Exercise training and balance function in middle-aged and older adults with diabetic peripheral neuropathy: a GRADE-based systematic review and meta-analysis.
Ma R, Xu S, et al. • Frontiers in public health • 2026
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, and no significant effect was found on six-minute walking capacity.
Key Findings
Results
Exercise training significantly improved Berg Balance Scale scores in middle-aged and older adults with diabetic peripheral neuropathy.
Meta-analysis of 16 RCTs involving 759 middle-aged and older adults with DPN was performed.
Berg Balance Scale improvement: MD = 2.14, 95% CI (1.57–2.73).
Evidence certainty was rated as low to very low using the GRADE framework.
Studies were identified through systematic search of Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, and Scopus from inception to March 21, 2025.
Results
Exercise training significantly improved Functional Reach Test distance in middle-aged and older adults with DPN.
Functional Reach Test improvement: MD = 3.23, 95% CI (1.82–4.64).
Evidence certainty was low to very low per GRADE rating.
The Functional Reach Test measures dynamic balance and forward reach capacity.
Results
Exercise training significantly improved Timed Up and Go test performance in middle-aged and older adults with DPN.
Timed Up and Go test improvement: MD = -1.65, 95% CI (-1.98 to -1.32), with negative values indicating faster (better) performance.
Evidence certainty was low to very low per GRADE rating.
The Timed Up and Go test is a measure of dynamic balance and functional mobility.
Results
Exercise training significantly increased One-Leg Stand Test duration both with eyes open and eyes closed in middle-aged and older adults with DPN.
One-Leg Stand Test with eyes open improvement: MD = 2.93, 95% CI (2.10–3.76).
One-Leg Stand Test with eyes closed improvement: MD = 1.37, 95% CI (0.55–2.19).
Evidence certainty was low to very low per GRADE rating.
The One-Leg Stand Test measures static balance function.
Results
The Five-Times Sit-to-Stand Test showed significant improvement after exclusion of a study contributing substantial heterogeneity.
After exclusion of one high-heterogeneity study, Five-Times Sit-to-Stand Test improvement: MD = -3.07, 95% CI (-4.87 to -1.28), with negative values indicating faster performance.
The result was not statistically significant prior to sensitivity analysis excluding the heterogeneity-contributing study.
Evidence certainty was low to very low per GRADE rating.
Results
No significant effect of exercise training was observed on Six-Minute Walk Test performance in middle-aged and older adults with DPN.
Six-Minute Walk Test result: MD = 27.36, 95% CI (-18.43 to 73.14), which was not statistically significant.
The wide confidence interval crossing zero indicates insufficient evidence for an effect on six-minute walking capacity.
Evidence certainty was low to very low per GRADE rating.
Methods
The systematic review included 16 randomized controlled trials with a total of 759 middle-aged and older adults with diabetic peripheral neuropathy.
Studies were required to enroll middle-aged and older adults with DPN and report at least one validated balance-related outcome.
Risk of bias was assessed using standard RCT risk-of-bias tools, and 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).
The search covered six databases: Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, and Scopus, from inception to March 21, 2025.
Ma R, Xu S, Kang J, Liu X, Liu M. (2026). Exercise training and balance function in middle-aged and older adults with diabetic peripheral neuropathy: a GRADE-based systematic review and meta-analysis.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1756867