We tell our patients to stay active. We tell them it matters. But how much activity, exactly? And what kind? A new study from our colleagues at Michigan and Oxford starts to put hard numbers behind the advice.
Reynolds and colleagues published a cross-sectional analysis of 2,878 people with diabetes in the Journal of Neurology, Neurosurgery & Psychiatry. What makes this study different from the usual self-reported questionnaire work is the method: participants wore wrist-mounted accelerometers that objectively captured their physical activity in milli-gravity (mG) intensity bands — light (45–100 mG), moderate (100–400 mG), and vigorous (>400 mG).
The headline finding is clean. More time spent at moderate-to-vigorous intensity decreased the odds of diabetic peripheral neuropathy (DPN). The dose-response was striking at the vigorous end — an odds ratio of 0.40 (95% CI 0.22–0.70) — meaning vigorous activity was associated with a 60% reduction in the odds of neuropathy. Even moderate activity moved the needle, with an OR of 0.95 (0.91–0.99).
An interesting wrinkle: physical activity did not significantly reduce painful DPN (pDPN) across the whole group. But when the investigators stratified by sex, a clear signal emerged in females. Among women with diabetes, more time above even fairly low activity thresholds (50 mG) was associated with reduced painful neuropathy odds (OR 0.92, 0.87–0.98). That sex-based difference deserves further attention.
The honest caveat — and the authors are transparent about this — is that this is cross-sectional work. We cannot be certain of the directionality. Does reduced activity contribute to neuropathy development, or does neuropathy itself lead people to move less? Likely both. But the magnitude of the associations, particularly for vigorous activity, is hard to ignore.
For those of us in the limb preservation space, the implications are immediate. Peripheral neuropathy is the on-ramp to ulceration, infection, and amputation. Anything that modifies that first domino matters enormously. And this study suggests that the intensity of activity matters — not just whether patients move, but how vigorously they do so.
We need the longitudinal data. We need the randomized trials. But in the meantime, these data from Michigan and Oxford give us something we have lacked: accelerometer-derived, objective benchmarks for the physical activity prescriptions we write for our patients with diabetes.
Move more. Move harder. Keep your feet.
Reference: Reynolds EL, Russman D, Baskozos G, Eid S, Feldman EL, Bennett DLH, Callaghan BC. Physical activity decreases the likelihood of peripheral neuropathy in persons with diabetes. J Neurol Neurosurg Psychiatry. 2026 Mar 4:jnnp-2025-337592. doi: 10.1136/jnnp-2025-337592.
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