In general, becoming more physically active is beneficial for virtually everyone. However, diabetic peripheral neuropathy does present some special challenges that should be addressed before an individual with diabetes embarks upon an exercise program. In this article, we will discuss some of the challenges faced by patients managing this condition, we’ll offer some tips on how to incorporate safe exercises, and list physical activities that are best avoided by individuals managing diabetes.

Physical Challenges Associated With Diabetes

It’s not uncommon for diabetic patients to experience problems with peripheral nerve issues. Common symptoms include tingling, burning, and/or numbness in the extremities, as well as foot pain and/or leg pain. Most peripheral issues affect the legs, feet, and toes, but it is possible for a diabetic patient to also experience similar issues in their arms, legs, or fingers. Individuals with diabetes can eventually lose their ability to detect accurate sensation levels in their lower extremities, as well as their upper extremities, thus making it difficult for them to determine if an actual injury occurred in any of these areas. Since increased physical activity may increase the likelihood of experiencing an injury, patients with diabetes must be prudent about those activities they engage in and which activities are best avoided.

How A Physical Therapist Can Help

A professional physical therapist is specially trained in helping patients improve and maximize physical movement while reducing the likelihood of further injury. This holds true for healthy patients recovering from an athletic injury, as well as other patients facing special challenges such as diabetes. With a diabetic patient, a physical therapist can help determine their level of sensation in their extremities by conducting specific tests designed to check vibratory and position sense, deep tendon reflexes (DTRs), as well as touch sensors. With the use of a special 5.07 (10g) monofilament device, a physical therapist can determine the level of protective sensation a diabetic patient may have lost in their various extremities.

After evaluating a diabetic patient’s responses to the various tests, a physical therapist can then help create a comprehensive exercise program for their patients. In line with the recommendations of the American Diabetes Association, physical therapists will likely advise their patients with significant peripheral neuropathy issues to avoid weight-bearing exercises. This is because diabetic patients with significant PN are less able to detect if an injury has occurred to one of their extremities during weight-bearing, repetitive exercise.

Instead, a physical therapist is likely to recommend exercise alternatives such as swimming, cycling, rowing, exercises performed while seated in a chair, arm exercises, or other non-weight-bearing exercises. In order to follow additional guidelines presented by the ADA, the diabetic patient will likely be advised to avoid weight-bearing exercises such as prolonged walking, jogging, using a treadmill, or any step exercises since these types of exercises tend to increase the risk of ulcerations and/or fractures of extremities.


Physical activity has many benefits including increasing the likelihood of weight loss, it enables the heart, lungs, and circulatory system to become more physically fit, helps to increase muscle strength, and many people report that regular exercise helps them to sleep better as well. With all the health benefits associated with regular exercise, it’s not surprising that diabetic patients might be interested in increasing their activity levels.

By working directly with a professional physical therapist, the diabetic patient can safely take advantage of all the benefits offered by physical activity, while being under the direct guidance of someone who understands the unique health challenges of diabetic peripheral neuropathy. If you or someone you know has diabetes and would like more information on how to become more physically active, please contact us at 570-208-2787 or email us at

Written By Dr. Jeff Frail DPT