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You know that exercise is vital to leading a healthy life with diabetes, to help boost your cardiovascular health, reduce body fat levels, and better manage blood sugar. But if you’re managing neuropathy, or nerve damage — which a report published in January 2017 in the journal Diabetes Care estimates half of people with type 2 diabetes are — is it even safe to break a sweat?
Short answer: Yes. You just have to take certain precautions when doing so.
What Is Neuropathy and What Causes It When You Have Diabetes?
First, know that neuropathy is nerve damage to cells that can occur anywhere in the body, though the condition often exhibits in feet and hands. In people with diabetes, high blood sugar levels, or persistent hyperglycemia, can cause neuropathy, not to mention a slew of other potential diabetes complications. Meanwhile, in those people with poor circulation — a common side effect of diabetes — a lack of blood flow and oxygen to hard-to-reach nerves can cause further damage and cell death.
What Are the Common Symptoms of Neuropathy?
The result of this damage includes everything from chronic pain to impaired digestive system, urinary tract, and cardiovascular function. But the most common signs of neuropathy include pain, tingling, and numbness in the extremities.
When such symptoms set in, the idea of exercising can become a bit scary. After all, sense of touch is your body’s built-in protective system, says Jason Machowsky, RD, CSCS, a sports dietitian and exercise physiologist at the Hospital for Special Surgery in New York City. So if that protective system isn’t running at top speed, and your hands and feet are tingling or even numb, how safe is your workout?
Before You Break a Sweat, Determine Whether You Need Neuropathy Treatment
If you feel tingling, numbness, loss of sensation, or pain from common clothing like socks or even bedsheets, that’s your cue to stop what you’re doing and potentially seek treatment for neuropathy. If you find from checking your feet daily that you have a blister or ulcer, be sure to notify your physician to help prevent infections.
“Loss of sensation in the foot or ankle can significantly increase the risk of getting infections in those areas from routine cuts or abrasions,” Machowsky says. “Since you may not feel the extent of the damage done and therefore not take action to treat it until it becomes a major medical emergency.”
Meanwhile, if you’re standing on the gym floor performing squats, it’s the nerves in your feet that help you gauge your body’s positioning (called proprioception) and maintain balance, he explains. Both are vital to performing your workouts safely and effectively.
Why You Still Need to Exercise if You Have Diabetes-Related Neuropathy
Despite all of the excuses you may come up with to skip the gym when you have neuropathy, you have even more reasons to make exercise a priority if you’re managing this complication. That’s because exercise is actually good for neuropathy.
“One of the best ways to prevent progression of diabetic neuropathy is to stay active,” Machowsky says. For instance, in one study published in September 2012 in the Journal of Diabetes and Its Complications, all it took was 10 weeks of exercise to significantly reduce pain and symptoms in men and women with diabetes-related neuropathy. In that time frame, the participants’ nerve health and function also improved.
That’s not exactly surprising when you consider what researchers already know about the benefits of exercise for diabetes. Physical activity is a great way to keep your blood sugar levels in check, improve insulin sensitivity, and reduce inflammation, Machowsky says. Plus, by undoing some of the blood vessel damage that can occur with diabetes, exercise can help increase the flow of blood, oxygen, and other nutrients to nerve cells, further helping to improve neuropathic symptoms.
The 4 Best Workouts for People With Diabetes Who Are Managing Neuropathy
To minimize the risks and amplify the possible rewards of exercising with neuropathy, prioritize these expert-approved workouts:
1. Low-Impact Cardiovascular Exercise
Cardio’s ability to improve vascular health in people with type 2 diabetes is well established, and a study published in January 2017 in the International Journal of Neuroscience suggests that aerobic exercise may also improve blood vessel health in those dealing with diabetes-related neuropathy. Aerobic exercise can also help reduce blood sugar and cholesterol levels, according to the American Diabetes Association (ADA), which helps to further improve blood flow to your hands and feet, and improve nerve health.
To boost your blood flow while preventing cuts, scrapes, and blisters, skip pounding the pavement in favor for gentler, low-impact activities, such as swimming and cycling, Machowsky recommends. If you aren’t the most balanced on a bike, stick with an indoor one. Whatever workout you choose, try to perform at least 30 minutes of aerobic exercise five times per week, the ADA recommends.
2. Strength Training (Seated)
Your muscle, insulin, and vascular health are tightly linked, with muscle acting as a sort of sugar-burning furnace that just so happens to help your blood vessels “pump” blood to and from your heart.
While weight-bearing exercises that keep you on your feet are great for helping you get the most out of every rep, if you’re not so steady on your feet, working out with a barbell across your back is probably not a great idea! Don’t worry. It’s impressive how many effective strength exercises you can perform from the seated position, Machowsky says.
Check out your gym’s seated leg-strengtheners, including the leg extension, hamstring curl, and glute kickback machines. Meanwhile, you can perform a vast array of upper-body exercises, from bicep curls to shoulder presses, while seated on a bench. The ADA recommends performing strength exercises at least twice per week, in addition to your cardio workouts.
3. Balance and Stability Work
By damaging nerve function and sensation in your feet, diabetes-related neuropathy greatly increases your risk of falls, according to a review published in December 2014 in the International Journal of Nursing Sciences. It notes that in one previous study of older adults, those with diabetes-related neuropathy were 23 times more likely to suffer a fall compared with those without. That’s where balance and stability work comes in: training your muscles and the neurons in charge of them to properly fire and work together, Machowsky says. The most important muscles for keeping you upright are found in your feet, legs, and core.
Try to integrate some sort of balance or stability work into every workout. Perform one-legged exercises (holding onto the wall or a sturdy object for balance), practice walking from heel to toe in a straight line, and complete core exercises, including planks, dead-bugs, bird-dogs, and cable chops, he says.
4. Mind-Body Exercise
Yoga, tai chi, and active meditation exercises may really be what your nervous system needs. After all, studies have repeatedly shown that yoga is beneficial in the management of various neurological disorders, diabetes-related neuropathy included, according to a review published in October 2012 in the journal Annals of Indian Academy of Neurology.
Researchers note that yoga is beneficial in reducing stress levels, blood pressure, and inflammation, all of which can affect the progression of diabetes-related neuropathy. And although yoga might feel less intense compared with cycling or strength training, it still gets your heart pumping and can build muscle.
Perform your mind-body method of choice in a way that meets your needs and augments your other workouts. For instance, you could consider a gentle flow yoga class as a way to recover after a more intense strength or cardio workout. Meanwhile, more advanced yoga classes (call your local studio for details) can function as a great cardio and strength workout in one.
Originally written for Everyday Health