Q: I am a 54-year-old diabetic who is disabled due to my diabetes and peripheral neuropathy. I want to get more exercise, but I am physically unable to do most exercises. What can I do?

 Diabetic neuropathy is nerve damage caused by diabetes. People with diabetes have high blood sugar levels. Over time, this causes nerve damage. Symptoms related to neuropathy include muscle weakness, numbness and tingling or burning sensation in the extremities. When neuropathy is present in the feet or legs, balance and walking may be impaired.

Exercise is one of the cornerstones of diabetes care. It helps with weight loss, builds muscle strength, improves glucose control and helps with circulation. Studies have shown that regular exercise helps in preventing the development of neuropathy and improving neuropathic symptoms. People with neuropathy who are involved in repetitive weight-bearing exercise - like running, jogging, or step aerobics - are at risk for development of foot ulcers, fractures and joint deformities.

Swimming is a good alternative to weight-bearing exercise. Water helps to support the limbs, making exercise more comfortable. The water should be warm, as exposure to cold water for a prolonged period of time can reduce circulation further.

Yoga is a good form of exercise in people with diabetic neuropathy. It helps stretch muscles and keeps joints limber. There are various poses (asanas) which can be tailored to one's comfort and ability. Yoga has an additional benefit in terms of chronic stress reduction. Several trials have shown an improvement in diabetes control, reducing the resting heart rate and decreasing inflammation in the body.

Tai Chi is an ancient form of therapeutic meditative exercise that includes choreographed movements, which provide a fluid form of motion with a varying center of gravity. Each movement is done slowly and it gradually works every major muscle group in the body.

Before beginning an exercise program, you should talk to your care provider. You may also need the approval of your cardiologist. 

Arti Bhan, M. D., is a senior staff physician, Division of Endocrinology, Diabetes, Bone and Mineral Disorders, at Henry Ford Health System in Detroit.  She received her fellowship training in Endocrinology at Henry Ford, where she is currently involved in teaching residents and fellows. Her clinical interests include diabetes, thyroid disorders, and disorders of bone and mineral metabolism.