Community exercise is feasible for neuromuscular diseases and can improve aerobic capacity

Abstract

ObjectiveThe aim of this phase 2 trial was to ascertain the feasibility and effect of community-based aerobic exercise training for people with 2 of the more common neuromuscular diseases: Charcot-Marie-Tooth disease type 1A (CMT) and inclusion body myositis (IBM).MethodsA randomized single-blinded crossover trial design was used to compare a 12-week aerobic training program using recombinant exercise bicycles compared to a control period. The training occurred 3 times per week in community gyms local to the participants. Support was available from trained gym staff and a research physiotherapist. The 2 disease groups were analyzed separately. The primary outcome measure was peak oxygen uptake (VO2 peak) during a maximal exercise test, with secondary measures of muscle strength, function, and patient-reported measures.ResultsData from 23 people with CMT and 17 people with IBM were included in the analysis. Both disease groups had high levels of participation and demonstrated improvements in VO2 peak, with a moderate effect size in the CMT participants (Cohen d = 0.53) and a strong effect size in the IBM group (Cohen d = 1.72). No major changes were observed in the secondary outcome measures. Qualitative interviews revealed that participants valued the support of gym instructors and the research physiotherapists in overcoming challenges to participation.ConclusionTwelve weeks of aerobic training in community gyms was feasible, safe, and improved aerobic capacity in people with CMT and IBM.Classification of evidenceThis study provides Class II evidence that for patients with CMT type 1A and IBM, an aerobic training program increases aerobic capacity.

The effect of a 24-week training focused on activities of daily living, muscle strengthening, and stability in idiopathic inflammatory myopathies: a monocentric controlled study with follow-up

“…In line with our findings of improvement in MMT-8, outcome measures assessing muscle strength improved to a different extent also in other mentioned studies, including MMT-8 in [ 37 , 40 ], voluntary repetition maximum (VRM) in [ 40 , 41 ], peak isometric torque (PIT) in [ 41 , 48 ], leg press and/or leg extension and/or bench press in [ 42 , 43 , 51 ], or dynamometry of both distal and proximal muscles in [ 45 ]. Contrary to our study, no improvement in muscle strength was found according to MMT-8 in [ 39 , 44 , 49 , 51 ], MMT on a scale from 0 to 20 in [ 48 ], or PIT in [ 50 ]. Similar to our findings, muscle endurance improved to a varying extent in four studies by Alexanderson et al, assessing FI-2 with improvement only in shoulder flexion in [ 44 ] or FI in [ 38 , 46 , 47 ].…”

“…We believe that the significant mitigation of depression observed in our study is secondary to the functional improvement and sustained motivation thanks to the physiotherapist. In line with our findings, no significant change in perceived exertion or muscle pain during the intervention was found in four studies [ 39 , 44 , 45 , 50 ]. Similarly, no increase in either one or several systemic markers of muscle damage or inflammation (mostly CK, LD, CRP, or ESR) was detected in any of the 15 above-mentioned studies [ 37 – 51 ].…”

“…For indirect comparison, we focus on the top 12 published studies ranked by quality in the recent systematic review by Van Thillo et al [13], which comprised five randomized controlled trials (RCTs) [37][38][39][40][41] and seven non-randomized non-controlled trials (nRnCTs) [42][43][44][45][46][47][48]. Additionally, we chose two RCTs [49,50] and one nRnCT [51] from the more recent systematic reviews [14,15]. These 15 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] recruited mostly PM/DM patients (except for two studies with IBM patients), 3-23 patients each, and used various inclusion criteria.…”

In Pursuit of an Effective Treatment: the Past, Present and Future of Clinical Trials in Inclusion Body Myositis

“…A significant increase in peak oxygen uptake (VO 2 max) (mean 1.5 L/min ± SE 0.2 before the programme to 2.1 L/min ± 0.3 after, p G 0.05) was observed, as well as mean strength on hip abduction (16.6%), shoulder abduction (39.8%), hip flexion (35.6%), and knee flexion (10.5%, all p G 0.05) post-exercise programme. Some findings were replicated in a prospective randomized single-blinded crossover trial [26], where 17 IBM participants undertook a 12-week aerobic exercise programme, showing a large increase in VO 2 max (1.72 on Cohen d analysis ± SD 0.28, and 1.68 on Hedges g analysis ± SD 0.42).…”

Secondary Causes of Myositis

“…In fact, a subset of dermatomyositis and polymyositis patients undergoing resistance training showed decreased disease activity [ 90 ]. A recent randomized, single-blinded crossover trial examining aerobic training with exercise bicycles showed safety and improved aerobic capacity in patients with inclusion body myositis, providing class II evidence for aerobic training improving cardiopulmonary fitness [ 91 ]. We recommend combined aerobic and strength training [ 86 ], with avoidance of high-impact and eccentric exercises.…”