Comparison the effects of two types of therapeutic exercises Frenkele vs. Swiss ball on the clinical balance measures in patients with type II diabetic neuropathy

Effectiveness of various exercise types in reducing fall risk among older adults with diabetic peripheral neuropathy: A systematic review and meta-analysis

Background

Diabetic peripheral neuropathy (DPN) increases fall risk in diabetics. Due to varying variables used to assess fall risk, the impact of exercise on fall prevention remains inconsistent. This study reviews and compares the effects of different exercises on fall risk among older adults with DPN.

Methods

A comprehensive literature search was conducted in PubMed, EBSCO, Web of Science, and Cochrane Library up to February 17th, 2025. Inclusion criteria were: older adults with DPN; exercise intervention only, an inactive or non-exercising control group, and randomized controlled trials with outcome variables: timed up and go (TUG) time, gait speed, Berg Balance Scale (BBS) score, one-legged standing (OLS) time with eye open (EO) and closed (EC). The mean difference (MD) and 95 % confidence interval (CI) were calculated.

Results

A total of 21 articles included five exercise types: balance exercise (BE), multi-component exercise (ME), strength exercise (SE), whole-body vibration (WBV) and foot-ankle functional training (FT). BE reduced TUG time (MD = -1.47, 95 % CI = -1.79 to -1.15) and increased gait speed (0.11, 0.04-0.18), BBS score (0.93, 0.49-1.37), and OLS time (EO: 2.72, 1.86-3.58; EC:1.58, 1.0-2.17). ME reduced TUG time (-1.71, -2.26 to -1.17) and increased BBS score (2.0, 1.28-2.72) and OLS time (EO: 7.07, 4.35-9.79; EC: 2.61, 1.28-3.94); SE reduced TUG time (-1.45, -2.75 to -0.15) and increased gait speed (0.09, 0.06-0.12); WBV increased OLS time (EO: 1.94, 1.32-2.56; EC: 1.86, 0.16-3.56) but did not affect TUG time or gait speed. FT did not affect TUG time or gait speed.

Conclusions

Exercise reduced fall risks among older adults with DPN. BE and ME were effective in reducing fall risks, followed by SE. WBV improved static balance but failed in dynamic balance. FT showed limited effects on fall prevention and was not recommended.

Home-Based Rehabilitation With Frenkel's Exercises for Adrenomyeloneuropathy: A Case Report

Adrenoleukodystrophy (ALD) encompasses a spectrum of X-linked genetic disorders, including the adult-onset adrenomyeloneuropathy (AMN) phenotype. We report the case of a 32-year-old male with AMN and examine the impact of a tailored home-based rehabilitation regimen, specifically employing Frenkel's exercises. The patient displayed classic AMN symptoms, including spastic paraparesis, peripheral neuropathy, and urinary disturbances. Initial assessments revealed significant ataxia-related impairments, particularly in gait, stance, and heel-shin slide. A home-visit nurse collaborated with the patient to develop and implement a personalized regimen utilizing Frenkel's exercises. Over one month, the patient demonstrated remarkable improvement, reducing his Scale for the Assessment and Rating of Ataxia score from 10 to 5. Detailed analysis revealed specific enhancements in gait, stance, and fine motor control, aligning with the goals of Frenkel's exercises. These findings suggest that Frenkel's exercises can be a valuable addition to AMN rehabilitation, addressing ataxia-related motor deficits. While recognizing AMN's complexity and individual variability, further research is essential to refine rehabilitation strategies. Long-term follow-up studies are needed to assess intervention sustainability and its impact on the ALD spectrum's overall disease progression and quality of life.

A Systematic Review of the Effect of Physical Rehabilitation on Balance in People with Diabetic Peripheral Neuropathy Who are at Risk of Falling

Background

Falls are a significant issue in people with diabetic peripheral neuropathy. Balance interventions have been broadly administered in individuals with diabetic peripheral neuropathy, but the effects on static and dynamic balance in those who are at risk of falling have not yet been comprehensively reviewed.

Objective

To provide a synthesis of the literature regarding the effectiveness of physical rehabilitation interventions to improve balance in people with diabetic peripheral neuropathy who are at risk of falling.

Methods

Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Cumulated Index in Nursing and Allied Health Literature) were systematically searched from inception to July 2022. Articles meeting the eligibility criteria (ie, participants with diabetic peripheral neuropathy and at risk of falling based on validated fall balance outcome risk cut off scores; inclusion of physical rehabilitation intervention) underwent a quality assessment using the Physiotherapy Evidence Database scale. Data regarding fall risk was extracted.

Results

Sixteen studies met the eligibility criteria. Participants in six studies improved balance such that their fall risk was reduced from a moderate-high risk of falls to no or low risk of falls from pre- to post-intervention. Interventions within these six studies were variable and included balance exercise, gait training, endurance, tai-chi with mental imagery, proprioceptive training, aerobic training, and yoga. Participants in seven of the remaining studies showed no improvement and participants in three studies showed mixed results regarding improved balance and reduced fall risk status by post-intervention.

Conclusion

While physical rehabilitation is sufficient to improve balance in individuals with diabetic peripheral neuropathy who are at risk of falling, few interventions led to improved balance and reduced fall risk. Interventions involving intentional weight shifting, manipulation of the base of support, and displacement of the center of mass such as tai-chi and yoga appear to provide the most consistent results in terms of decreasing fall risk. To better understand the effectiveness of rehabilitation on balance and fall risk, future studies should examine the impact of physical interventions on prospective fall rates.

Effects of Cawthorne-Cooksey exercises on vestibular symptoms: A systematic review of randomized controlled trials

OBJECTIVES

To examine the effects of Cawthorne-Cooksey exercises on individuals with vestibular dysfunction symptoms.

METHODS

Systematic search was conducted using PubMed, EBSCO SCOPUS, Web of Science, and Google Scholar from inception to March 2023. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the risk of bias in the included studies.

RESULTS

Ten randomized controlled trials met the eligibility criteria. In total, 610 participants, 41.31 % of whom were men were included in this review. The PEDro scale scores ranged from 6 to 8 with a median of 6.5/10. Our findings revealed improvements in patients' vestibular dysfunction symptoms after Cawthorne-Cooksey exercises and other conventional interventions.

CONCLUSIONS

The initial findings showed that Cawthorne-Cooksey exercises are not superior to other concurrent vestibular rehabilitation interventions in improving vestibular dysfunction symptoms. Additional trials with long-term follow-ups are strongly recommended to understand the impacts of Cawthorne-Cooksey exercises on vestibular dysfunction symptoms.

Therapeutic Interventions to Improve Static Balance in Type 2 DiabetesMellitus: A Systematic Review and Meta-Analysis

INTRODUCTION

Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance.

OBJECTIVE

This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM.

METHODS

For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included.

RESULTS

The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway.

CONCLUSION

There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.

Exercise as Treatment for Neuropathy in the Setting of Diabetes and Prediabetic Metabolic Syndrome: A Review of Animal Models and Human Trials

BACKGROUND

Peripheral neuropathy is among the most common complications of diabetes, but a phenotypically identical distal sensory predominant, painful axonopathy afflicts patients with prediabetic metabolic syndrome, exemplifying a spectrum of risk and continuity of pathogenesis. No pharmacological treatment convincingly improves neuropathy in the setting of metabolic syndrome, but evolving data suggest that exercise may be a promising alternative.

OBJECTIVE

The aim of the study was to review in depth the current literature regarding exercise treatment of metabolic syndrome neuropathy in humans and animal models, highlight the diverse mechanisms by which exercise exerts beneficial effects, and examine adherence limitations, safety aspects, modes and dose of exercise.

RESULTS

Rodent models that recapitulate the organismal milieu of prediabetic metabolic syndrome and the phenotype of its neuropathy provide a strong platform to dissect exercise effects on neuropathy pathogenesis. In these models, exercise reverses hyperglycemia and consequent oxidative and nitrosative stress, improves microvascular vasoreactivity, enhances axonal transport, ameliorates the lipotoxicity and inflammatory effects of hyperlipidemia and obesity, supports neuronal survival and regeneration following injury, and enhances mitochondrial bioenergetics at the distal axon. Prospective human studies are limited in scale but suggest exercise to improve cutaneous nerve regenerative capacity, neuropathic pain, and task-specific functional performance measures of gait and balance. Like other heath behavioral interventions, the benefits of exercise are limited by patient adherence.

CONCLUSION

Exercise is an integrative therapy that potently reduces cellular inflammatory state and improves distal axonal oxidative metabolism to ameliorate features of neuropathy in metabolic syndrome. The intensity of exercise need not improve cardinal features of metabolic syndrome, including weight, glucose control, to exert beneficial effects.

Exercise and Neuropathy: Systematic Review with Meta-Analysis

INTRODUCTION

Peripheral neuropathies are a prevalent, heterogeneous group of diseases of the peripheral nervous system. Symptoms are often debilitating, difficult to treat, and usually become chronic. Not only do they diminish patients' quality of life, but they can also affect medical therapy and lead to complications. To date, for most conditions there are no evidence-based causal treatment options available. Research has increased considerably since the last review in 2014 regarding the therapeutic potential of exercise interventions for patients with polyneuropathy.

OBJECTIVE

Our objective in this systematic review with meta-analysis was to analyze exercise interventions for neuropathic patients in order to update a systematic review from 2014 and to evaluate the potential benefits of exercise on neuropathies of different origin that can then be translated into practice.

METHODS

Two independent reviewers performed a systematic review with meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Inclusion criteria according to the PICOS approach were: neuropathic patients, exercise interventions only, an inactive or non-exercising control group, and solely randomized controlled trials with the following outcome parameters: neuropathic symptoms, balance parameters, functional mobility, gait, health-related quality of life, and HbA1c (glycated hemoglobin).

RESULTS

A total of 41 randomized, controlled trials met all inclusion criteria, 20 of which could be included in the quantitative analysis. Study quality varied from moderate to high. Current data further support the hypothesis that exercise is beneficial for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN) (27 studies) as well as for chemotherapy-induced peripheral neuropathy (CIPN) (nine studies), while there are only few studies (five) on all other causes of neuropathy. We found standardized mean differences in favor of the exercise group of 0.27-2.00 for static balance, Berg Balance Scale, Timed-up-and-go-test, nerve conduction velocity of peroneal and sural nerve as well as for HbA1c in patients with DPN, and standardized mean differences of 0.43-0.75 for static balance, quality of life, and neuropathy-induced symptoms in patients with CIPN.

CONCLUSION

For DPN, evidence-based recommendations can now be made, suggesting a combination of endurance and sensorimotor training to be most beneficial. For patients with CIPN, sensorimotor training remains the most crucial component. For all other neuropathies, more high-quality research is needed to derive evidence-based recommendations. Overall, it seems that sensorimotor training has great potential to target most neuropathies and combined with endurance training is therefore currently the best treatment option for neuropathies. REGISTRATION NUMBER: (PROSPERO 2019 CRD42019124583)/16.04.2019.

Effect of Yogasana Intervention on Standing Balance Performance among People with Diabetic Peripheral Neuropathy: A Pilot Study

Background

Diabetic peripheral neuropathy (DPN) is known to cause impaired balance and eventually increased risk of fall. Yogasanas characterized by slow, gentle transitions into postures with a varying base of support and focus on body awareness during movement hold potential for training balance control. Therefore, the current study aimed to evaluate effect of structured Yogasana intervention compared to conventional balance exercise on static and dynamic balance performance among people with diabetic neuropathy.

Methods

: Thirty-five people with DPN aged 42-70 years were recruited to Yogasana intervention group (n = 11), conventional balance exercises group (n = 10), and Control group (n = 14) following ethical approval. All participants were evaluated at baseline and post 12-week intervention on star excursion balance test, single-limb stance test, and center of pressure (CoP) excursion for balance performance, Modified fall efficacy scale for fear of falls and lower extremity strength using chair stand test and step-up test.

Results

Balance performance (static and dynamic measured by star excursion balance test, single-limb stance test, and CoP excursion, lower extremity strength (using chair stand test and step-up test) demonstrated improvement and fear of fall reduced among Yogasana intervention group (p = 0.05) and conventional balance exercises group (p = 0.05) post 12-week intervention. CoP excursion increased in the control group indicating deterioration in balance performance after 12 weeks (p = 0.05). Post hoc comparison revealed that Yogasana intervention was marginally more effective in improving static and dynamic balance performance compared to conventional balance exercises in all variables of standing balance performance (p = 0.025).

Conclusion

Yogasana and conventional balance exercises were effective in improving static and dynamic balance performance, lower extremity muscle strength, and reducing fear of fall among people with DPN. Yogasana intervention demonstrated marginally greater improvement in static and dynamic balance performance and lower extremity muscle strength compared to conventional exercise.

A Systematic Review and Meta-analysis on Efficacy of Exercise on Posture and Balance in Patients Suffering from Diabetic Neuropathy

BACKGROUND

Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability.

OBJECTIVE

The aim of this study is to assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus.

METHODS

Mean changes in Timed Up and Go test (TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on the PEDro Rating scale. The risk of bias was assessed by the Cochrane collaboration tool of risk of bias. Included studies had a low risk of bias. Sixteen RCT's were included for the meta-analysis.

RESULTS

Results of meta-analysis showed that there was a statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I2 = 84%, p < 0.00001) in the experimental group as compared to control group. There was a statistically significant difference in Berg Balance Scale scores and heterogeneity of I2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I2 = 100%, p =0.01 and eyes closed, heteogeneity I2 = 0%, p =0.01). Sensitivity analysis causes a change in heterogeneity.

CONCLUSION

It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training, etc. have a significant effect on improving balance and posture in diabetic neuropathy.

Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review

The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.

Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy

PURPOSE

The aim of the study was to evaluate the effect of sensorimotor training on balance measures, and proprioception, among middle-aged and older adults with diabetic peripheral neuropathy (DPN).

METHODS

A randomized controlled study with four parallel arms (two intervention groups and two control groups) was conducted at CPRS, Jamia Millia Islamia. Thirty-seven individuals were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to intervention and control groups, respectively. Subjects in the intervention group were administered eight weeks (3days/week) of sensorimotor training, involving 10 different types of exercises, progressed from easy to hard every two weeks, along with diabetes and foot care education; subjects in control group received diabetes and foot care education only. Outcomes measures involved static and dynamic balance measures, centre of pressure (COP) range, COP sway, and proprioception, measured before and after eight weeks.

RESULTS

Baseline measures showed significant age effect for timed up and go test (TUG) (p =  0.002), one leg stance (OLS) in eyes open (EO) and eyes closed (EC) (p ≤ 0.041), COP range in front (p =  0.007), back (p =  0.009) and right direction (p =  0.013), COP sway with visual feedback in front-back direction (p =  0.027), COP sway without visual feedback in left-right direction (p =  0.028), and proprioception in right direction (p =  0.026). After intervention, OLS EO and EC on both legs showed significant time effect (p ≤  0.003), group effect as well as time×group interaction (p <  0.05), and age effect and time×age interaction (p ≤  0.04). Functional reach test, TUG, COP range, COP sway, and proprioception were found with significant time effect (p <  0.03), group effect, and time×group interaction (p ≤  0.035). Age effect and time×age interaction were found to be non-significant for all COP ranges and COP sway.

CONCLUSION

Sensorimotor training improved static and dynamic balance as well as proprioception measures after eight weeks of exercise intervention. Static balance showed greater improvement in the middle-aged than older aged adults, while dynamic balance and proprioception showed similar results for both.

Protocol for evaluating the effects of a foot-ankle therapeutic exercise program on daily activity, foot-ankle functionality, and biomechanics in people with diabetic polyneuropathy: a randomized controlled trial

BACKGROUND

Diabetic polyneuropathy (DPN) negatively affects foot and ankle function (strength and flexibility), which itself affects the daily physical activity and quality of life of patients. A physical therapy protocol aiming to strengthen the intrinsic and extrinsic foot muscles and increase flexibility may be a promising approach to improve lower-extremity function, prevent further complications, and improve autonomy for daily living activities in these patients. Thus, the inclusion of a specific foot-related exercises focused on the main musculoskeletal impairments may have additional effects to the conventional interventions in the diabetic foot.

METHODS/DESIGN

A prospective, parallel-group, outcome-assessor blinded, randomized controlled trial (RCT) will be conducted in 77 patients with DPN who will be randomly allocated to usual care (control arm) or usual care with supervised foot-ankle exercises aiming to increase strengh and flexibility twice a week for 12 weeks and remotely supervised foot-ankle exercises for a year through a web software. Patients will be evaluated 5 times in a 1 year period regarding daily physical activity level, self-selected and fast gait speeds (primary outcomes), foot ulcer incidence, ulcer risk classification, neuropathy testing, passive ankle range of motion, quality of life, foot health and functionality, foot muscle strength, plantar pressure, and foot-ankle kinematics and kinetics during gait.

DISCUSSION

This study aims to assess the effect of a foot-ankle strength and flexibility program on a wide range of musculoskeletal, activity-related, biomechanical, and clinical outcomes in DPN patients. We intend to demonstrate evidence that the year-long training program is effective in increasing gait speed and daily physical activity level and in improving quality of life; foot strength, functionality, and mobility; and biomechanics while walking. The results will be published as soon as they are available.

TRIAL REGISTRATION

This study has been registered at ClinicalTrials.gov as NCT02790931 (June 6, 2016) under the name "Effects of foot muscle strengthening in daily activity in diabetic neuropathic patients".

The effect of ball exercise on the balance ability of young adults

[Purpose] The aim of this study was to investigate the effects of static and dynamic balance by using Medicine-ball and Swiss-ball exercises. [Subjects and Methods] Thirty-six normal adults who agreed to participate were included in the study. Subjects were randomly assigned to the Medicine-ball (n=18) and Swiss-ball groups (n=18). The participants performed the exercise for 6 weeks. Balance error scoring system and one leg standing test were performed to determine static balance, and functional reach test and timed up and go test were performed to determine dynamic balance. [Results] A significant improvement was observed from the Medicine-ball and Swiss-ball exercises, but no difference was found between the groups. In addition, a significant difference was found between balance error scoring system, one leg standing test and functional reach test after pre- and post-exercise of the Medicine-ball and Swiss-ball. [Conclusion] The findings of this study showed that the Medicine-ball and Swiss-balls were effective in improving static and dynamic balance.

Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: a randomized controlled trial

OBJECTIVE

To evaluate the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis.

DESIGN

It was a three-arm parallel randomized controlled trial study.

SETTING

Outpatient clinic.

SUBJECTS

Patients with multiple sclerosis.

INTERVENTIONS

Subjects in the intervention groups completed a 12-week program consisted of Cawthorne-Cooksey or Frenkel exercises. The control group only received routine care.

MAIN MEASURES

The outcome measure was the Berg Balance Scale.

RESULTS

Seventy-two patients completed the study. At the end of the intervention, there was a statistically significant improvement in Berg Balance Scale in the Cawthorne-Cooksey group ( n = 24) in comparison with the other two groups ( P = 0.001). In the Frenkel group ( n = 23), the improvement was statistically greater than the changes in the control group ( n = 25), but it did not appear to be clinically significant. The Berg Balance Scale score increased to 8.9 in the Cawthorne-Cooksey group and 2.3 in the Frenkel group, while it decreased to 1.2 in the control group. When comparing inter-group changes, Berg Balance Scale showed significant improvements in favor of the Cawthorne-Cooksey group after the intervention ( P < 0.05).

CONCLUSION

This study demonstrated that in comparison with Frenkel and the control groups, a program of Cawthorne-Cooksey exercise is more effective in improving balance in patients with multiple sclerosis.

The Obesity-Impulsivity Axis: Potential Metabolic Interventions in Chronic Psychiatric Patients

Pathological impulsivity is encountered in a broad range of psychiatric conditions and is thought to be a risk factor for aggression directed against oneself or others. Recently, a strong association was found between impulsivity and obesity which may explain the high prevalence of metabolic disorders in individuals with mental illness even in the absence of exposure to psychotropic drugs. As the overlapping neurobiology of impulsivity and obesity is being unraveled, the question asked louder and louder is whether they should be treated concomitantly. The treatment of obesity and metabolic dysregulations in chronic psychiatric patients is currently underutilized and often initiated late, making correction more difficult to achieve. Addressing obesity and metabolic dysfunction in a preventive manner may not only lower morbidity and mortality but also the excessive impulsivity, decreasing the risk for aggression. In this review, we take a look beyond psychopharmacological interventions and discuss dietary and physical therapy approaches.