Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Metabolic Fitness Association, Monterotondo, Rome, Italy.
Diabetes Res Clin Pract. 2022 Jan;183:109183. doi: 10.1016/j.diabres.2021.109183. Epub 2021 Dec 17.
Diabetic peripheral neuropathy (DPN) is a common condition that is associated with neuromuscular dysfunction and peripheral sensory impairment. These deficits predispose patients to sensory and motor system limitations, foot ulcers and a high risk of falls. Exercise training has been proposed as an effective tool to alleviate neural deficits and improve whole-body function. Here we review the effects of DPN on neuromuscular function, the mechanisms underlying this impairment, and the neural and muscular adaptations to exercise training. Muscle dysfunction is an early hallmark of DPN. Deficits in muscle strength, power, mass and a greater fatigability are particularly severe in the lower extremity muscles. Non-enzymatic glycation of motor proteins, impaired excitation-contraction coupling and loss of motor units have been indicated as the main factors underlying muscular dysfunction. Among the exercise-based solutions, aerobic training improves neural structure and function and ameliorates neuropathic signs and symptoms. Resistance training induces marked improvement of muscle performance and may alleviate neuropathic pain. A combination of aerobic and resistance training (i.e., combined training) restores small sensory nerve damage, reduces symptoms, and improves muscle function. The evidence so far suggests that exercise training is highly beneficial and should be included in the standard care for DPN patients.
糖尿病周围神经病变（DPN）是一种常见病症，与神经肌肉功能障碍和周围感觉损伤有关。这些缺陷使患者易出现感觉和运动系统受限、足部溃疡和高跌倒风险。运动训练被提议作为一种缓解神经缺陷和改善全身功能的有效工具。在这里，我们回顾了 DPN 对神经肌肉功能的影响、导致这种损伤的机制，以及对运动训练的神经和肌肉适应。肌肉功能障碍是 DPN 的早期标志。下肢肌肉的力量、功率、质量和疲劳性下降尤为严重。运动蛋白的非酶糖基化、兴奋-收缩偶联受损和运动单位丧失被认为是肌肉功能障碍的主要因素。在基于运动的解决方案中，有氧运动改善神经结构和功能，并改善神经病变的迹象和症状。阻力训练可显著改善肌肉性能，并可能缓解神经病变性疼痛。有氧和阻力训练的结合（即组合训练）可恢复小的感觉神经损伤，减轻症状，并改善肌肉功能。到目前为止的证据表明，运动训练非常有益，应该包含在 DPN 患者的标准护理中。
