Science News: Relation of Exercise and Pain in Patients With Idiopathic Distal Axonal Polyneuropathies

Submitted by: Pritikanta Paul, MD
Edited by: Hristelina Ilevia, MD, PhD

Stewart S, Thomas S, Van Doormaal PT, Höke A. Relation of exercise and pain in patients with idiopathic distal axonal polyneuropathies. J Peripher Nerv Syst. 2020;25(4):388-394. doi:10.1111/jns.12415

Summary: Benefits of exercise in peripheral neuropathy related to diabetes mellitus or metabolic syndrome were studied. Exercise improves glycemic control and control of other metabolic measures resulting into improved small fiber function and reducing risk of developing neuropathy. However, role of exercise specifically in patients with idiopathic axonal peripheral neuropathy (IPN) has not been studied. This cross-sectional study looked at relation between self-reported exercise and severity of neuropathy in IPN. Comprehensive metabolic equivalents of task (METs) was derived for each participant to define exercise activity. The authors looked at relation between exercise and physician and patient-reported pain symptom as well as exam findings analyzed using Total Neuropathy Score.
 
Patients with IPN who exercised were less likely to develop painful neuropathy and also exercise correlated with less pain but not with numbness, weakness or balance issues. There was no dose-dependent response for level of exercise further emphasizing the beneficial role of exercise irrespective of duration and/or intensity.
 
Even after adjustment for metabolic syndrome factors, patients who did exercise were at lower risk for painful neuropathy. Additionally, this study is based on self-reported response and took into account benefit of the varying types and frequencies of exercise as seen in our clinical practice.

Comments: This study emphasizes the importance of exercise in reducing risk of painful neuropathy in IPN. Two major limitations of the study: 1. No definite before and after exercise correlation given the cross-sectional nature of the study. 2. Also, the causes for patients who didn’t do exercise were not stated. Painful neuropathy itself can prevent patients from exercising cause worse outcome.