What question did this study set out to answer?

This research evaluates how exercise training impacts balance function in adults with diabetic peripheral neuropathy (DPN).

February 26, 2026SHILAP Revista de lepidopterología0 citationsOpen Access

Exercise training and balance function in middle-aged and older adults with diabetic peripheral neuropathy: a GRADE-based systematic review and meta-analysis

Q: What does this research mean for the field?

Exercise training improves static and dynamic balance function in middle-aged and older adults with diabetic peripheral neuropathy (DPN). Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

RMRui Ma SXShuang Xu JKJianxin Kang

Key Points

This research evaluates how exercise training impacts balance function in adults with diabetic peripheral neuropathy (DPN).
Systematic search of multiple databases for randomized controlled trials (RCTs) on exercise and balance in DPN.
Inclusion of studies reporting validated balance outcomes in middle-aged and older adults with DPN.
Assessment of risk of bias and certainty of evidence using the GRADE framework.
Meta-analyses performed using R software to calculate mean differences in outcomes.
Sixteen RCTs involving 759 adults with DPN showed that exercise significantly improved balance scores measured by the Berg Balance Scale and Functional Reach Test.
Exercise increased performance on the Timed Up and Go test and One-Leg Stand Test in both eyes open and closed conditions.
No significant effect on walking capacity as measured by the Six-min Walk Test was found.

Abstract

Objective To systematically evaluate, using the GRADE framework, the effects of exercise training on static and dynamic balance function in middle-aged and older adults with DPN. Methods We systematically searched the Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, and Scopus from inception to March 21, 2025, for randomized controlled trials (RCTs) investigating exercise interventions targeting balance in adults with DPN. Eligible studies enrolled middle-aged and older adults with DPN and reported at least one validated balance-related outcome. Risk of bias was assessed, and the certainty of evidence was rated using the GRADE approach. Meta-analyses were performed using R software and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Results Sixteen RCTs involving 759 middle-aged and older adults with DPN were included. Low to very low certainty evidence indicated that exercise training significantly improved Berg Balance Scale scores MD = 2.14, 95% CI (1.57–2.73), Functional Reach Test distance MD = 3.23, 95% CI (1.82–4.64), and Timed Up and Go test performance MD = −1.65, 95% CI (−1.98–1.32). Exercise also increased One-Leg Stand Test duration with eyes open MD = 2.93, 95% CI (2.10–3.76) and eyes closed MD = 1.37, 95% CI (0.55–2.19). After exclusion of a study contributing substantial heterogeneity, the Five-Times Sit-to-Stand Test showed significant improvement MD = −3.07, 95% CI (−4.87–1.28). No significant effect was observed for the Six-min Walk Test MD = 27.36, 95% CI (−18.43–73.14). Conclusion Exercise training may confer beneficial effects on both static and dynamic balance function in middle-aged and older adults with DPN, although the certainty of evidence is generally low to very low. No significant effect was found on six-min walking capacity. Larger, pragmatic trials are needed to confirm effects and to guide implementation in community and outpatient services, including monitoring of fall-related and longer-term functional outcomes. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261305039 .

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