Neuropathy Patients Hate Exercise But They Mustnt Avoid It

Today's short post from journals.lww.com (see link below) is a response from a doctor to a question most of us with neuropathy hope the answer to, will be a resounding "No". Unfortunately, the answer is yes to the question as to whether exercise helps with neuropathy. So we need to be prepared to put our bodies through yet more pain and discomfort for their benefit in the long run. The key is, making exercise something that is so obviously valuable that we can't ignore it and making it as pleasurable as possible. You can groan all you want (I do too) but the fact is that neuropathy weakens our muscles and joints to such an extent that it makes the pain considerably worse, never mind the fact that we can't do simple tasks any more. Read the article and think about your best strategy but don't overdo it and listen to your body when it tells you that you're doing just that.

Departments: Ask the Experts
You Ask. We Answer: 
Is exercise helpful for peripheral neuropathy?
Ensrud, Erik MD Neurology Now: October/November 2016 - Volume 12 - Issue 5 - p 31 doi: 10.1097/01.NNN.0000503487.82934.2d
 
Q Is exercise helpful for PERIPHERAL NEUROPATHY?

ERIK ENSRUD, MD, RESPONDS:

Answer: Yes, as long as you aren't overdoing it. The same benefits that anyone gets from exercise—improved cardiovascular function, increased mobility, a boost in mood—are realized by people with peripheral neuropathy, regardless of its cause. People with neuropathy may also experience an improvement in function and quality of life, as well as a decrease in pain.

PICK AN APPROPRIATE EXERCISE

Peripheral neuropathy is a general term for a group of diseases that affects motor and sensory nerves outside the brain and spinal cord. There are different types of neuropathy, and each has different causes and effects. Focal neuropathy, for instance, usually affects just one nerve or group of nerves. A common example is carpal tunnel syndrome, which involves nerve damage in the wrist. Any exercise that involves repetitive motion directly on the joint, such as playing tennis or texting or typing for hours on end, could aggravate the condition. Proximal neuropathy can reduce muscle strength in the legs and hips, so patients with this type of neuropathy might try riding a recumbent bike to avoid putting too much force on a compromised leg or hip joint.

STAY WITHIN YOUR LIMITS

When people think of exercise, they often think of the intense workout regimens of Olympic athletes like Michael Phelps and Katie Ledecky. But for most people, intense exercise is counterproductive. For people with neuropathy in particular, overstressed muscles may not recover as well because of existing nerve problems. A good rule of thumb during exercise is the talk test: If you can maintain a conversation without becoming breathless while exercising, you are likely at the right exertion level.

MAKE EXERCISE ENJOYABLE

If physical activity feels like a chore or is inconvenient, you'll eventually stop doing it. Decide what you like to do—swimming, biking, walking, dancing, yoga, tai chi—and how you like to do it—with friends, at home, in nature, as part of a class—and you're more likely to stick with it. The goal is to create a positive association with exercise so you do it more often. Consider an activity tracker, which logs your steps every day; seeing the steps add up can be very motivating for some people.

START SLOWLY AND BUILD

Before beginning any exercise program, talk to your doctor. You want to be sure you don't have any conditions that may affect the type of exercise you can do or how long you can safely do it. Once you get the all-clear, start out with five to 20 minutes of exercise three times a week. As your fitness improves, gradually add minutes, distance, or intensity. A good way to start is by walking around a large indoor shopping mall or store. The surface is level, the temperature is comfortable, you can use a shopping cart for stability, and it's free—unless, of course, you buy things.

Dr. Ensrud is director of neuromuscular disease rehabilitation at St. Luke's Rehabilitation Institute in Spokane, WA. He is also a member of the American Academy of Neurology.

© 2016 American Academy of Neurology

http://journals.lww.com/neurologynow/Pages/articleviewer.aspx?year=2016&issue=12050&article=00019&type=Fulltext

Autonomic Neuropathy And Exercise Take Care What You Do

Today's post from neuropathydr.com (see link below) is a cautionary tale for those neuropathy patients who have been diagnosed as having autonomic neuropathy. A reminder for all those who are unaware what that is: it is a form of nerve damage that affects all the involuntary functions of the body that you normally don't have to think about and as such, is a dangerous but unfortunately relatively common form of neuropathy. This article warns such patients to be more aware when they decide to take on exercise as a part of their treatment - it may not be the best option in your case and needs to be carefully thought about before starting. Now this blog is (reluctantly) all for exercise for neuropathy patients but it's no easy option at the best of times! People with autonomic neuropathy need also to be aware of their limitations thanks to that form of neuropathy and should seek advice from their doctor or therapist. A useful article.
 

Exercising Caution With Autonomic Neuropathy
Posted by john on February 9, 2017

If you’ve been diagnosed with autonomic neuropathy, you know you’re at risk for some serious medical issues. Autonomic neuropathy (i.e., nerve damage to the autonomic nervous system) can affect every system in the body, especially:

• Cardiovascular – your heart, blood pressure and circulation

• Respiratory

• Gastrointestinal – your digestion, ability to ability to empty your bowels

• Genitourinary – erectile dysfunction and loss of bladder control

• While you’re dealing with some or all of these issues, exercise may not be on your radar.

But it should be.

Exercise can help control the symptoms of your underlying illness (whatever caused your autonomic neuropathy) and by doing that, you can help lessen the symptoms of your autonomic neuropathy.

But a word of caution is in order here.

The very nature of your autonomic neuropathy can affect the systems that are most sensitive to the effects of exercise. Any exercise program you begin should be designed and monitored by a medical professional well versed in the effects of autonomic neuropathy, like your NeuropathyDR® clinician.

Use Vs. Disuse

When you’re thinking about starting an exercise program and you’re thinking about how dangerous it can be, you also need to consider the effects of not starting an exercise program. The effects of not exercising are called “disuse syndrome”. We’ll discuss more about “disuse syndrome” in our next post.

What You Need To Think About Before You Start Exercising

Think about what happens to your body when you exercise. Your heart rate increases, your breathing becomes labored, you sweat.

Every single one of those results is controlled by the autonomic nervous system. Autonomic neuropathy can seriously impact how your body responds to the stimulus of exercise. And your body may not react as it should.

• Heart rate – If your autonomic neuropathy affects your cardiovascular system, you need to make sure that your exercise program is designed and monitored by your NeuropathyDR® clinician. Your autonomic neuropathy can lead to abnormal heart rate, inability to properly regulate blood pressure and redistribution of blood flow. Your cardiovascular autonomic neuropathy may cause you to have a higher resting rate and lower maximal heart rates during exercise.

• Blood pressure – Blood pressure response with posture change and during exercise is abnormal in patients with cardiovascular autonomic neuropathy. Postural hypotension, defined as a drop in blood pressure may be seen. This can mean that the blood pressure doesn’t react normally during exercise. Symptoms are similar to hypoglycemia and may be mistaken for a drop in blood glucose even though it’s actually a drop in blood pressure. Patients should be alerted to the potential confusion in these symptoms and instructed to check blood glucose before treating for hypoglycemia.

• Sweating and Disruption of Blood Flow – Autonomic neuropathy may reduce or even eliminate your ability to sweat. The loss of sweating, especially in your feet, can cause dry, brittle skin on the feet and you can develop skin ulcers. It can also make it more difficult for your body to respond to cold and heat. You need to make sure that you’re taking proper care of your feet before and during any exercise program. Make sure your shoes fit properly and examine your feet regularly to make sure you don’t have any sores, cracks or ulcers.

Autonomic neuropathy can have a serious effect on the very systems in the body that are directly affected by exercise. Make sure you talk to your local NeuropathyDR® clinician before you start an exercise program and let them monitor your progress.

For more information on coping with neuropathy, get your Free E-Book and subscription to our newsletters at http://neuropathydr.com.

http://neuropathydr.com/autonomic-neuropathy-4/

DIET EXERCISE DURING PREGNANCY HAS HIDDEN BENEFITS

It  might not be obvious on the scales, but healthy eating and increased physical activity from walking during pregnancy is directly associated with a range of improved outcomes at birth, according to researchers from the University of Adelaide.

Results of the world's biggest study of its kind -- offering healthy eating and exercise advice to pregnant women who are overweight or obese -- are published today in two papers in the journal BMC Medicine.

"While it might have been expected that healthier eating and increased physical activity during pregnancy would be associated with differences in weight gain, our findings highlight that weight gain in pregnancy is not an ideal measure of pregnancy health," says study leader Professor Jodie Dodd, from the University of Adelaide's Robinson Research Institute and the Women's and Children's Hospital.

"Importantly, however, these changes in diet and physical activity were directly associated with significant improvements in outcomes for babies.

"Women who received dietary and lifestyle advice increased the number of servings they consumed per day of fruits and vegetables, while reducing the percentage of energy in their diet derived from saturated fats.

"Women were also successful in increasing their physical activity, with about 15-20 minutes of brisk walking on most days of the week," Professor Dodd says.

Study leaders have previously reported a significant reduction in the number of babies born over 4kg to women who received the diet and lifestyle advice during pregnancy. The researchers can now report a range of other benefits for these babies, including a reduced chance of moderate to severe respiratory distress syndrome and reduced length of stay in hospital.

"Approximately 50% of women are overweight or obese during pregnancy. Until this study was conducted, there had been little evidence about the overall benefits of dietary and lifestyle interventions on this group of women," says study co-author Dr Rosalie Grivell from the University's Robinson Research Institute.

"Our hope is that by following some simple, practical and achievable lifestyle advice, pregnant women can improve their health and the outcomes for their babies. We would, of course, recommend that these lifestyle changes be adopted as much as possible before women become pregnant," Dr Grivell says.

Can Exercise Repair Nerve Damage

It's very difficult to know what to make of the information in today's post from sciencedaily.com (see link below). When you read about studies being carried out on mice leading to conclusions for neuropathy patients, you can sometimes feel that you're pretty far removed from the science. What's more, turning mice-studies into practical end-product help for a patient is often hugely time-consuming. However, this one does back up what neuropathy patients are frequently told...we need to exercise. However unpalatable and painful that advice sounds for many people with nerve damage, it does seem sensible and logical, if only to avoid muscular atrophy.
This study from two American universities however, suggests that exercise can help regenerate damaged nerves in certain situations; ie nerve damage caused by physical injury and not disease or drug side-effects. In the past this has been thought to be possible if done quickly enough after the injury. The question is, does exercise have any relevance for long-term neuropathy patients, in terms of nerve regeneration? The article doesn't give enough information regarding other forms of neuropathy but if we know we have to exercise anyway to maintain muscle tone and strength, we'll keep trying. If it helps in any other way with our nerve damage then that's a bonus. This study is interesting but we need more information to know whether it's relevant for a wider neuropathy population or not.

Study Sheds Light On Role of Exercise and Androgens Such as Testosterone On Nerve Damage Repair
ScienceDaily (Oct. 15, 2012)

A study by researchers from Emory University and Indiana University found that the beneficial effects daily exercise can have on the regeneration of nerves also require androgens such as testosterone in both males and females. It is the first report of both androgen-dependence of exercise on nerve regeneration and of an androgenic effect of exercise in females.

"The findings will provide a basis for the development of future treatment strategies for patients suffering peripheral nerve injuries," said Dale Sengelaub, professor in the Department of Psychological and Brain Sciences at IU. "And they underscore the need to tailor those treatments differently for men and women."

The researchers discussed the study on Monday at the Neuroscience 2012 scientific meeting in New Orleans.

Injuries to peripheral nerves are common. Hundreds of thousands of Americans are victims of traumatic injuries each year, and non-traumatic injuries, such as carpal tunnel syndrome, are found in even higher numbers. The researchers previously showed that two weeks of moderate daily exercise substantially improves regeneration of cut nerves and leads to functional recovery in mice, though different types of exercise are required to produce the effect in males and females. They now report that these beneficial effects of exercise require androgens such as testosterone in both males and females.

In the study they conducted, they exercised three groups of male and female mice. Nerves of the three groups were cut and surgically repaired. Once group received the drug flutamide, which blocks the androgen receptor. A second group received a placebo treatment. The third group was unexercised. Regenerating nerve fibers in the placebo group grew to more than twice the length of those in unexercised mice in both males and females. In flutamide-treated mice, the effects of exercise were blocked completely in both sexes.

The study, "Enhancement of peripheral axon regeneration by exercise requires androgen receptor signaling in both male and female mice," will be discussed from 11 a.m. to noon on Monday in Hall F-J. Co-authors are Arthur W. English and Nancy Thompson, both from Emory University.

http://www.sciencedaily.com/releases/2012/10/121015122205.htm

MORE EXERCISE IS NOT ALWAYS BETTER

There is strong epidemiological evidence of the importance of regular physical activity, such as brisk walking and jogging, in the management and rehabilitation of cardiovascular disease and in lowering the risk of death from other diseases such as hypertension, stroke, and type 2 diabetes. The Physical Activity Guidelines for Americans recommends about 150 minutes per week of moderate-intensity exercise or about 75 minutes of vigorous-intensity exercise. But there is clear evidence of an increase in cardiovascular deaths in heart attack survivors who exercise to excess, according to a new study published in Mayo Clinic Proceedings.

Paul T. Williams, PhD, of the Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, and Paul D. Thompson, MD, of the Department of Cardiology, Hartford Hospital, Hartford, CT, studied the relationship between exercise and cardiovascular disease-related deaths in about 2,400 physically active heart attack survivors. They conducted a prospective long-term study using the National Walkers' and Runners' Health Studies databases. This study confirmed previous reports indicating that the cardiovascular benefits for walking and running were equivalent, as long as the energy expenditures were the same (although when walking, as compared to running, it will take about twice as long to burn the same number of calories).

Remarkable dose-dependent reductions in deaths from cardiovascular events of up to 65% were seen among patients who were running less than 30 miles or walking less than 46 miles per week. Beyond this point however much of the benefit of exercise was lost, in what is described as a reverse J-curve pattern.

"These analyses provide what is to our knowledge the first data in humans demonstrating a statistically significant increase in cardiovascular risk with the highest levels of exercise," say Williams and Thompson. "Results suggest that the benefits of running or walking do not accrue indefinitely and that above some level, perhaps 30 miles per week of running, there is a significant increase in risk. Competitive running events also appear to increase the risk of an acute event." However, they point out that "our study population consisted of heart attack survivors and so the findings cannot be readily generalized to the entire population of heavy exercisers."

In the same issue, investigators in Spain report on a meta-analysis of ten cohort studies aimed at providing an accurate overview of mortality in elite athletes. The studies included over 42,000 top athletes (707 women) who had participated in a range of sports including football, baseball, track and field, and cycling, including Olympic level athletes and participants in the Tour de France.

"What we found on the evidence available was that elite athletes (mostly men) live longer than the general population, which suggests that the beneficial health effects of exercise, particularly in decreasing cardiovascular disease and cancer risk, are not necessarily confined to moderate doses," comments senior investigator Alejandro Lucia, MD, PhD, of the European University Madrid, Spain. "More research is needed however, using more homogeneous cohorts and a more proportional representation of both sexes."

"Extrapolation of the data from the current Williams and Thompson study to the general population would suggest that approximately one out of twenty people is overdoing exercise," comments James H. O'Keefe, MD, from the Mid America Heart Institute in Kansas City, MO, and first author of an editorial on "Exercising for Health and Longevity versus Peak Performance: Different Regimens for Different Goals," which appears in the same issue. Along with co-authors Carl "Chip" Lavie, MD, and Barry Franklin, PhD, he explains that "we have suggested the term 'cardiac overuse injury' for this increasingly common consequence of the 'more exercise is better' strategy." Even so, these authors state that about 10 out of every twenty people are not getting the minimum recommended amount of physical activity (>150 minutes/week of moderate exercise).

O'Keefe, Franklin and Lavie point out that a weekly cumulative dose of vigorous exercise of not more than about five hours has been identified in several studies to be the safe upper range for long-term cardiovascular health and life expectancy, and that it may also be beneficial to take one or two days a week off from vigorous exercise, and to refrain from high-intensity exercise on an everyday basis. They propose that individuals from either end of the exercise spectrum (sedentary people and over-exercisers) would probably reap long-term health benefits by changing their physical activity levels to be in the moderate range.

"For patients with heart disease, almost all should be exercising, and generally most should be exercising 30-40 minutes most days, but from a health stand-point, there is no reason to exercise much longer than that and especially not more than 60 minutes on most days," says Lavie, who is a cardiologist at the John Ochsner Heart and Vascular Institute, New Orleans, LA. "As Hippocrates said more than 2,000 years ago, 'if we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.' I and my co-authors believe this assessment continues to provide wise guidance," he concludes.

EASY EXERCISE TO HELP TO CONTROL SNORING

If snoring is hampering your partner’s sound sleep, simple mouth and tongue exercises can do wonders.

Researchers have found that these exercises can reduce frequency of snoring by 36 percent and total power of snoring by 59 percent.

“This study demonstrates a promising, non-invasive treatment for large populations suffering from snoring, the snorers and their bed partners, that are largely omitted from research and treatment,” said Barbara Phillips, medical director, sleep laboratory at the University of Kentucky College of Medicine in the US.

Snorers can try pushing the tip of the tongue against the roof of the mouth and sliding the tongue backward.

Sucking the tongue upward against the roof of the mouth, and pressing the entire tongue against the roof of the mouth can also help.

Forcing the back of the tongue against the floor of the mouth while keeping the tip of the tongue in contact with the bottom, front teeth and elevating the back of the roof of the mouth and uvula while saying the vowel “A” are other exercises that the researchers suggested.

The study was conducted on 39 patients who were randomised for three months of treatment with nasal dilator strips plus respiratory exercises (Control) or daily oropharyngeal exercises (therapy).

The participants were evaluated at study entry and end by sleep questionnaires and full polysomnography with objective measurements of snoring.

“The exercises significantly reduced snoring in our study group,” said study author Geraldo Lorenzi-Filho from University of Sao Paulo, Brazil.

The study appeared in the journal Chest.

Just Saying That Exercise Helps Neuropathy Doesnt Necessarily Make It So

Today's post from nursing.onclive.com (see link below) again promotes exercise as a way of reducing neuropathy symptoms but in this case, the evidence seems a little thin. By testing a group of cancer patients with neuropathy as a side effect, they found that walking and other general exercise prevented the symptoms from worsening, especially in older patients. I would suggest that moderate exercise will help older patients feel generally better anyway than sitting or lying for long periods of time but they'll need to provide much more specific evidence to prove that neuropathic symptoms can be reduced by a graduated walking course. In this case, I would suggest that with this sort of patient, there are far too many variables to come to the conclusion that exercise is more effective in reducing or limiting nerve damage symptoms in older people. That said, there is a general consensus among doctors that regular exercise will improve neuropathy, or at least stop it getting worse but in this case, I feel too much is being assumed from too little data.

Walking and Resistance Training Eases CIPN, Especially Among Older Patients
LAUREN M. GREEN @OncNurseEditor Wednesday, July 20, 2016

Patients undergoing chemotherapy prescribed a formal exercise program experienced less chemotherapy-induced peripheral neuropathy (CIPN), and the finding held true across all chemotherapy regimens tested. The effect was strongest in older patients, according to findings from a nationwide randomized controlled trial reported at the 2016 ASCO Annual Meeting.

CIPN is a highly prevalent and severe side effect of certain chemotherapy types, such as platinums, taxanes, and vinca alkaloids, affecting more than 50% of patients receiving these therapies. Nevertheless, “there are currently no established treatments for CIPN—despite 50 randomized clinical trials—testing the efficacy of drugs to prevent or treat it,” explained lead study author Ian Kleckner, PhD.

Kleckner, a research assistant professor at the University of Rochester Medical Center, and colleagues performed a secondary analysis of a subset of 314 sedentary patients receiving taxane-, vinca alkaloid-, or platinum-based chemotherapy derived from a larger, phase III, national, randomized controlled trial (N = 619).

The majority of patients were women (92%), and 78% had breast cancer. They were randomized to chemotherapy alone or chemotherapy plus exercise. Patients randomized to the EXCAP arm (Exercise for Cancer Patients) which is a personalized, 6-week, home-based, moderate-intensity progressive program, were prescribed a daily walking regimen (eg, steps per day), supplied with pedometers, and also given a set of resistance bands to perform specific exercises.

Walking and resistance exercises were recommended for the control group. They did not receive any formalized support; however, control participants were given the exercise kit at the end of the study.

The investigators used patient self-report of tingling and numbness at baseline and after the intervention, rated on a 0-10 scale with 10 being the worst level of CIPN. In the EXCAP arm, CIPN was reduced compared with controls, with an effect size of 0.26 (P = .06), and the finding was independent of other variables, such as gender, BMI, and cancer stage. However, age was a moderating variable.

“We found that exercise was more effective for older patients,” said Kleckner. “Older patients in the control arm experienced a large increase in CIPN after 6 weeks of chemotherapy, whereas older patients in the experimental exercise arm had a very small, if any, increase in CIPN.”

Kleckner said that based on these findings, he and colleagues hope to expand their research. “What we’d like to do now is design a randomized clinical trial testing exercise against chemotherapy alone, where CIPN is the primary outcome. Only one trial to date has looked at this, and it was very small—60 patients.”

He hopes researchers can identify biomarkers in the brain circuitry or signals of the role inflammation may play to help better identify who is most at risk for CIPN.

Over the next few years, Kleckner would like to see this research continue to “scale up, so we can better learn about the effectiveness of exercise, understand what dose/intensity of exercise is important, what type of exercise, and who responds best to exercise … we’re hoping for an exercise prescription, instead of the generic ‘please exercise.’”

Kleckner I, Kamen CS, Peppone LJ, et al. A URCC NCORP nationwide randomized controlled trial investigating the effect of exercise on chemotherapy-induced peripheral neuropathy in 314 cancer patients. J Clin Oncol. 2016; 34 (suppl; abstr 10000).

http://nursing.onclive.com/web-exclusives/walking-and-resistance-training-eases-cipn-especially-among-older-patients

Swimming Is An Exercise Option For Neuropathy Patients

Today's post from houstonfootspecialists.blogspot.com (see link below) talks about a form of exercise which may not have occurred to some people with neuropathy and that is swimming. Many neuropathy patients shudder at the thought of exercise bringing yet more pain to their feet, legs or arms but swimming solves that problem by taking the weight off your limbs while still giving you a work out.

Have Neuropathy? Try Swimming!
Dr. Jeffrey Bowman is the Podiatrist for Houston Foot Specialists.Tuesday, June 4, 2013

There are many reasons why people have numbness and tingling in their feet. A common disorder that affects the peripheral nerves is neuropathy. Peripheral neuropathy is characterized by nerve damage and results in numbness, tingling or burning sensations. Dr. Jeff Bowman, foot specialist in Houston, TX sees the effects of neuropathy on a regular basis in his patients with diabetes.

The symptoms of neuropathy can be improved especially when the underlying cause is managed well. Another way to manage neuropathy is though exercise.

How can exercise help with neuropathy?

There are many reasons for doing your best to stay active when you have neuropathy:

Reduces pain
Restores balance
Improves blood circulation
Improves your range of motion
Strengthens weak muscles
Reduces foot cramps from contracted muscles

Choosing lower impact options such as cycling, tai chi and Pilates will be safe for feet while still offering a cardiovascular workout. Swimming is a great option suitable for anyone at any age. Swimming works all the major muscle groups in your body and it is great for those with neuropathy since the water holds your body weight. Swimming can lower glucose levels, which ultimately reduces your risk for further nerve damage. You can do some pool walking, swim laps, do water aerobics or try synchronized swimming even.

http://houstonfootspecialists.blogspot.com/2013/06/have-neuropathy-try-swimming.html

Tai Chi The Gentle Exercise For Neuropathy Sufferers Vid

Today's post from foundationforpn.org and denverpost.com (see links below) revisits a therapy for people living with neuropathy that is gaining in popularity, mainly because it's so easy to perform. In contrast with yoga and other forms of exercise (which we all know we have to try to do), Tai Chi is far less painful and stressful and yet the results have been shown to be extremely helpful for nerve damage patients. The article (plus videos) pretty much covers all you need to know and even if you dismiss the idea, is worth a read. Gentle therapies are exactly what older people with neuropathy are asking for and Tai Chi fits the bill perfectly. Definitely worth a read.

Tai Chi for Peripheral Neuropathy
Researchers have determined that an ancient Chinese health practice called Tai Chi (Taiji) may provide benefits to people who suffer from PN.

How Tai Chi Can Help

A 2010 study published in the American Journal of Chinese Medicine from the Department of Kinesiology, Louisiana State University, showed that Tai Chi (also known as Taiji) practice actually increases the nerves’ ability and speed of sending signals back to the brain and spinal cord. After only a few weeks of Tai Chi practice, patients with PN can improve physical function and it is a safe and effective intervention.

Tai Chi can significantly improve balance, reducing both the likelihood – and the fear -of falling. Since the mid-1990‘s the Surgeon General has recommended that people over the age of 65 practice Tai Chi to improve balance and stability. One reason Tai Chi is so effective is that it teaches you to re-integrate the muscle control of legs, hips and low back. As we get older, or succumb to the side effects of diseases like diabetes, we start to lose muscle strength and function in certain areas of our bodies. Often this is a function of lifestyle – you know the old saying, “Use it or lose it.”

People with Peripheral Neuropathy tend to be less active because of the pain and uncertainty that comes with movement. And the less active they are, the more that whole body synergy is lost. It’s a vicious cycle. But Tai Chi can re-awaken the connections between muscles in the body, and between the muscles and the mind. Studies on Taiji and PN show that the more someone with Peripheral Neuropathy learns to use their whole body for both exercise and simple daily tasks – even walking! – the less pain they experience, and the more comfort they have in their bodies overall.

Recommendations

As with any new exercise program, I recommend starting small and easy – but the good news is that Tai Chi is as easy as walking and maybe less demanding! I am looking forward to providing some simple steps to making Tai Chi a part of your daily life and reducing the pain levels for those suffering from this disease.

Ezy Tai Chi: A simpler practice for seniors

As a form of exercise, tai chi increasingly appeals to the growing proportion of older adults that looks for alternative and convenient ways to exercise for health. Originally developed for martial arts purposes in China more than 300 hundred years ago, this practice has been used as a traditional exercise to improve fitness, health and longevity for individuals of all ages. Tai chi’s low-to-moderate intensity and beneficial effects on strength, flexibility, breathing and balance make it especially attractive to mature adults. Click here to read the full article.

 Click on the following links below to view Tai Chi instructional videos:




Want to Live Longer? Try Tai Chi

Dr. Xianglan Zhang, Vanderbilt School of Medicine, in a recent study found that Chinese men who practiced TaiChi were less like to die over a five-year period than men who didn’t exercise at all.

https://www.foundationforpn.org/living-well/integrative-therapies/tai-chi/

Want to live longer? Try tai chi 
By Reuters PUBLISHED: July 23, 2013 at 12:13 am | UPDATED: April 29, 2016 at 5:15 pm

 
People practice tai chi, a Chinese martial art, during morning exercises at Longtan Park in Beijing September 13, 2010. REUTERS/Grace Liang

Chinese men who practiced tai chi were less likely to die over a five-year period than men who didn’t exercise at all, in a new study.

The findings support past studies that found health benefits related to the traditional Chinese exercise.

“It combines slow motion exercise and mind concentration to focus on movement. That itself can reduce your stress and, of course, it will increase your flexibility and endurance,” said Dr. Xianglan Zhang, one of the study’s authors from the Vanderbilt University School of Medicine in Nashville, Tenn.

Zhang said her study could not prove, however, that tai chi was responsible for some men’s longer lifespan.

Earlier research has shown tai chi can be beneficial for people with chronic conditions, for example by improving balance among those with Parkinson’s disease.

To see whether tai chi and other forms of exercise might influence lifespan, Zhang and her colleagues looked to a large study of middle aged and elderly men in Shanghai.

More than 61,000 men participated in the study. Researchers tracked their health and lifestyle for more than five years.

Close to 22,000 participants reported that they exercised at least once a week, and the rest were considered non-exercisers.

Over the course of the study, 2,421 men died, including 3.3 percent of the non-exercisers and 5.1 percent of the men who exercised.

Exercisers tended to be older and more of them had heart disease and diabetes.

After Zhang’s group took into account men’s age, health conditions and whether they smoked, exercise was tied to a 20 percent lower likelihood of dying.

Similarly, 6.2 percent of the close to 10,000 men who practiced tai chi died during the study, but after accounting for other risk factors, the researchers found they were 20 percent less likely to die than men who didn’t exercise.

Men who walked regularly were 23 percent less likely to die during the study, and men who jogged were 27 percent less likely to die, Zhang’s team reports in the American Journal of Epidemiology.

Dr. Chenchen Wang, director of the Center for Complementary and Integrative Medicine at Tufts Medical Center in Boston, said that because Zhang’s study was observational, and did not randomly assign people to practice tai chi or not, it’s impossible to say whether the exercise itself is responsible for the findings.

There’s always the possibility, for instance, that people who choose tai chi tend to have healthier lifestyles.

But Wang, who wasn’t involved in the new study, told Reuters Health the results are interesting, and “they provide a very important foundation for future research.”

Zhang said the findings support tai chi as a healthy activity.

“I think for the elderly people, especially to maintain flexibility and balance, this is a good option for people to consider,” Zhang told Reuters Health.

http://www.denverpost.com/2013/07/23/want-to-live-longer-try-tai-chi/

Exercise And Nerve Problems

Today's post from sciencedaily.com (see link below) is another one looking at how forms of exercise may help in reducing nerve pain. The latest study has examined reactions in lab rats, which seems a million miles away from our daily grind but may well lead to discoveries about reducing so-called 'cytokines' which scientists believe cause inflammation in the nervous system. They are trying to find ways to reduce drug treatment for neuropathic pain and for that reason alone, we have to wish them success although many neuropathy sufferers will cringe at the idea of doing exercise, when even normal movements are very difficult.

How Does Exercise Affect Nerve Pain?

ScienceDaily (June 1, 2012)

Exercise helps to alleviate pain related to nerve damage (neuropathic pain) by reducing levels of certain inflammation-promoting factors, suggests an experimental study in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The results support exercise as a potentially useful nondrug treatment for neuropathic pain, and suggest that it may work by reducing inflammation-promoting substances called cytokines. The lead author was Yu-Wen Chen, PhD, of China Medical University, Taichung, Taiwan.

Exercise Reduces Nerve Pain and Cytokine Expression in Rats. Neuropathic pain is a common and difficult-to-treat type of pain caused by nerve damage, seen in patients with trauma, diabetes, and other conditions. Phantom limb pain after amputation is an example of neuropathic pain.
Dr Chen and colleagues examined the effects of exercise on neuropathic pain induced by sciatic nerve injury in rats. After nerve injury, some animals performed progressive exercise -- either swimming or treadmill running -- over a few weeks. The researchers assessed the effects of exercise on neuropathic pain severity by monitoring observable pain behaviors.

The results suggested significant reductions in neuropathic pain in rats assigned to swimming or treadmill running. Exercise reduced abnormal responses to temperature and pressure -- both characteristic of neuropathic pain
.
Exercise also led to reduced expression of inflammation-promoting cytokines in sciatic nerve tissue -- specifically, tumor necrosis factor-alpha and interleukin-1-beta. That was consistent with previous studies suggesting that inflammation and pro-inflammatory cytokines play a role in the development of neuropathic pain in response to nerve injury.

Exercise also led to increased expression of a protein, called heat shock protein-27, which may have contributed to the reductions in cytokine expression.

Neuropathic pain causes burning pain and numbness that is not controlled by conventional pain medications. Antidepressant and antiepileptic drugs may be helpful, but have significant side effects. Exercise is commonly recommended for patients with various types of chronic pain, but there are conflicting data as to whether it is helpful in neuropathic pain.

The new results support the benefits of exercise in reducing neuropathic pain, though not eliminating it completely. In the experiments, exercise reduced abnormal pain responses by 30 to 50 percent.
The study also adds new evidence that inflammation contributes to the development of neuropathic pain, including the possible roles of pro-inflammatory cytokines. The results provide support for exercise as a helpful, nondrug therapy for neuropathic pain -- potentially reducing the need for medications and resulting side effects.

http://www.sciencedaily.com/releases/2012/06/120601120513.htm

EXERCISE BOOSTS TUMOR FIGHTING ABILITY OF CHEMOTHERAPY

Study after study has proven it true: exercise is good for you. But new research from University of Pennsylvania scientists suggests that exercise may have an added benefit for cancer patients undergoing chemotherapy

Their work, performed in a mouse model of melanoma, found that combining exercise with chemotherapy shrunk tumors more than chemotherapy alone.

Joseph Libonati, an associate professor in the School of Nursing and director of the Laboratory of Innovative and Translational Nursing Research, was the senior author on the study, which appears in the American Journal of Physiology. His collaborators included Penn Nursing's Geetha Muthukumaran, Dennis Ding and Akinyemi Bajulaiye plus Kathleen Sturgeon, Keri Schadler, Nicholas J. Thomas, Victor Ferrari and Sandra Ryeom of Penn's Perelman School of Medicine.

Exercise has long been recommended to cancer patients for its physical and psychological benefits. Libonati and colleagues were particularly interested in testing whether exercise could protect against the negative cardiac-related side effects of the common cancer drug doxorubicin. Though effective at treating a variety of types of cancer, doxorubicin has is known to damage heart cells, which could lead to heart failure in the long-term.

"The immediate concern for these patients is, of course, the cancer, and they'll do whatever it takes to get rid of it," Libonati said. "But then when you get over that hump you have to deal with the long-term elevated risk of cardiovascular disease."

Previous studies had shown that an exercise regime prior to receiving chemotherapy could protect heart cells from the toxic effects of doxorubicin, but few had looked to see whether an exercise regimen during chemotherapy could be beneficial.

To do so, Libonati's team set up an experiment with four groups of mice. All were given an injection of melanoma cells in the scruffs of their neck. During the next two weeks, two of the groups received doxorubicin in two doses while the other two groups received placebo injections. Mice in one of the treated groups and one of the placebo groups were put on exercise regimens, walking 45 minutes five days a week on mouse-sized treadmills, while the rest of the mice remained sedentary.

After the two-week trial, the researchers examined the animals' hearts using echocardiogram and tissue analysis. As expected, doxorubicin was found to reduce the heart's function and size and increased fibrosis -- a damaging thickening of tissue. Mice that exercised were not protected from this damage.

"We looked, and the exercise didn't do anything to the heart -- it didn't worsen it, it didn't help it," Libonati said. "But the tumor data -- I find them actually amazing."

The "amazing" result was that the mice that both received chemotherapy and exercised had significantly smaller tumors after two weeks than mice that only received doxorubicin.

Further studies will investigate exactly how exercise enhances the effect of doxorubicin, but the Penn team believes it could be in part because exercise increases blood flow to the tumor, bringing with it more of the drug in the bloodstream.

"If exercise helps in this way, you could potentially use a smaller dose of the drug and get fewer side effects," Libonati said.

Gaining a clearer understanding of the many ways that exercise affects various systems of the body could also pave the way for developing drugs that mimic the effects of exercise.

"People don't take a drug and then sit down all day," Libonati says. "Something as simple as moving affects how drugs are metabolized. We're only just beginning to understand the complexities."

Exercise Therapy For Neuropathy

Today's post from portlandtribune.com (see link below) is yet another article promoting exercise therapy as being important for neuropathy patients. It's a message nobody with neuropathy wants to hear but is nevertheless an important one. The key is finding a therapy that is tailored to your own symptoms and for that you need a therapist/doctor/specialist who knows what they're doing and what they're talking about. An ordinary physical therapist is sometimes just not good enough because their general medical knowledge often doesn't take into account the peculiarities of neuropathy and nerve damage. First, you need to accept that exercise will help you; then you need to talk to your doctor and finally you need to do your own research and together with your health professional, develop a course of exercises appropriate to your condition and capabilities. This can be as soft or hard as you wish but doing nothing is a much worse option.

New research shows exercise therapy helps diabetic peripheral neuropathy
Created on Wednesday, 15 October 2014 10:36 | Written by Colin Hoobler |

Focus on Fitness

I’m 54 years old and have had Type 2 diabetes for 10 years, but now it’s worse because I also have pain, numbness and tingling going down my legs. My doctor says this is common in people with diabetes and prescribed medication along with a series of injections, which have helped. But I don’t like the side effects. Can physical therapy help? – Gwen from Vancouver

The answer is yes, but it should be a certain type of physical therapy if you want to address both your leg pain and diabetes, which is the likely cause of your leg pain.

You get Type 2 diabetes from eating a poor diet and inadequate exercise over an extended period. In Type 2 diabetes, your body’s cells aren’t effectively processing insulin, the hormone from your pancreas that controls blood sugar. Consequently, blood sugar is isn’t absorbed from the bloodstream well and remains chronically higher.

The pain, numbness and tingling you’re having is called diabetic peripheral neuropathy, which occurs in about 33 percent of American diabetics over 40 years old and is the result of nerve degeneration. Many people with peripheral neuropathy eventually have problems with walking, maintaining balance and lower leg injury

Extensive research has shown the importance of regular exercise accompanied by a sound diet in managing diabetes. Peripheral neuropathy, however, is another story. Only recently has research shown the importance of exercise therapy for people with diabetic peripheral neuropathy; where those who followed a 10-week supervised endurance and strengthening program yielded dramatic reductions in pain and nerve pain and symptoms, while increasing new nerve growth. This is a big deal, because it offers a new, cost-effective physical therapy that you can use in addition to medication and/or injections to expedite recovery.

Physical therapy can help, but it should be in the form of exercise therapy as opposed to “traditional” methods (e.g., manual therapy, ultrasound, modalities) so you start to address the cause of your diabetes. Many physician and physical therapy offices are recognizing the need for an exercise therapy emphasis in the medical treatment of diabetes and peripheral neuropathy. Health insurance companies (including Medicare) are also recognizing the importance of this medical model, as they are covering physical therapy services for exercise therapy to treat diabetic peripheral neuropathy, back pain, osteoarthritis and many other costly lifestyle-related conditions.

Specifically, your exercise therapy program should help you learn how to exercise safely and effectively on your own with whatever equipment you have available. A skilled physical therapist can show you how to strengthen, stretch and improve endurance of your muscles. Note that your muscles are like “blood sugar sponges;” the stronger they are, the more blood sugar they can absorb and therefore control your blood sugar.

The use of exercise therapy to help treat peripheral neuropathy is relatively new, so you may have to suggest it to your doctor to get the proper physical therapy referral for insurance coverage. Regardless, you have more control over your recovery than previously thought.

Colin Hoobler is a certified physical therapist and writes a regular column

http://portlandtribune.com/nbg/144-features/237048-102974-new-research-shows-exercise-therapy-helps-diabetic-peripheral-neuropathy