According to Gram Research analysis, a 2026 cross-sectional study of 463 people with diabetes found that those with high physical activity levels had significantly higher rates of nerve damage (84.3%) compared to those with low activity (66.7%), with high activity associated with 2.47 times greater odds of neuropathy. This counterintuitive finding suggests that exercise recommendations for people with diabetes should be individualized based on existing nerve health rather than universally promoted.
A new study of 463 people with diabetes in Saudi Arabia found something surprising: those who exercised the most actually had higher rates of nerve damage in their feet and legs. Researchers discovered that 78.6% of participants had peripheral neuropathy (nerve damage), and the rates were highest among people with high physical activity levels. While exercise is generally good for diabetes management, this research suggests that people with diabetes may need personalized activity plans that account for existing nerve damage. The study also found that metformin, a common diabetes medication, was linked to higher neuropathy rates, possibly due to vitamin B12 depletion.
Key Statistics
A 2026 cross-sectional study of 463 adults with diabetes in Saudi Arabia found that 78.6% had peripheral neuropathy, with prevalence increasing from 66.7% in the low activity group to 84.3% in the high activity group.
High physical activity was associated with 2.47 times greater odds of peripheral neuropathy compared to low activity in a 2026 study of 463 people with diabetes, after adjusting for age, gender, blood sugar control, and medication use.
Among 463 people with diabetes surveyed in 2026, metformin use was independently associated with peripheral neuropathy, suggesting the need for vitamin B12 monitoring in patients taking this common diabetes medication.
The prevalence of diabetic peripheral neuropathy in a 2026 study of 463 Saudi Arabian adults with diabetes was 78.6%, substantially higher than rates typically reported in other populations, indicating significant regional burden of this complication.
The Quick Take
- What they studied: Whether people with diabetes who exercise more have fewer or more problems with nerve damage in their feet and legs
- Who participated: 463 adults aged 18 and older with type 1 or type 2 diabetes living in the Northern Border Region of Saudi Arabia, surveyed online between November 2025 and February 2026
- Key finding: Contrary to expectations, people with high physical activity levels had the highest rates of nerve damage (84.3%), compared to those with low activity (66.7%). Those with high activity were 2.47 times more likely to have neuropathy than those with low activity.
- What it means for you: If you have diabetes, you shouldn’t avoid exercise, but you may need a personalized activity plan that considers your individual nerve health. Talk to your doctor about the right type and amount of exercise for your situation, especially if you already have nerve damage symptoms.
The Research Details
Researchers conducted a cross-sectional study, which is like taking a snapshot of a group of people at one point in time rather than following them over months or years. They recruited 463 adults with diabetes from the Northern Border Region of Saudi Arabia through an online questionnaire shared on social media between November 2025 and February 2026.
Participants answered questions about their physical activity using a standard international questionnaire that measures activity in MET minutes per week (a way to calculate how much energy exercise uses). Researchers also assessed nerve damage using a validated symptom score specifically designed for diabetic nerve problems. They then analyzed the data to see if people with different activity levels had different rates of nerve damage.
The researchers adjusted their analysis for other factors that might affect nerve damage, including age, gender, diabetes type, how well controlled their blood sugar was, and whether they took metformin. This helps isolate the relationship between activity and nerve damage from other confounding factors.
Cross-sectional studies are useful for identifying associations and patterns in populations, but they cannot prove cause-and-effect. This study is important because it challenges the assumption that more physical activity always prevents complications in diabetes. The findings suggest that the relationship between exercise and nerve damage may be more complex than previously thought, and that people with existing nerve damage might experience different effects from exercise than those without it.
This study has several strengths: it used validated, internationally recognized questionnaires for measuring both activity and neuropathy, included a reasonably large sample size (463 participants), and adjusted for multiple confounding variables. However, there are important limitations: the cross-sectional design cannot establish cause-and-effect, the online survey method may have introduced selection bias (only people with internet access could participate), and the study was conducted in one specific region of Saudi Arabia, which may limit how well findings apply to other populations. The high prevalence of neuropathy (78.6%) is notably higher than in many other studies, which may reflect local factors or characteristics of the study population.
What the Results Show
The study found that peripheral neuropathy was extremely common in this population, affecting 78.6% of all participants. This is much higher than rates typically reported in other countries, suggesting that this particular population faces significant challenges with diabetes complications.
The most striking finding was that neuropathy prevalence actually increased with higher physical activity levels. Among people with low physical activity, 66.7% had neuropathy. This increased to 78.2% in the moderate activity group and jumped to 84.3% in the high activity group. This pattern was statistically significant (p = 0.040), meaning it’s unlikely to have occurred by chance.
When researchers adjusted for other factors like age, gender, blood sugar control, and medication use, people with high physical activity had 2.47 times greater odds of having neuropathy compared to those with low activity. In other words, high activity was independently associated with neuropathy even after accounting for other variables that might explain the difference.
Metformin use was also independently associated with neuropathy in the analysis. This is important because metformin is one of the most commonly prescribed diabetes medications worldwide. The researchers suggest this association may be related to metformin’s effect on vitamin B12 levels, as B12 deficiency can contribute to nerve damage.
The study identified metformin use as an independent risk factor for neuropathy, which has important implications for diabetes management. This finding aligns with previous research suggesting that long-term metformin use may deplete vitamin B12, a nutrient essential for nerve health. The researchers recommend that patients taking metformin should have their vitamin B12 levels monitored regularly.
This finding is somewhat counterintuitive compared to most existing research on diabetes and exercise. Generally, physical activity is recommended as a cornerstone of diabetes management because it improves blood sugar control, reduces cardiovascular risk, and improves overall health. However, this study suggests that the relationship between activity and nerve damage may be more nuanced. One possible explanation is that people with existing nerve damage may continue or increase their physical activity despite symptoms, or that high-impact activities could potentially worsen nerve damage in susceptible individuals. Alternatively, people with more severe diabetes (who are more likely to develop neuropathy) may have been advised to increase their activity levels, creating a reverse causality situation where neuropathy leads to increased activity recommendations rather than activity causing neuropathy.
This study has several important limitations that readers should understand. First, as a cross-sectional study, it captures only a single moment in time and cannot prove that high activity causes neuropathy—it only shows they occur together. Second, the study relied on self-reported activity and symptoms through an online survey, which may not be as accurate as direct measurement or clinical examination. Third, the online recruitment method means the sample may not represent all people with diabetes in the region, as it excluded those without internet access or social media use. Fourth, the extremely high prevalence of neuropathy (78.6%) compared to other populations suggests this particular group may have unique characteristics that limit how well findings apply elsewhere. Finally, the study did not collect information about the type, intensity, or duration of physical activity, or about the specific characteristics of the neuropathy, which could have provided more detailed insights.
The Bottom Line
Based on this research, people with diabetes should not stop exercising, as physical activity remains important for overall health and blood sugar control. However, the findings suggest that exercise recommendations should be individualized and consider existing nerve damage. If you have diabetes, discuss with your healthcare provider whether you have signs of nerve damage and what types of activity are safest for you. If you take metformin, ask your doctor about monitoring your vitamin B12 levels. The confidence level for these recommendations is moderate, as the study is cross-sectional and cannot prove cause-and-effect.
People with diabetes, especially those in high-burden settings with limited healthcare access, should pay attention to these findings. Healthcare providers managing diabetes should consider screening for neuropathy and tailoring activity recommendations accordingly. People taking metformin should discuss B12 monitoring with their doctors. However, these findings should not discourage anyone from exercising—rather, they suggest the need for more personalized, careful activity planning.
The timeline for seeing benefits or experiencing problems from physical activity in diabetes is highly individual. Some people may notice improvements in blood sugar control within weeks of starting an exercise program, while nerve damage typically develops over months to years. If you have existing nerve damage, changes from activity modifications may take several weeks to months to become apparent.
Frequently Asked Questions
Should people with diabetes stop exercising if they have nerve damage?
No, but exercise should be tailored to your individual situation. A 2026 study found high activity linked to more neuropathy, suggesting personalized activity plans are important. Discuss with your doctor what type and amount of exercise is safe for your nerve health.
Does metformin cause nerve damage in people with diabetes?
A 2026 study found metformin independently associated with neuropathy, possibly through vitamin B12 depletion. If you take metformin, ask your doctor about monitoring B12 levels, as deficiency can contribute to nerve problems.
What is diabetic peripheral neuropathy and how common is it?
Diabetic peripheral neuropathy is nerve damage in the feet and legs causing tingling, numbness, or pain. A 2026 study found it affected 78.6% of people with diabetes in Saudi Arabia, though rates vary by region and population.
Can exercise make diabetic nerve damage worse?
A 2026 cross-sectional study found higher activity associated with more neuropathy, but this doesn’t prove exercise causes it. The relationship is complex and may involve reverse causality or individual differences in how people respond to activity.
What should I do if I have diabetes and nerve damage symptoms?
Talk to your healthcare provider about screening for neuropathy and developing a personalized activity plan. If you take metformin, request vitamin B12 level checks. Low-impact activities like swimming may be safer than high-impact exercise.
Want to Apply This Research?
- Track both your physical activity (type, duration, and intensity) and any symptoms of nerve damage (tingling, numbness, or pain in feet and legs) on a weekly basis. Note any correlation between activity levels and symptom changes to share with your healthcare provider.
- Instead of simply increasing activity, work with your healthcare provider to identify the optimal type and amount of exercise for your individual situation. Consider low-impact activities like swimming or walking on flat surfaces if you have nerve damage symptoms, and gradually adjust intensity based on how you feel.
- Maintain a long-term log of your activity patterns and any neuropathy symptoms. Schedule regular check-ins with your doctor (at least quarterly) to discuss how your current activity level is affecting your nerve health and blood sugar control. If you take metformin, request annual vitamin B12 level checks.
This research is a cross-sectional study that shows association, not cause-and-effect. The findings are specific to the study population in Saudi Arabia and may not apply universally. People with diabetes should not change their exercise routine based solely on this study without consulting their healthcare provider. Physical activity remains an important part of diabetes management for most people. If you have symptoms of nerve damage (tingling, numbness, or pain in your feet or legs), seek evaluation from a healthcare professional. This article is for informational purposes only and should not replace medical advice from your doctor.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.