Pharmaceuticals targeting the pathogenesis
of diabetic distal symmetric polyneuropathy have all failed in clinical trials,
limiting recourse to palliative treatments. The American Diabetes Association
regards the effectiveness of glycemic control and lifestyle modification
therapies on diabetic neuropathies as inconclusive. The objective of this
research was to determine if and how physical exercise influences distal
symmetric polyneuropathic severity in type 2 diabetes patients. Embase,
MEDLINE, and Google Scholar were searched to collect randomized and controlled
studies published between January 1, 2012 and April 20, 2020. Titles had to
mention diabetes, physical exercise of any type or lifestyle interventions in
general, and neuropathy. Abstracts had to indicate satisfaction of PICOS
criteria, whereas full-text reviews had to be fully confirmatory. Extracted
data was thematically synthesized based primarily on relationships between exercise
interventions and effects on distal symmetric polyneuropathic severity outcomes
in type 2 diabetes patients. Qualitative analysis scoring criteria objectively
mirrored PICO except for the bias and
limitation score component, which assessed common markers of validity
for randomized trials (as specified in the PRISMA statement). Database searches
yielded 379 unique records, 15 of which passed eligibility screening. Thematic
synthesis supported exercise as an ameliorative treatment of type 2 diabetes
distal symmetric polyneuropathy through improved Michigan Diabetic Neuropathy
Scores and increased sural sensory nerve conduction velocity, though efficacy
may be limited by neuropathic severity. This is the first systematic review to acquire these results, and to
do so within the context of neuropathic severity. This review protocol
is registered on PROSPERO (CRD42020181211) at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020181211
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