Exercise improves balance in diabetic neuropathy

Diabetic peripheral neuropathy damages the nerves that feed sensory information from the feet and legs, and impaired balance is a common consequence for people living with it. Because drug treatment does not restore balance function, non-pharmacological approaches such as exercise and therapeutic modalities are the main candidates for helping people stay steady on their feet. The evidence for these approaches has been scattered across many small trials using different methods. This review set out to gather the most recent data and provide evidence-based support for which non-drug treatments actually enhance balance in this population.

The authors systematically searched PubMed, Embase, Web of Science and the Cochrane Library up to June 10, 2026, following PRISMA guidelines, for randomised controlled trials of non-pharmacological treatments for balance in diabetic peripheral neuropathy. Seventeen articles met the criteria, covering two treatment types: exercise and therapeutic modalities. Outcomes were three standard balance measures — timed up and go (TUG) time, Berg Balance Scale (BBS) scores and one-leg stance (OLS) time. Mean differences with 95% confidence intervals were pooled, and heterogeneity was estimated with I² indices.

Exercise improved all three measures: TUG time fell (mean difference -0.98, 95% CI -1.38 to -0.58), BBS scores rose (mean difference 2.67, 95% CI 1.43 to 3.91) and one-leg stance time lengthened (mean difference 1.61, 95% CI 0.58 to 2.64). Therapeutic modalities also reduced TUG time (mean difference -1.35, 95% CI -1.89 to -0.81) and increased one-leg stance time (mean difference 2.21, 95% CI 0.59 to 3.38). However, the modalities' effect on BBS scores (mean difference 1.29, 95% CI -0.43 to 3.01) was not statistically significant. Overall, the authors conclude non-pharmacological treatments can significantly improve balance in this condition.

This synthesis strengthens the case that balance in diabetic peripheral neuropathy is trainable rather than fixed, with exercise showing consistent effects across all three validated measures. It also introduces a useful distinction: passive therapeutic modalities helped on some measures but not on the Berg Balance Scale, hinting that active training may be the more complete option. The authors call for standardisation of treatment parameters and rigorous evaluation of long-term efficacy and safety, which remain open questions. The absolute sizes of the improvements also need translating into real-world outcomes such as fall reduction.

For anyone affected by, or supporting someone with, diabetic nerve damage, this is a reason to think that balance is not simply lost to the condition — structured exercise was associated with measurably better performance on standard balance tests. The pattern also suggests that actively training the body may cover more ground than passive treatments alone. Because treatment protocols varied and long-term effects were not assessed, this evidence informs a conversation with a clinician rather than a do-it-yourself programme.