomic neuropathy: cardiovascular, hormonal, and metabolic studies. Diabetes 1982;31:730–737.

    PubMed  CAS  Google Scholar 

  34. Vranic M, Wasserman D, Bukowiecki L. Metabolic implications of exercise and physical fitness in physiology and diabetes. In: Rifkin HP, ed. Diabetes Mellitus: Theory and Practice. Elsevier, New York, 1990, pp. 198–219.

    Google Scholar 

  35. Giacca AM, Davidson J, Lickley H. In: Davidson J, ed. Clinical Diabetes Mellitus: A Problem Oriented Approach. Thieme-Stratton, New York, 1991; pp. 218–265.

    Google Scholar 

  36. Holloszy J, Schultz J, Kusnierkierkieweicz J, Hagberg J, Ehasani A. Effects of exercise on glucose tolerance and insulin resistance. Acta Med Scand 1986;711(Suppl.):55–65.

    CAS  Google Scholar 

  37. Wasserman D, Zinman B. In: Ruderman N, Devlin J. eds. Health Professionals Guide to Diabetes and Exercise. American Diabetes Association, Alexandria, VA, 1995, pp. 29–47.

    Google Scholar 

  38. Newsholme EA, Leech AR. In: Biochemistry for the Medical Sciences. Wiley, New York, 1983, pp. 339–346.

    Google Scholar 

  39. Hespel P, Richter EA. Glucose uptake and transport in contracting, perfused rat muscle with different pre-contraction glycogen concentrations. J Physiol 1990;427:347–359.

    PubMed  CAS  Google Scholar 

  40. Richter EA, Galbo H. High glycogen levels enhance glycogen breakdown in isolated contracting skeletal muscle. J Appl Physiol 1986;61:827–831.

    PubMed  CAS  Google Scholar 

  41. Richter EA, Hansen SA, Hansen BF. Mechanisms limiting glycogen storage in muscle during prolonged insulin stimulation. Am J Physiol 1988;255:E621–E628.

    PubMed  CAS  Google Scholar 

  42. Wahren J, Sato Y, Ostman J, Hagenfeldt L, Felig P. Turnover and splanchnic metabolism of free fatty acids and ketones in insulin deficient diabetes at rest and in response to exercise. J Clin Invest 1984;73:1367–1376.

    Article  PubMed  CAS  Google Scholar 

  43. Olefsky JM, Garvey WT, Henry RR, Brillon D, Freidenberg MS. Cellular mechanisms of insulin resistance in non-insulin dependent (type II) diabetes. Am J Med 1988;85:86–105.

    Article  PubMed  CAS  Google Scholar 

  44. Wallberg-Henriksson H. Glucose transport into skeletal muscle. Influence of contractile activity, insulin, catecholamines an diabetes mellitus. Acta Physiol Scand 1987;131:1–80.

    Article  Google Scholar 

  45. Andreasson K, Galuska D, Thorne A, Sonnenfeldt T, and Wallberg-Henriksson H. Decreased insulin stimulated 3-0-methylglucose transport in in vitro incubated muscle strips from type II diabetic patients. Acta Physiol Scand 1991;142:255–260.

    Article  PubMed  CAS  Google Scholar 

  46. Goodyear L, King P, Hirshman M, Thompson C, Horton ED, Horton ES. Contractile activity increases plasma membrane glucose transporters in the absence of insulin. Am J Physiol 1990;259:E667–672.

    Google Scholar 

  47. Hirshman M, Wallberg-Henriksson H, Wardzala L, Horton ED, Horton ES. Acute exercise increases the number of plasma membrane glucose transporters in rat skeletal muscle. FEBS Lett 1988;238:235–239.

    Article  PubMed  CAS  Google Scholar 

  48. King P, Hirshman M, Horton ED, Horton E. Glucose transport in skeletal muscle membrane vesicles from control and exercised rats. Am J Physiol 1989;257:C1128–1134.

    PubMed  CAS  Google Scholar 

  49. Friedman J, Neufer P, Dohm GL. Regulation of glycogen resynthesis following exercise. Sports Medicine 1991;11:232–243.

    Article  PubMed  CAS  Google Scholar 

  50. Maehlum SH, Hostmark AT, Hermansen L. Synthesis of muscle glycogen during recovery after prolonged severe exercise in diabetic and non-diabetic subjects. Scand J Clin Lab Invest 1977;37:309–316.

    Article  PubMed  CAS  Google Scholar 

  51. King DS, Staten MA, Kohrt W, Clutter WE, Dalsky GP, Holloszy JO. Insulin secretory capacity in endurance trained and untrained young men. Am J Physiol 1990;259:E155–E161.

    PubMed  CAS  Google Scholar 

  52. Seals DR, Hagberg JM, Allen WK, Hurley BF, Dalsky GP, Ehsani AH, Holloszy JA. Glucose tolerance in young and older athletes and sedentary men. J Appl Physiol 1984;56:1521–1525.

    PubMed  CAS  Google Scholar 

  53. Dela F, Mikines KJ, Von-Listow M, Galbo H. Does training spare insulin secretion and diminish glucose levels in real life? Diabetes Care 1992;15:1712–1715.

    Article  PubMed  CAS  Google Scholar 

  54. Landt K, Campaigne B, James F, Serling M. Effects of exercise training on insulin sensitivity in adolescents with type I diabetes. Diabetes Care 1985;8:461–465.

    Article  PubMed  CAS  Google Scholar 

  55. Devlin J. Effects of exercise on insulin sensitivity in humans. Diabetes Care 1992;15:1690–1693.

    Article  PubMed  CAS  Google Scholar 

  56. Schneider S, Amorosa L, Khachadurian A, Ruderman N. Studies on the mechanism of improved glucose control during regular exercise in type 2 diabetes. Diabetologia 1984;26:355–360.

    Article  PubMed  CAS  Google Scholar 

  57. Helmrich, S, Ragland D, Leung R, Paffenbarger R. Physical activity and reduced occurrence of noninsulin-dependent diabetes mellitus. N Engl J Med 1991;325:147–152.

    Article  PubMed  CAS  Google Scholar 

  58. Hilsted J, Galbo H, Christensen N, Parving H, Benn J. Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy. Diabetologia 1982;22:318–323.

    Article  PubMed  CAS  Google Scholar 

  59. Veves A, Saouaf R, Donaghue VM, Mullooly CA, Kistler JA, Giurini JM, Horton ES, Fielding RA. The relationship of regular exercise to maximal aerobic capacity and endothelial function in young insulin-dependent diabetic patients, in press.

    Google Scholar 

  60. Barkai L, Peja M, Vamosi I. Physical work capacity in diabetic children and adolescents with and without cardiovascular autonomic dysfunction. Diabetic Med 1996;13:254–258.

    Article  PubMed  CAS  Google Scholar 

  61. Hilsted J, Galbo H, Christensen N. Impaired cardiovascular responses to graded exercise in diabetic autonomie neuropathy. Diabetes 1979;28:313–319.

    Article  PubMed  CAS  Google Scholar 

  62. Hilsted J, Galbo H, Christensen N. Impaired responses of catecholamines, growth hormone, and cortisol to graded exercise in diabetic autonomie neuropathy. Diabetes 1980;29:257–262.

    PubMed  CAS  Google Scholar 

  63. Hilsted J. Autonomie neuropathy: cardiovascular, hormonal and metabolic studies. Acta Endocrinologica 1980;94:139–144.

    Google Scholar 

  64. Vinik A, Milicevic Z. Preventive measures and treatment options for diabetic neuropathy. Cont Int Med 1994;6:41–55.

    CAS  Google Scholar 

  65. Berger M. Metabolie and hormonal effects of muscular exercise in juvenile type I diabetes. Diabetologia 1977;13:355-355-367.

    Google Scholar 

  66. Thomas PK, Eliasson SG. Diabetic Neuropathy. In: Dyck PJ, Thomas PK, Lambert EH, Burger R, eds. Peripheral Neuropathy, vol. 2. Saunders, Philadelphia, 1984, pp. 1773–1810.

    Google Scholar 

  67. Ewing DCB. Diagnosis and management of diabetic autonomie neuropathy. Br Med J 1982;285: 916–918.

    Article  CAS  Google Scholar 

  68. Robinson BF, Epstein SE, Beiser GD, Braunwald E. Control of heart rate by the autonomie nervous system. Circ Res 1966;19:400–411.

    Article  PubMed  CAS  Google Scholar 

  69. Page M, Watkins P. The heart in diabetes: autonomie neuropathy and diabetes. Clin Endocrinol Metab 1977;6:377–389.

    Article  PubMed  CAS  Google Scholar 

  70. Freyschuss U. Cardiovascular adjustments to somatomotor activation. Acta Physiol Scand Suppl 1970;342:1–63.

    PubMed  CAS  Google Scholar 

  71. Christensen NBO. The relationship between plasma catecholamine concentration and pulse rate during exercise and standing. Eur J Clin Invest 1977;3:299–306.

    Article  Google Scholar 

  72. Hornung RS, Mahler RF, Raftery EB. Ambulatory blood pressure and heart rate in diabetic patients: an assessment of autonomie function. Diabetic Med 1989;6:579–585.

    Article  PubMed  CAS  Google Scholar 

  73. Radice M, Rocca A, Bendon E, Musacchio N, Morabito A, Segalini G. Abnormal response to exercise in middle-aged NIDDM patients with and without autonomie neuropathy. Diabetic Med 1996;13:259–265.

    Article  PubMed  CAS  Google Scholar 

  74. Clausen J. Circulatory adjustments to dynamic exercise and effect of physical training in normal subjects and in patients with coronary artery disease. Prog Cardiovasc Dis 1976;18:459–495.

    Article  PubMed  CAS  Google Scholar 

  75. Sanderson J, Brown DJ, Kovallese A, Kohner J. An echocardiac study of young diabetics. Br Med J 1978;6110:404–407.

    Article  Google Scholar 

  76. Bessman AN. Foot problems in diabetes. Compr Ther 1982;8:32–37.

    PubMed  CAS  Google Scholar 

  77. Young MJ, Veves A, Boulton AJM. The diabetic foot: aetiopathogenesis and management. Diabetes Metab Rev 1993;9:109–127.

    Article  PubMed  CAS  Google Scholar 

  78. Brand PW. Repetitive stress in the development of diabetic foot ulcers. In: Levin ME, O’Neal LW, eds. The Diabetic Foot. Mosby, St. Louis, 1988, pp. 83–90.

    Google Scholar 

  79. Delbridge L, Perry P, Marr S, Arnold N. Yue OK, Turtle JR, Reeves TS. Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabetic Med 1988;5:333–337.

    Article  PubMed  CAS  Google Scholar 

  80. Fernando DJS, Masson EA, Veves A, Boulton AJM. Limited joint mobility: relationship to abnormal foot pressures and diabetic foot ulceration. Diabetes Care 1991;14:8–11.

    Article  PubMed  CAS  Google Scholar 

  81. Veves A, Murray HJ, Young MJ, Boulton AJM. The risk of foot ulcerationin diabetic patients with high foot pressure: a prospective study. Diabetologia 1992;35:660–663.

    Article  PubMed  CAS  Google Scholar 

  82. Sanders LJ, Frykberg RG. In: Levin ME, O’Neal LW, Bowker JH, eds. The Diabetic Foot. Mosby, St. Louis, 1993, pp. 149–180.

    Google Scholar 

  83. Assal JP, Mulhauser I, Permat A, Gfeller R, Jorgens V, Berger M. Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 1985;28:602–613.

    Article  PubMed  CAS  Google Scholar 

  84. Veves A, Masson EA, Fernando DJS, Boulton AJM. The use of experimental hosiery to reduce plantar foot pressures in diabetic neuropathy. Diabetes Care 1989;9:653–655.

    Article  Google Scholar 

  85. Coker TP. Sports injuries to the foot and ankle. In: Jahss MH, ed. Disorders of the Foot and Ankle. Medical and Surgical Management, 2nd ed. Saunders, Philadelphia, 1991, pp. 2415–2445.

    Google Scholar 

  86. Levin ME. Preventing amputation in the patient with diabetes. Diabetes Care 1995;18:1383–1394.

    PubMed  CAS  Google Scholar 

  87. Janzon L, Bergent S, Ericsson B, Hanson M, Lindeil S. Leg blood flow in intermittent claudication—a comparison between non-insulin dependent diabetics and non diabetics. Angiology 1984;36:724–728.

    Article  Google Scholar 

  88. Boyd C, Bird P, Teates C, Wellons H, MacDougall M, Wolfe L. Pain-free physical training in intermittent claudication. J Sports Med 1984;24:24–28.

    Google Scholar 

  89. Graham CL-MP. Exercise options for persons with diabetic complications. Diabetes Educ 1990;16:212–220.

    Article  PubMed  CAS  Google Scholar 

  90. American College of Sports Medicine. Guidelines for Exercise Testing and Prescription, 5th ed. Lea and Febiger, Philadelphia, 1996.

    Google Scholar 

  91. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehab Med 1970;2:92–98.

    CAS  Google Scholar 

  92. Valbona C. In: Kottke FS, Lehman G, eds. Krusen Handbook of Physical Medicine and Rehabilitation, 3rd ed. Saunders, Philadelphia, 1982, pp. 963–975.

    Google Scholar 

  93. Fielding RA, Costill DL, Fink WJ, King DS, Kovaleski JE, Kirwan JP. Effect of pre-exercise carbohydrate feedings on muscle glycogen use during exercise in well-trained runners. Eur J Appl Physiol 1986;56:225–229.

    Article  Google Scholar 

Download references

Authors
  1. Nathan K. LeBrasseur MSPT
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roger A. Fielding PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Aristidis Veves MD

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

LeBrasseur, N.K., Fielding, R.A. (1998). Exercise and Diabetic Neuropathy. In: Veves, A. (eds) Clinical Management of Diabetic Neuropathy. Contemporary Endocrinology, vol 7. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-1816-6_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1816-6_16

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-7296-0

  • Online ISBN: 978-1-4612-1816-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation