Effect of Regular Exercise on Nerve Symptoms and Mobility in Older People with Diabetic Neuropathy

INTERVENTION: Intervention1: SEN‐BALANCE‐DPN Protocol (Sensorimotor Balance Training for Diabetic Peripheral Neuropathy) : 3 sessions/week (45 50 min) Warm‐up (5 7 min): Breathing, ankle pumps Neurodynamic techniques (10 min): Sciatic & tibial nerve sliders (gentle oscillatory range) Balance & proprioception (10 min): Static standing (feet together, semi‐tandem) Vibration therapy (5 min): Foot sole (20 30 Hz) Diabetic foot care education (10 min) Control Intervention1: Conventional Physiotherapy: Resistance Exercise (10 mins) (Khan et. al., 2022) Introduce basic resistance exercises targeting major muscle groups Low; 1 2 sets of 10 12 repetitions at 40 50% of one‐repetition maximum (1RM), performed 3 times per week. Focus on mastering proper form and technique to ensure safety. Adjust exercises based on individual comfort and baseline strength levels. Aerobic exercise (5 mins) (Kiani et. al., 2028) Begin with low‐impact aerobics activities such as walking, stationary cycling. Low to moderate; aim for 40 50% of maximum heart rate (MHR) or a Rate of Perceived Exertion (RPE) of 9 11 on the 6 20 Borg scale. Start with 10 minutes per session, 3 times per week. Adjust activity type and duration based on individual fitness levels and any existing foot complications. Standard Foot Care Exercise (5 mins) (Khurshid et. al., 2025) Begin with gentle foot mobility and stretching exercises, such as toe curls, ankle circles, and seated foot rolls. Low; sessions of 5 minutes, 3 times per week. Focus on mastering proper form and technique to ensure safety. Adjust exercises based on individual comfort and baseline foot mobility. Yoga and Relaxation (5 mins) (Kumar et. al., 2025) Introduce foundational yoga poses emphasizing gentle stretching and balance, such as Tadasana (Mounta CONDITION: Health Condition 1: E114‐ Type 2 diabetes mellitus with neurological complications PRIMARY OUTCOME: Static BalancePostural stability (single‐leg stance)Unipedal Stance Test (UST)Primary ; Dynamic BalanceMobility and dynamic balanceTimed Up and Go (TUG) TestPrimary ; Gait ParametersSpatiotemporal gait performanceGAITON SystemPrimary ; Neuropathy SymptomsOverall neuropathy gradingModified Total Neuropathy Score (mTNS)Primary ; Timepoint: Time points: Baseline, 4 weeks, and 8 weeks SECONDARY OUTCOME: Confidence & concern about falling Falls Efficacy Scale International (FES‐I) SecondaryTimepoint: Time points: Baseline, 4 weeks, & 8 weeks INCLUSION CRITERIA: Age between 50 to 70 years Diagnosed with Type 2 Diabetes Mellitus for at least five years Confirmed case of distal symmetrical polyneuropathy Michigan Neuropathy Screening Instrument score greater than or equal to seven Monofilament test showing two or more insensate sites Modified Toronto Clinical Neuropathy Score between one to sixteen indicating mild to moderate neuropathy Glycated hemoglobin HbA1c between si Xpoint five percent to nine percent indicating controlled diabetes Ability to walk at least ten meters independently with or without assistive device Mini Mental State Examination score greater than or equal to twenty four Willing to participate in the study and provide informed consent