Low-Impact Exercise Options If You Have Peripheral Neuropathy

If you suffer from peripheral neuropathy, you may feel caught in a catch-22 when it comes to exercise. On the one hand, exercise is crucial for managing both your symptoms and slowing the progression of the disease. Exercise improves blood and nutrient flow to the legs and feet—and the nerves they contain— reduces swelling, and strengthens and stabilizes weakened muscles and supporting tissues. And of course, if your neuropathy is linked to diabetes or high blood sugar, regular exercise will help you keep those exacerbating factors in better control.

This means that exercise not only makes your feet and legs feel better but also keeps your neuropathy from advancing to a more severe stage. This reduces your risk of falls, wounds, and other severe complications.

However, on the other hand, certain forms of exercise can be dangerous for someone who has already lost a lot of feeling, strength, and/or balance in their lower limbs. There's an increased risk of falling or suffering other kinds of accidental injuries. There's also a lack of force feedback from your feet. This means you could suffer a cut, pull your Achilles tendon, or even break a bone without immediately feeling it. The longer a medical issue goes unnoticed, the greater your risk of developing severe infections or deformities.

Many of our patients at Sunshein Podiatry come to us with this dilemma, and we totally understand their frustration. So, our experienced podiatrists want to share these safe exercise tips for peripheral neuropathy if you're facing a similar challenge. 

What Are Some Low-Impact Exercises People With Neuropathy Can Do?

Before you lace up or suit up, we'd like to stress a couple of important points:

1. Stick to exercises that put less weight, pressure, and risk on your feet and ankles.
2. Focus on movement that specifically counteracts some of the most common problems associated with neuropathy.

Let’s break these categories down a bit.

Easy Cardio

Cardiovascular fitness exercises are a crucial component of overall health and well-being for all individuals. Regular cardio helps weight management, improves blood sugar control, provides more oxygen and nutrients to your lower extremities, and even promotes better sleep—all of which have profoundly positive effects on the course of your neuropathy.

The problem is many cardio exercises—such as running, pickleball, jump rope, basketball, or tennis—are high-impact. In other words, they place heavy demands on your feet, ankles, and joints. If your lower limbs have been weakened by neuropathy, these activities may be too severe to perform safely.

So here are alternative cardio exercises we recommend: 

• Walking. Although it may be lower in intensity than running, brisk walking is still an excellent cardio exercise—especially if you can manage at least 30 minutes at a time and have supportive footwear.
• Cycling. Both going outside for a bike ride or riding a stationary cycle are great forms of cardio that put less stress on your feet. The stationary bike may be preferred if your neuropathy is severe, you're unsure of how far you can comfortably ride, or are uncertain about weather conditions.
• Aquatics. The natural buoyancy properties of water allow you to get great cardio while putting almost no strain on your joints. Swimming laps is great, and so is water aerobics.

Strength and Balance Training

Stronger muscles provide better support and balance, which helps you stay more resistant to injuries. Plus, with regular conditioning, your muscles become more efficient at using the oxygen delivered by your blood. 

Fortunately, many of these exercises can be performed at home with little to no specialized equipment. For instance:

• Calf raises. Slowly rise up to your tiptoes, hold the position as long as you comfortably can, then slowly lower. For support, use a wall, kitchen counter, or sturdy piece of furniture. As you get more comfortable, try one foot at a time, with your other foot lifted behind you.
• Heel-to-toe walking. A great one for balance! Simply walk in a straight line by placing your heel directly in front of the toes of the other foot with each step. The shoes should touch.
• Seated dorsiflexion exercises. Sit in a comfy but straight-backed chair with your feet flat on the floor. Then, keeping your heels on the floor, flex your feet and toes upward as high as you can, hold, and slowly let them down.

Of course, if you do like to go to the gym, you can try the leg extension machine, hamstring curl machines, and other low-impact strength training exercises. However, avoid exercises that require heavy weight bearing while standing, such as barbell squats.

Range of Motion Exercises

Flexibility stretches are also a key part of building up resistance to peripheral neuropathy-related injuries. They're foundational to all the other forms of exercise you engage in, since they help warm up your muscles and joints and allow you to safely sustain higher levels of activity. Here are a couple of good examples:

• Calf stretches. Face a wall—close enough to put your hands on it for support if needed—with your feet shoulder-width apart. Then, step back with one leg as far as you comfortably can, with your back foot flat on the floor and the back knee only slightly bent. You’ll have to bend your front knee. Lean forward as well as you can, then hold the stretch at least 10–15 seconds. Switch and repeat.
• Ankle circles. This stretch is really straightforward. Sit in a chair, with one leg crossed over the other knee. Move your ankle in a slow, steady circle at least 10 times in each direction. Alternatively, you can try imagining your big toe as the tip of a pen and writing out the alphabet using only your ankle. If you can't cross your leg, hold up one leg under your thigh and rotate your ankle, then switch to the other leg.

How Can You Prepare Safely for Exercising?

We hope you’re excited to reintroduce healthy movement into your daily life. However, there are a couple of safety checks to keep in mind:

1. If you have noticeable signs of peripheral neuropathy, always seek the input of a physician—whether your personal care provider or one of the doctors here at Sunshein Podiatry—before putting together a comprehensive workout plan. We’ll help ensure your plan is well-suited to your unique situation and personal needs, from both a safety and optimal benefit perspective.
2. Start slowly at first, especially if you're not accustomed to regular exercise or are making significant changes to your previous routine. It will take your body time to adapt to the new kinds of stresses and challenges. Better to move at a pace or intensity you know you can handle, and then increase by no more than 10-15% per week.
3. Always make sure you have the appropriate safety gear, including the right kind of athletic shoes in good repair and fit your feet well. Once again, our team can assist you with this.

To help you with the at-home component, we’ve written a brief downloadable guide on health and wellness. Keep it on your phone or print it out to keep exercise guidelines easily accessible and top of mind!