It can make exercising trickier, but not impossible, says Ann Albright, PhD, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention in Atlanta.
For example, people with autonomic neuropathy may have problems controlling their blood pressure and body temperature during exercise, and they may sweat too much or not enough.
"Autonomic neuropathy may affect several systems that are necessary for the body's adjustment to exercise," says Albright. "That's why careful screening of the precise complication and the exercise the patient would like to do is so important," she says.
Risk of silent heart attacks
In 2004, researchers at Yale University found that more than one in five patients with type 2 diabetes had had silent heart attacks, which is damage to the heart tissue without any signs or symptoms of a heart attack. People with autonomic neuropathy were at greater risk of such silent heart attacks than other people in the study.
Exercise may be more likely to trigger these silent attacks in people with autonomic neuropathy than those who don't have this complication.
However, exercise usually lowers blood sugar, which can help prevent nerve damage. Talk to your doctor to see if a gentle exercise program is safe for you. While it may seem safer to skip exercise altogether, there are "potentially detrimental effects of not doing any exercise at all," says Albright.
People with autonomic neuropathy should avoid working out in temperatures that are too hot or too cold, and be sure to drink enough water to avoid dehydration.
To improve the chance of determining and managing complications before the start of an exercise regimen, the American Diabetes Association recommends a detailed medical evaluation including a medical history and a physical examination for any possible symptoms of problems related to the nervous system, feet, kidneys, eyes, blood vessels and heart.
Avoiding heart and blood pressure problems
Autonomic neuropathy affecting the heart and blood vessels may limit—but not eliminate—your capacity for exercise. It increases your risk of having a heart attack (often a silent heart attack) during strenuous exercise and may cause sudden shifts in your blood pressure during or after exercise. Make sure you talk to your doctor before you start an exercise program. He or she can help you plan a gentle program that will improve your health without pushing you beyond your body's limits.
Maintaining safe body temperature during exercise
Autonomic neuropathy may reduce the body's ability to regulate its own temperature (thermoregulation). Abnormally profuse or abnormally reduced sweating are the usual signs of this problem. People with this type of neuropathy should not exercise in very hot or very cold environments because their bodies cannot safely adapt to these temperatures. Use silica gel or air midsoles and wear polyester or polyester/cotton blend socks to keep your feet dry during exercise. It is also important to drink plenty of water before, during, and after exercise. The body is better able to control its temperature when it is well hydrated.
Autonomic neuropathy affecting the heart and blood vessels may limit—but not eliminate—your capacity for exercise. It increases your risk of having a heart attack (often a silent heart attack) during strenuous exercise and may cause sudden shifts in your blood pressure during or after exercise. Make sure you talk to your doctor before you start an exercise program. He or she can help you plan a gentle program that will improve your health without pushing you beyond your body's limits.
Maintaining safe body temperature during exercise
Autonomic neuropathy may reduce the body's ability to regulate its own temperature (thermoregulation). Abnormally profuse or abnormally reduced sweating are the usual signs of this problem. People with this type of neuropathy should not exercise in very hot or very cold environments because their bodies cannot safely adapt to these temperatures. Use silica gel or air midsoles and wear polyester or polyester/cotton blend socks to keep your feet dry during exercise. It is also important to drink plenty of water before, during, and after exercise. The body is better able to control its temperature when it is well hydrated.
Last Updated: July 27, 2006 
