Aerobic exercise improve HbA1c levels and sensory outcome in diabetic peripheral neuropathy: A systematic review and meta-analysis

Asyarotul Jannah; Bambang Purwanto; Citrawati Dyah Kencono Wungu; Indah Binti  Mohd Amin; Hafizah Sururul Nur Rakhmawati; Ketut Wahyu Adi Saputra

doi:10.23750/abm.v96i2.16893

Aerobic exercise improve HbA1c levels and sensory outcome in diabetic peripheral neuropathy: A systematic review and meta-analysis

Authors

Asyarotul Jannah Master Program of Sport Health science, Faculty of Medicine ,Universitas Airlangga, Surabaya, East Java, Indonesia https://orcid.org/0009-0009-6432-4673
Bambang Purwanto Division of Physiology, Department of Medical Physiology and Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
Citrawati Dyah Kencono Wungu Division of Biochemistry, Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, indonesia
Indah Binti Mohd Amin Center of Preclinical Science Studies, Faculty of Dentistry, Universiti Teknologi MARA, Selangor Darul Ehsan, Malaysia
Hafizah Sururul Nur Rakhmawati Department of Physical Therapy, Faculty of Health, Universitas Anwar Medika, Sidoarjo, East Java, Indonesia
Ketut Wahyu Adi Saputra Undergraduate Program Of Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia

Keywords:

aerobix exercise, diabetic peripheral neuropathy, hemoglobin A1c, sensory function, glycemic control, systematic review, meta analysis, exercise therapy, neuropathy complication, physical activity

Abstract

Background and aim: Diabetic peripheral neuropathy (DPN) is one of the complications of type 1 and type 2 diabetes. Some parts of the body experience damage to the nerves due to high blood sugar levels. Aerobic exercise is known to improve glycaemic control and nerve function. This meta-analysis aimed to evaluate the effect of aerobic exercise on sensory and haemoglobin A1c (HbA1c) in patients with DPN.

Methods: Literature searches were conducted in ScienceDirect, Pubmed, Web of Science, and Scopus for eligible articles published from 2010 to 2024. Inclusion criteria were determined using the PICOS approach with a moderate-intensity aerobic exercise intervention. The primary outcomes were sensory scores (sural and peroneal NCV) and HbA1c with a randomised control trial (RCT) research design.

Results: We found that the pooled effect analysis of aerobic exercise on HbA1c of the three studies were significant (SMD -0.53; 95% CI = -0.89-0.17; P = 0.004) however there was no significant effect of non-physical activity/standard care on HbA1c (SMD 0.08; 95% CI = -0.26-0.42; P = 0.64). Meanwhile, analysis shows a moderate effect of aerobic exercise on NCV-sural examination scores with a pooled standardised mean difference (SMD) 1.40 (95% CI = 0.44-2.36).

Conclusions: Our findings highlight aerobic exercise could be an effective non-pharmacological intervention to improve sural nerve function in DPN. Aerobic exercise regimens should be structured in a comprehensive therapy strategy. Further research is needed to focus on identifying the more optimal and tolerable aerobic exercise to maximise therapeutic approaches. In addition, there is a need to develop analyses of the effect of various intensities and types of exercise on DPN management.

Author Biography

Asyarotul Jannah, Master Program of Sport Health science, Faculty of Medicine ,Universitas Airlangga, Surabaya, East Java, Indonesia

The name Asyarotul Jannah was born in Lamongan on April 24, 1997. She studied at the Sabilul Huda Elementary School in Lamongan from 2002 to 2008. The Tanwirut Tholibin Junior High School in Lamongan from 2008 to 2011. Then at the Al Munawwariyyah Junior High School in Malang from 2011 to 2014. Then she continued her studies at the undergraduate level by taking a bachelor's degree in physiotherapy at the University of Muhammadiyah Malang from 2014 to 2018.

References

1. Sumardiyono B, Suri IK. Neuropati diabetika kontribusi karakteristik individu, lama sakit, merokok. J Kesehat Masy Indones 2022;17(2):1–5. doi: 10.26714/jkmi.17.2.2022.1-5.

2. Moreira RO, Cobas R, Lopes Assis Coelho RC. Combination of basal insulin and GLP-1 receptor agonist: is this the end of basal insulin alone in the treatment of type 2 diabetes? Diabetol Metab Syndr 2018;10:26. doi: 10.1186/s13098-018-0327-4.

3. Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. Outcomes on control and complications of type 2 diabetic patients in Indonesia. Med J Indones 2010;19(4):235–244. doi: 10.13181/mji.v19i4.412.

4. Aleidan FAS, Ahmad BA, Alotaibi FA, et al. Prevalence and risk factors for diabetic peripheral neuropathy among Saudi hospitalized diabetic patients: a nested case-control study. Int J Gen Med 2020;13:881–889. doi: 10.2147/IJGM.S273807.

5. Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep 2019;19(10):86. doi: 10.1007/s11892-019-1212-8.

6. Martins JP, Marson FAL. A narrative review of the complex panorama regarding chronic neuropathic pain mainly for the psychological issues. Heliyon 2024;10(19):e38282. doi: 10.1016/j.heliyon.2024.e38282.

7. Kurniawan SN. Patofisiologi biomolekular neuropati diabetes. Neurona 2012;29(4):1–10.

8. Dixit S, Maiya AG, Shastry BA. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. J Diabetes Complications 2014;28(3):332–339. doi: 10.1016/j.jdiacomp.2013.12.006.

9. Yoo M, Sharma N, Pasnoor M, Kluding PM. Painful diabetic peripheral neuropathy: presentations, mechanisms, and exercise therapy. J Diabetes Metab 2013;Suppl 10:005. doi: 10.4172/2155-6156.S10-005.

10. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

11. Amir-Behghadami M, Janati A. Population, intervention, comparison, outcomes and study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J 2020;37(6):387. doi: 10.1136/emermed-2020-209567.

12. Nejadghaderi SA, Balibegloo M, Rezaei N. The Cochrane risk of bias assessment tool 2 (RoB 2) versus the original RoB: a perspective on the pros and cons. Health Sci Rep 2024;7(6):e2165. doi: 10.1002/hsr2.2165.

13. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021;12(1):55–61. doi: 10.1002/jrsm.1411.

14. Gholami F, Nikookheslat S, Salekzamani Y, Boule N, Jafari A. Effect of aerobic training on nerve conduction in men with type 2 diabetes and peripheral neuropathy: a randomized controlled trial. Neurophysiol Clin 2018;48(4):195–202. doi: 10.1016/j.neucli.2018.03.001.

15. Gholami F, Nazari H, Alimi M. Cycle training improves vascular function and neuropathic symptoms in patients with type 2 diabetes and peripheral neuropathy: a randomized controlled trial. Exp Gerontol 2020;131:110799. doi: 10.1016/j.exger.2019.110799.

16. Dixit S, Maiya A, Shastry BA. Effect of moderate-intensity aerobic exercise on glycosylated haemoglobin among elderly patients with type 2 diabetes & peripheral neuropathy. Indian J Med Res 2017;145(1):129–132. doi: 10.4103/ijmr.IJMR_699_14.

17. Adler AI, Erqou S, Lima TA, Robinson AHN. Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus-review and meta-analysis. Diabetologia 2010;53(5):840–849. doi: 10.1007/s00125-009-1638-7.

18. Balgis, Sumardiyono, Suri IK. Neuropati diabetika: kontribusi karakteristik individu, lama sakit, merokok, dan hiperglikemi. J Kesehat Masy Indones 2022;17(2):e-ISSN: 2613-9219.

19. Byrkjeland R, Njerve IU, Anderssen S, Arnesen H, Seljeflot I, Solheim S. Effects of exercise training on HbA1c and VO2peak in patients with type 2 diabetes and coronary artery disease: a randomised clinical trial. Diabetes Vasc Dis Res 2015;12(5):325–333. doi: 10.1177/1479164115590552.

20. Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011;305(17):1790–1799. doi: 10.1001/jama.2011.576.

21. Helal L, Umpierre D, Moraes RS. High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes: considerations regarding HbA1c starting levels and intervention design. Eur J Appl Physiol 2017;117(11):2365–2366. doi: 10.1007/s00421-017-3682-1.

22. Singh B, Koneru YC, Zimmerman H, et al. A step in the right direction: exploring the effects of aerobic exercise on HbA1c reduction. Egypt J Intern Med 2023;35(1):n.p. doi: 10.1186/s43162-023-00247-8.

23. Cassidy S, Thoma C, Houghton D, Trenell MI. High-intensity interval training: a review of its impact on glucose control and cardiometabolic health. Diabetologia 2017;60(1):7–23. doi: 10.1007/s00125-016-4106-1.

24. Wrench E, Rattley K, Lambert JE, et al. There is no dose-response relationship between the amount of exercise and improvement in HbA1c in interventions over 12 weeks in patients with type 2 diabetes: a meta-analysis and meta-regression. Acta Diabetol 2022;59(11):1399–1415. doi: 10.1007/s00592-022-01918-8.

25. Azizi S, Najafi S, Rezasoltani Z, Sanati E, Zamani N, Dadarkhah A. Effects of aerobic exercise on electrophysiological features of diabetic peripheral neuropathy: single-blind clinical trial. Top Geriatr Rehabil 2019;35(2):164–169. doi: 10.1097/TGR.0000000000000229.

26. Galiero R, Caturano A, Vetrano E, et al. Peripheral neuropathy in diabetes mellitus: pathogenetic mechanisms and diagnostic options. Int J Mol Sci 2023;24(4):3554. doi: 10.3390/ijms24043554.

27. Orlando G, Balducci S, Bazzucchi I, Pugliese G, Sacchetti M. Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training. Diabetes Metab Res Rev 2016;32(1):40–50. doi: 10.1002/dmrr.2658.

28. Yang C, Zhao X, An X, et al. Axonal transport deficits in the pathogenesis of diabetic peripheral neuropathy. Front Endocrinol (Lausanne) 2023;14:1136796. doi: 10.3389/fendo.2023.1136796.

29. Yosten CY, Maric-Bilkan C, Luppi P, Wahren J. Physiological effects and therapeutic potential of proinsulin C-peptide. Am J Physiol Endocrinol Metab 2014;E-00130. doi: 10.1152/ajpendo.00130.2014.

30. Holmes CJ, Hastings MK. The application of exercise training for diabetic peripheral neuropathy. J Clin Med 2021;10(21):5042. doi: 10.3390/jcm10215042.

31. Mendonca GV, Mouro M, Vila-Chã C, Pezarat-Correia P. Nerve conduction during acute blood-flow restriction with and without low-intensity exercise. Sci Rep 2020;10(1):7380. doi: 10.1038/s41598-020-64379-5.

32. Lestari AT, Sari DRK. Physical training and activity in people with diabetic peripheral neuropathy: a case report. Malahayati Int J Nurs Health Sci 2023;6(5):n.p. doi: 10.33024.

33. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451–1462.

34. Isojärvi H, Keinänen-Kiukaanniemi S, Kallio M, et al. Exercise and fitness are related to peripheral nervous system function in overweight adults. Med Sci Sports Exerc 2010;42(7):1241–1245. doi: 10.1249/MSS.0b013e3181cb8331.

35. Leitzelar BN, Koltyn KF. Exercise and neuropathic pain: a general overview of preclinical and clinical research. Sports Med Open 2021;7(1):21. doi: 10.1186/s40798-021-00307-9.