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Sports and Training with Polyneuropathy

Doing exercise helps with a large variety of diseases. For most chronic disease you will find recommendations of exercise in some form or another.

But what about polyneuropathy? Can nerve damage be improved with exercise? Can exercise keep you stronger even though you have the disease?

What kind of exercise works in which way and which movement is particularly important in polyneuropathy?

I will try to answer all these questions in this article.


Many wonder if their body is even capable of exercising if they suffer from polyneuropathy.

The answer is yes, the more you exercise the better! However, there are a few things to consider. Falls and injuries, in particular, pose a great danger to people with polyneuropathy. Therefore, you should take precautions to avoid them as much as possible. How this can be achieved is also explained in this article.

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Endurance training is associated with an incredible variety of positive effects on one's health. The blood vessels, sugar and fat metabolism, even the immune system and psychological wellbeing, also benefit from endurance sports.

Therefore, even people with polyneuropathy should practice some endurance exercise. Those who stay on the couch because of polyneuropathy instead of staying active will soon have to struggle with the negative consequences of a lack of exercise.

Nevertheless, one cannot simply exercise as if nothing were wrong.


The most important limitation for sports is the limitation in agility and lessened movement control due to polyneuropathy. This is because those with poorly functioning nerves also perceive and control their muscles and joints poorly.

Accordingly, it takes a little longer to react to disturbances such as stumbling or tripping and, consequently, one has a higher risk of falling and injuring oneself.

This is not only important if you want to do sports with a high risk of falling such as ball sports, skiing or skating. As a polyneuropathy patient you also have a higher risk of falling when jogging and walking.


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To protect yourself from falls and injuries , it is of course important to be a little more careful when doing exercises if you have polyneuropathy.

This means it makes sense to wear the best possible footwear and only choose activities that do not overstrain you. If you are just starting a new sport, you should not necessarily train alone, but team up with training partners you who can help you in an emergency.

However, it is also important not to be underconfident. If you just take it easy and don't take on any more challenges, your physical capabilities will decline faster.

The very best protection against injuries and falls are your own physical abilities. And the more you practice and the better you are trained, the better they become - or stay.


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Good coordination and balance are essential for this. If you can keep your balance in tricky situations you will not fall as easily. For example, if you can stand on one leg with your eyes closed, the risk of falling is much lower than if you are already swaying when standing normally.

If you have good balance, you are also a lot less likely to twist joints or suffer fractures.


The good news, especially for people with polyneuropathy, is that balance is easy to train. This means that if your balance is bad now, it can certainly be improved.

If you currently have a bad balance because of polyneuropathy, you will benefit from training. This is especially true when you are very weak as a lot can be achieved through training. A good workout can make the difference between walking normally and having to use a walking Aid!


In order to hold your balance during exercise, it is neccessary to constantly react appropriately to very small movements of your body. This means that you must be extremely self-aware at all times and you must react very fast to disturbances if you do not want to loose your balance. This means your nervous system has to work very hard to achieve a good balance.

So if you train your balance, you train and improve the function of your nervous system. It is therefore possible to train the exact thing that is suffering from polyneuropathy: you train how your body can be perceived and to control movements with more precision.

In other words, the better your balance is, the less your polyneuropathy will affect you when it comes to walking and the danger of falling. Furthermore, training your balance also helps to reduce pain and uncomfortable sensations caused by polyneuropathy. The nervous system learns to compensate for the nerve damage to a certain extent through the training and this can improve the symptoms of polyneuropathy.

A detailed explanation of balance exercises especially for polyneuropathy can be found here:


So far we talked about how balance training helps against the limitations caused by polyneuropathy.


But what are the effects of endurance training? Does biking or running also help against polyneuropathy?

Of course, scientists have tried and tested whether the nerves benefit from endurance exercises. It was shown that endurance training actually has an effect on the nerves. Those who do endurance training slow down the progression of polyneuropathy. However, this effect is relatively small and hardly noticeable in everyday life.

However, if you do endurance training at the same time as balance training, the two types of training complement each other and you will achieve a much better result. The training has a double benefit: The progression of Polyneuropathy is slowed down and at the same time your general fitness and health improve.

Endurance exercise has also been shown to reduce the fatigue that people with polyneuropathy often experience. So endurance exercise is an excellent idea for anyone suffering from polyneuropathy.

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It is obvious that having strong muscles is good for you. This is especially tru for those who have polyneuropathy for one important reason:

Strong muscles make strong bones and protect from injuries. When the muscles work, they pull on the bones. This causes a slight stress. The bones responds by adding more calcium to their structure. This makes the bones stronger. The structure of the bones, therefore, becomes more stable and more resistant to fractures.

This means that a person with strong muscles is more likely to survive falls and accidents without injuries than a person with weak muscles. And this is especially important if you suffer from polyneuropathy, because unfortunately you stumble more often and have a higher risk of falling.

This effect on the stability of bones only occurs through mechanical stress. It is not enough to have a diet rich in calcium because the stimulus that causes the bones to absorb the calcium is mechanical stress, i.e. the pull and pressure exerted by the muscles. This means that without physical activity, you cannot have strong bones!

To benefit from this, you need to lift relatiely heavy weights though. To increase bone strength, at least 70% of the maximum force of your muscles must be applied. This means, you need to use weights that you can lift a maximum of 10-12 times. If you only do exercises with light weights, the bones will hardly benefit at all from this training.


A common problem with polyneuropathy is that the nerves no longer reach all the muscle fibres. This is because each muscle fibre has its own nerve endings. This activates the muscle fibre and thus triggers movement. Therefore, without nerves there is no muscle work! For many patients with polyneuropathy, unfortunately, their nerves can no longer reach all their muscle fibres.

Of course, this also limits the strength because a muscle in which only a few muscle fibres work, is naturally weaker.

Luckily, this can be improved via training.

When a muscle is trained, this not only causes the muscle fibres themselves to adapt, but also the nerves that control this muscle. Interestingly, not all muscle fibres work at once; in healthy people, only about 60% can be activated at the same time.

This percentage increases when you do strength training. Strength training therefore increases the number of muscle fibres that are working simultaneously. (This is the famous Intramuscular Coordination). This increases the strength of the muscles without the muscles getting bigger. This is also the reason why some skinny-looking people can exert great strength: They are simply better at targeting their muscle fibers in a coordinated fashion.

In competitive sports, for example, these would be ski jumpers or climbers. They have to be as light as possible for their sports, so they shouldn't carry mountains of muscle around with them, but still need a lot of strength. These athletes use special training for this purpose, which you can also take advantage of.


Despite polyneuropathy, it is in fact possible to "learn" to activate more muscle fibres through strength training. This increases muscle strength despite having polyneuropathy. It is also important here to do movements with enough 'resistance'. This is because the nervous system only adapts when you apply a force that is at the limit of your personal capacity.

Consequently, with your current level of fitness permitting, you should do exercises that offers the greatest possible resistance. For example, things that you can just manage once or twice. This so-called maximum strength training has the greatest effect on the nervous system. In addition, the effort takes only a few seconds, which is beneficial for many people.

Even with less strenuous strength training, a significant increase in muscle strength is possible. It is generally possible to increase strength by 30-50%. There are also people who double their strength through regular training. Being so much stronger naturally makes everyday life much easier.

In the diagram on the right, you can see the knee flexion performance of one of my patients with severe polyneuropathy at the age of 91. He managed to increase the number of knee bends he did in one go from 15 to 33 in 5 weeks. That is more than double. All he needed was some practice and most importantly, the knowledge that it's possible. This is because many people think that they are either too ill or too old to increase their strength. However, as you can see, training still works in old age and in spite of polyneuropathy.




This patient was not chosen as an example because his results were  exceptionally good, but because this significant improvement is common in patients that practice regularly.

Of course there are natural limits to this training effect, which also depend on the severity of the polyneuropathy. This is because if the nerve that supplies a muscle fibre no longer functions, it can no longer activate the muscle and cause the Training Effect. In this case, however, it is possible to train the remaining nerves and muscle fibres and still at least maintain strength.


For many everyday problems, new solutions can be found when the old ones no longer work

For example, if you can no longer manage to apply a lot of force with your calves, the thighs can take over more work instead. Of course, the thigh muscles must be strong enough for this. Therefore it is necessary to have strong muscles in many places in order to cope well with polyneuropathy.


  • It is important to train the whole body and not just individual parts.

  • Furthermore, you should start exercising asap and NOT wait until you must rely on help.

Invest in your fitness now!


Whether there is a direct effect on the symptoms of polyneuropathy or even on the nerve damage is of course a crucial question: does strength training in polyneuropathy also benefit the nerves and not only the muscles?


Of course, studies have been carried out, i.e. strength training has been tested on patients with polyneuropathy and the severity of polyneuropathy has been investigated. These studies have shown that strength training alone has a small positive effect on nerve damage. As a result, if you do strength training, you will have fewer symptoms of polyneuropathy such as pain, numbness and lack of sensation. This effect, though, is quite small.

However, if you combine strength training with balance exercises, the effects complement each other. This means that if you do balance exercises at the same time as strength training, as described in my exercise guide "Movement in Polyneuropathy", you benefit much more.


In principle, it makes a lot of sense to continue doing sports that you are already good at and that you enjoy even if you suffer from polyneuropathy.

For example, if you like to play football, you should continue to do so - within your own capabilities. This is because everything you stop practicing deteriorates and,  specifically to sports, this includes: reactivity, speed, endurance and coordination. As soon as you stop practicing your sport, these things will deteriorate.


Therefore, you should continue as long as your nervous system allows for it. However, you should adjust your level and, depending on your state of health, step back a little. It is often also sensible to practice somewhat modified forms of sport. Mostly, this invloves those sports that avoid competition.

For example, if a basketball player is no longer fit enough for a competitive game, he can still just throw baskets. A footballer can kick the ball to a friend, a tennis player can do technique exercises. The risk of injury is then low, but you still have fun and gain the physical benefits!

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For all ball sports, whether with or without polyneuropathy, a good balance protects against injuries. Especially in the ankle and knee.

The most common sports injury of all can be reduced by more than half with some training for balance! We are of course talking about sprained ankles (medically supination trauma).  You can find an excellent study on this here.


As you can see, sport and polyneuropathy are not mutually exclusive. If you know how, you can actually do a lot of good to yourself through sport and training in spite of your polyneuropathic condition.

It is especially important to train your balance, as this is a very powerful way to stimulate the nervous system and improve its function. It also helps to prevent falls and injuries.

My most important advice is: stay active despite polyneuropathy!

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A German version of this article is available here:

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