{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:51:32Z","timestamp":1789239092052,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging"],"abstract":"\n Objective<\/jats:title>\n The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the effects of exercise on postural control, gait, and muscle strength in older adults with diabetic peripheral neuropathy (DPN).<\/jats:p>\n <\/jats:sec>\n \n Research Design<\/jats:title>\n Systematic review and meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An extensive literature search was performed in PubMed, EBSCO, Web of Science and Cochrane Library from database inception to 30 September 2023. The inclusion criteria were exercise intervention on postural control, gait characteristics, and muscle strength in older adults with DPN. Two reviewers independently extracted data and assessed the quality of studies by Cochrane Risk of Bias.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The literature search elicited a total of 523 references, 23 articles were included in this systematic review and meta-analyses. Exercise could effectively decrease the Centre of Pressure (COP) path (SMD = \u22120.38, 95%CI = \u22120.77\n \n \n \n \u223c<\/mml:mo>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n 0.01), increase gait speed (MD = 0.08, 95%CI = 0.05\n \n \n \n \u223c<\/mml:mo>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n 0.11), but did not change stride length (MD = 0.04, 95%CI = \u22120.01\n \n \n \n \u223c<\/mml:mo>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n 0.09), and enhance muscle strength (SMD = 0.76, 95%CI = 0.19\n \n \n \n \u223c<\/mml:mo>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n 1.33).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Exercise improves postural control, gait speed, and muscle strength in older adults with DPN, reducing fall risk and enhancing lower limb strength, though evidence on stride length improvement is limited.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n identifier CRD42023436799.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fragi.2025.1507232","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T04:42:21Z","timestamp":1745901741000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Exploring the exercise for enhancing postural control, gait, and muscle strength in older adults with diabetic peripheral neuropathy: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"6","author":[{"given":"Xiangsheng","family":"Pang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.12688\/f1000research.75806.3","article-title":"Effect of antigravity treadmill training on gait and balance in patients with diabetic polyneuropathy: a randomized controlled trial","volume":"11","author":"Abdelaal","year":"2022","journal-title":"F1000Research"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3091","DOI":"10.1007\/s10067-020-05086-4","article-title":"Therapeutic effects of proprioceptive exercise on functional capacity, anxiety, and depression in patients with diabetic neuropathy: a 2-month prospective study","volume":"39","author":"Abdelbasset","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.gaitpost.2019.08.018","article-title":"Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy","volume":"74","author":"Ahmad","year":"2019","journal-title":"Gait Posture"},{"key":"B4","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1080\/08990220.2021.1955671","article-title":"Effect of sensorimotor training on spatiotemporal parameters of gait among middle and older age adults with diabetic peripheral neuropathy","volume":"38","author":"Ahmad","year":"2021","journal-title":"Somatosens. and Mot. Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.gaitpost.2010.04.013","article-title":"An exercise intervention to improve diabetic patients\u2019 gait in a real-life environment","volume":"32","author":"Allet","year":"2010","journal-title":"Gait Posture"},{"key":"B6","doi-asserted-by":"publisher","first-page":"101501","DOI":"10.1016\/j.arr.2021.101501","article-title":"A systematic review of one-legged balance performance and falls risk in community-dwelling adults","volume":"73","author":"Blodgett","year":"2022","journal-title":"Ageing Res. Rev."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.2337\/dc14-1982","article-title":"Diabetic peripheral neuropathy compromises balance during daily activities","volume":"38","author":"Brown","year":"2015","journal-title":"Diabetes Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"101452","DOI":"10.1016\/j.arr.2021.101452","article-title":"Risk factors for falls in older people with cognitive impairment living in the community: systematic review and meta-analysis","volume":"71","author":"Chantanachai","year":"2021","journal-title":"Ageing Res. Rev."},{"key":"B9","article-title":"Cochrane handbook for systematic reviews of interventions","year":"2024"},{"key":"B10","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1097\/PHM.0000000000000426","article-title":"Analysis of postural control during quiet standing in a population with diabetic peripheral neuropathy undergoing moderate intensity aerobic exercise training: a single blind, randomized controlled trial","volume":"95","author":"Dixit","year":"2016","journal-title":"Am. J. Phys. Med. and Rehabilitation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1089\/ars.2022.0158","article-title":"Emerging nonpharmacologic interventions to treat diabetic peripheral neuropathy","volume":"38","author":"Enders","year":"2023","journal-title":"Antioxidants and Redox Signal."},{"key":"B12","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1159\/000371846","article-title":"Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: a randomized controlled trial","volume":"61","author":"Grewal","year":"2015","journal-title":"Gerontology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1080\/02703181.2023.2187104","article-title":"Functional fitness and risk of falling in older adults with diabetic neuropathy","volume":"41","author":"Gupta","year":"2023","journal-title":"Phys. and Occup. Ther."},{"key":"B14","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Br. Med. J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s42399-023-01470-8","article-title":"Effect of an exercise program on the balance, gait, vibration sense, and cardiometabolic parameters among patients with diabetic peripheral neuropathy: a randomized controlled trial","volume":"5","author":"Hizomi Arani","year":"2023","journal-title":"SN Compr. Clin. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"22","DOI":"10.18433\/jpps30151","article-title":"A review of beneficial low-intensity exercises in diabetic peripheral neuropathy patients","volume":"22","author":"Johnson","year":"2019","journal-title":"J. Pharm. and Pharm. Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1827","DOI":"10.1111\/jdi.13542","article-title":"Falls and fractures associated with type 2 diabetic polyneuropathy: a cross\u2010sectional nationwide questionnaire study","volume":"12","author":"Khan","year":"","journal-title":"J. Diabetes Investigation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1007\/s00125-021-05646-6","article-title":"Effects of progressive resistance training in individuals with type 2 diabetic polyneuropathy: a randomised assessor-blinded controlled trial","volume":"65","author":"Khan","year":"2022","journal-title":"Diabetologia"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e14470","DOI":"10.1111\/dme.14470","article-title":"Falls in individuals with type 2 diabetes; a cross\u2010sectional study on the impact of motor dysfunction, postural instability and diabetic polyneuropathy","volume":"38","author":"Khan","year":"","journal-title":"Diabet. Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.2522\/ptj.20090362","article-title":"Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: \u201cfeet first\u201d randomized controlled trial","volume":"90","author":"Kruse","year":"2010","journal-title":"Phys. Ther."},{"key":"B21","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1620\/tjem.231.305","article-title":"Whole-body vibration training improves balance, muscle strength and glycosylated hemoglobin in elderly patients with diabetic neuropathy","volume":"231","author":"Lee","year":"2013","journal-title":"J. Exp. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1097\/JES.0b013e31825f7483","article-title":"Select exercise modalities may reverse movement dysfunction because of peripheral neuropathy","volume":"40","author":"Li","year":"2012","journal-title":"Exerc. Sport Sci. Rev."},{"key":"B23","doi-asserted-by":"publisher","first-page":"198","DOI":"10.20945\/2359-3997000000337","article-title":"Efficacy of exercise on balance, fear of falling, and risk of falls in patients with diabetic peripheral neuropathy: a systematic review and meta-analysis","volume":"65","author":"Lima","year":"2021","journal-title":"Archives Endocrinol. Metabolism"},{"key":"B24","first-page":"737","article-title":"Risk bias assessment tool RoB2 (revised version 2019) for randomized controlled trial: an interpretation","volume":"21","author":"Liu","year":"2021","journal-title":"Chin. J. Evidence-based Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s40279-016-0559-0","article-title":"Effectiveness of exercise interventions to improve postural control in older adults: a systematic review and meta-analyses of centre of pressure measurements","volume":"47","author":"Low","year":"2017","journal-title":"Sports Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1123\/jab.2013-0186","article-title":"Strength training affects lower extremity gait kinematics, not kinetics, in people with diabetic polyneuropathy","volume":"30","author":"Melai","year":"2014","journal-title":"J. Appl. Biomechanics"},{"key":"B27","doi-asserted-by":"publisher","first-page":"7561","DOI":"10.1038\/s41598-022-11745-0","article-title":"Foot\u2013ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial","volume":"12","author":"Monteiro","year":"2022","journal-title":"Sci. Rep."},{"key":"B28","doi-asserted-by":"publisher","first-page":"5129","DOI":"10.3390\/s20185129","article-title":"Feasibility and preliminary efficacy of a foot-ankle exercise program aiming to improve foot-ankle functionality and gait biomechanics in people with diabetic neuropathy: a randomized controlled trial","volume":"20","author":"Monteiro","year":"2020","journal-title":"Sensors (Basel)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.apmr.2012.12.015","article-title":"Weight-bearing versus nonweight-bearing exercise for persons with diabetes and peripheral neuropathy: a randomized controlled trial","volume":"94","author":"Mueller","year":"2013","journal-title":"Archives Phys. Med. Rehabilitation"},{"key":"B30","doi-asserted-by":"publisher","first-page":"9305025","DOI":"10.1155\/2016\/9305025","article-title":"Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review","volume":"2016","author":"Mustapa","year":"2016","journal-title":"BioMed Res. Int."},{"key":"B31","doi-asserted-by":"publisher","first-page":"109183","DOI":"10.1016\/j.diabres.2021.109183","article-title":"Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: a narrative review","volume":"183","author":"Orlando","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"B32","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Br. Med. J."},{"key":"B33","doi-asserted-by":"publisher","first-page":"M761","DOI":"10.1093\/gerona\/56.12.m761","article-title":"Fall risk assessment measures: an analytic review","volume":"56","author":"Perell","year":"2001","journal-title":"Journals Gerontology Ser. A Biol. Sci. Med. Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3390\/medicina58010059","article-title":"The effect of structured exercise compared with education on neuropathic signs and symptoms in people at risk of neuropathic diabetic foot ulcers: a randomized clinical trial","volume":"58","author":"Perrin","year":"2021","journal-title":"Med. Kaunas."},{"key":"B35","doi-asserted-by":"publisher","first-page":"101117","DOI":"10.1016\/j.arr.2020.101117","article-title":"Center of pressure displacement characteristics differentiate fall risk in older people: a systematic review with meta-analysis","volume":"62","author":"Quijoux","year":"2020","journal-title":"Ageing Res. Rev."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.2337\/dc16-2183","article-title":"How does self-perceived unsteadiness influence balance and gait in people with diabetes? Preliminary observations","volume":"40","author":"Reeves","year":"2017","journal-title":"Diabetes Care"},{"key":"B37","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3390\/medicina57050457","article-title":"Sensory-motor mechanisms increasing falls risk in diabetic peripheral neuropathy","volume":"57","author":"Reeves","year":"2021","journal-title":"Med. Kaunas."},{"key":"B38","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1519\/JSC.0000000000003473","article-title":"Anodal transcranial direct current stimulation increases muscular strength and reduces pain perception in women with patellofemoral pain","volume":"36","author":"Rodrigues","year":"2022","journal-title":"J. Strength Cond. Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"110871","DOI":"10.1016\/j.jbiomech.2021.110871","article-title":"Effect of whole-body vibration training on transcutaneous oxygen levels of the foot in patients with type 2 diabetes: a randomized controlled trial","volume":"139","author":"Rodr\u00edguez-reyes","year":"2022","journal-title":"J. Biomechanics"},{"key":"B40","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/1471-2474-15-137","article-title":"Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial","volume":"15","author":"Sartor","year":"2014","journal-title":"BMC Musculoskelet. Disord."},{"key":"B41","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/1471-2474-13-36","article-title":"Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial","volume":"13","author":"Sartor","year":"2012","journal-title":"BMC Musculoskelet. Disord."},{"key":"B42","doi-asserted-by":"publisher","first-page":"12404","DOI":"10.1038\/s41598-021-91901-0","article-title":"Feasibility of a home-based foot\u2013ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II","volume":"11","author":"Silva","year":"2021","journal-title":"Sci. Rep."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.3390\/app13031423","article-title":"Effects of a home-based foot\u2013ankle exercise program with educational booklet for foot dysfunctions in people with diabetic neuropathy: results of the FOCA-II randomized controlled clinical trial","volume":"13","author":"Silva","year":"2023","journal-title":"Appl. Sci."},{"key":"B44","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1038\/s41574-021-00496-z","article-title":"Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy","volume":"17","author":"Sloan","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1089\/dia.2011.0036","article-title":"Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies","volume":"13","author":"Song","year":"2011","journal-title":"Diabetes Technol. and Ther."},{"key":"B46","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Br. Med. J."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1007\/s40279-021-01596-6","article-title":"Exercise and neuropathy: systematic review with meta-analysis","volume":"52","author":"Streckmann","year":"2022","journal-title":"Sports Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2200","DOI":"10.1007\/s00125-019-04979-7","article-title":"Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial","volume":"62","author":"Venkataraman","year":"2019","journal-title":"Diabetologia"},{"key":"B49","doi-asserted-by":"publisher","first-page":"456","DOI":"10.4103\/jod.jod_47_21","article-title":"Whole-body vibration, in addition to balance exercise, shows positive effects for strength and functional ability in patients with diabetic peripheral neuropathy: a single-blind randomized controlled trial","volume":"12","author":"Waheed","year":"2021","journal-title":"J. Diabetology"},{"key":"B50","doi-asserted-by":"publisher","first-page":"891356","DOI":"10.3389\/fendo.2022.891356","article-title":"Gait parameters and peripheral neuropathy in patients with diabetes: a meta-analysis","volume":"13","author":"Wang","year":"2022","journal-title":"Front. Endocrinol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s40200-015-0173-y","article-title":"Short-term effects of the whole-body vibration on the balance and muscle strength of type 2 diabetic patients with peripheral neuropathy: a quasi-randomized-controlled trial study","volume":"14","author":"Yoosefinejad","year":"2015","journal-title":"J. Diabetes and Metabolic Disord."},{"key":"B52","doi-asserted-by":"publisher","first-page":"e001909","DOI":"10.1136\/bmjdrc-2020-001909","article-title":"Effect of tap dance on plantar pressure, postural stability and lower body function in older patients at risk of diabetic foot: a randomized controlled trial","volume":"9","author":"Zhao","year":"2021","journal-title":"BMJ Open Diabetes Res. and Care"}],"container-title":["Frontiers in Aging"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2025.1507232\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T04:42:23Z","timestamp":1745901743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2025.1507232\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":52,"alternative-id":["10.3389\/fragi.2025.1507232"],"URL":"https:\/\/doi.org\/10.3389\/fragi.2025.1507232","relation":{},"ISSN":["2673-6217"],"issn-type":[{"value":"2673-6217","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,29]]},"article-number":"1507232"}}