Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
Department of Oncology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Sports Med. 2022 May;52(5):1043-1065. doi: 10.1007/s40279-021-01596-6. Epub 2021 Dec 29.
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.
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.
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).
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.
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.
(PROSPERO 2019 CRD42019124583)/16.04.2019.
周围神经病变是一组常见且具有异质性的周围神经系统疾病。这些疾病的症状常常使人虚弱，难以治疗，且通常呈慢性。它们不仅降低了患者的生活质量，还可能影响医疗治疗并导致并发症。迄今为止，对于大多数疾病，尚无基于证据的因果治疗选择。自 2014 年进行上次审查以来，针对多发性神经病患者的运动干预治疗的研究已经大大增加。
在本系统评价和荟萃分析中，我们的目的是分析针对神经病变患者的运动干预措施，以更新 2014 年的系统评价，并评估运动对不同来源的神经病变的潜在益处，然后将其转化为实践。
两名独立的审查员根据《系统评价和荟萃分析的首选报告项目》（PRISMA）进行了系统评价和荟萃分析。根据 PICOS 方法的纳入标准为：神经病变患者，运动干预措施，不活动或非运动对照组，以及仅随机对照试验，具有以下结局参数：神经病变症状，平衡参数，功能移动性，步态，健康相关生活质量和 HbA1c（糖化血红蛋白）。
共有 41 项随机对照试验符合所有纳入标准，其中 20 项可进行定量分析。研究质量从中等到高不等。目前的数据进一步支持运动对神经病变患者有益的假设。这在患有糖尿病周围神经病（DPN）（27 项研究）和化学疗法引起的周围神经病（CIPN）（9 项研究）的患者中得到了最好的证明，而其他神经病变原因的研究很少（5 项）。我们发现，DPN 患者的运动组具有 0.27-2.00 的标准化平均差异，而 CIPN 患者的平衡静息状态，伯格平衡量表，计时起立行走测试，腓肠神经和腓浅神经的神经传导速度以及 HbA1c 也具有标准化平均差异。在 CIPN 患者中，平衡，生活质量和神经病变引起的症状的标准化平均差异为 0.43-0.75。
现在可以为 DPN 提供基于证据的建议，建议将耐力和感觉运动训练相结合，以获得最大的益处。对于 CIPN 患者，感觉运动训练仍然是最重要的组成部分。对于所有其他神经病变，需要更多高质量的研究来得出基于证据的建议。总体而言，感觉运动训练似乎具有针对大多数神经病变的巨大潜力，并且与耐力训练相结合，目前是治疗神经病变的最佳选择。
（PROSPERO 2019 CRD42019124583）/16.04.2019。
