Effects of long-term respiratory muscle endurance training on respiratory and functional outcomes in patients with Myasthenia gravis

Freitag, Sophie; Hallebach, Stephanie; Baumann, I.; Kalischewski, Petra; Raßler, Beate

doi:10.1016/j.rmed.2018.09.001

Cited by 25 publications

(24 citation statements)

References 39 publications

(74 reference statements)

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“…A multicenter randomized controlled trial is currently underway in Denmark to investigate the effect of breathing retraining on the impact on quality of life in poorly controlled asthmatics (148). In a small study (149), 12 MG patients underwent long-term respiratory muscle endurance training, which resulted in a change in their breathing pattern with prolonged expiration. Interestingly patients reported an improvement in their MG symptoms, in their respiratory symptoms and in their physical fitness.…”

Section: Dysfunctional Breathing In Myasthenia Gravismentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

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When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of corticosteroids when background comorbidities preclude or restrict the use of steroids. Rituximab has a role in refractory MG, while plasmapheresis and immunoglobulin therapy are commonly prescribed to treat MG crisis and in some cases of refractory MG. Data from the MGTX trial showed clear evidence that thymectomy is beneficial in patients with acetylcholine receptor (AChR) antibody positive generalized MG, up to the age of 65 years. Minimally invasive thymectomy surgery including robotic-assisted thymectomy surgery has further revolutionized thymectomy and the management of MG. Ocular MG is not life-threatening but can be significantly disabling when diplopia is persistent. There is evidence to support early treatment with corticosteroids when ocular motility is abnormal and fails to respond to symptomatic treatment. Treatment needs to be individualized in the older age-group depending on specific comorbidities. In the younger age-groups, particularly in women, consideration must be given to the potential teratogenicity of certain therapies. Novel therapies are being developed and trialed, including ones that inhibit complement-induced immunological pathways or interfere with antibody-recycling pathways. Fatigue is common in MG and should be duly identified from fatigable weakness and managed with a combination of physical therapy with or without psychological support. MG patients may also develop dysfunctional breathing and the necessary respiratory physiotherapy techniques need to be implemented to alleviate the patient's symptoms of dyspnoea. In this review, we discuss various facets of myasthenia management in adults with ocular Farrugia and Goodfellow Practical Approaches to Myasthenia Management and generalized disease, including some practical approaches and our personal opinions based on our experience.

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Section: Dysfunctional Breathing In Myasthenia Gravismentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

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“…The training group participated in training of diaphragmatic breathing and pursed lips breathing and improved their respiratory muscle endurance, maximum inspiratory and expiratory pressures, and thoracic mobility in comparison with their own baseline levels and compared with controls (70). Smaller studies have shown the benefit of long-term respiratory muscle endurance training on lung function and respiratory endurance in mild to moderate MG (71,72).…”

Section: Respiratory Muscle Training In Mgmentioning

confidence: 99%

Myasthenia Gravis and Physical Exercise: A Novel Paradigm

2020

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The benefits of physical exercise for healthy individuals are well-established, particularly in relation to reducing the risks of chronic lifestyle related diseases. Furthermore, physical exercise has been seen to provide beneficial effects in many chronic diseases such as multiple sclerosis, rheumatoid arthritis, and chronic obstructive pulmonary disease and is therefore recommended as part of the treatment regimen. Myasthenia Gravis (MG) is a chronic autoimmune disease that causes neuromuscular transmission failure resulting in abnormal fatigable skeletal muscle weakness. In spite of this fluctuating skeletal muscle weakness, it is reasonable to assume that MG patients, like healthy individuals, could benefit from some of the positive effects of physical exercise. Yet exercise-related research in the field of MG is sparse and does not provide any guidelines on how MG patients should perform physical training in order to obtain exercise's favorable effects without risking disease deterioration or more pronounced muscle fatigue. A handful of recent studies report that MG patients with mild disease activity can adhere safely to general exercise recommendations, including resistance training and aerobic training regimens, without subjective or objective disease deterioration. These findings indicate that MG patients can indeed improve their functional muscle status as a result of aerobic and high-resistance strength training. This knowledge is important in order to establish collective as well as personalized guidelines on physical exercise for MG patients. This review discusses the present knowledge on physical exercise in MG.

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“…The main improvement items in MGC include swallowing and breathing. The effect of RMT in patients with MG has been shown in several previous reports [5,6]. Weakness and fatigue of respiratory muscles are responsible for dyspnea and reduced exercise tolerance and thus can compromise quality of life.…”

Section: Discussionmentioning

confidence: 86%

“…However, Fregonezi et al [7] state that using the interval-based inspiratory muscle training 3 times a week for 8 weeks did not show any changes in lung function in MG patients. A recent study shows that long-term (thirteen months) respiratory muscle endurance training significantly increased respiratory endurance measured as time until exhaustion (T lim ) to 412% of the baseline in MG patients [6]. This can be explained by the specificity of the training of different types of RMT [30].…”

Section: Discussionmentioning

confidence: 99%

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Respiratory Muscle Training Improves Functional Outcomes and Reduces Fatigue in Patients with Myasthenia Gravis: A Single-Center Hospital-Based Prospective Study

Hsu

Lin

Tsai

et al. 2020

BioMed Research International

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Background. Myasthenia gravis (MG) is an immune-mediated disorder characterized by muscle fatigue and fluctuating weakness. Impairment in respiratory strength and endurance has been described in patients with generalized MG. We tested the hypothesis that respiratory muscle training (RMT) can improve functional outcomes and reduce fatigue in patients with MG. Methods. Eighteen patients with mild to moderate MG participated in this study. The training group underwent home-based RMT three times a week for 12 weeks. Sixteen patients with MG without RMT were enrolled as a disease control group. Lung function, autonomic testing, Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), and functional outcome measurement by using quantitative myasthenia gravis (QMG) score and myasthenia gravis composite (MGC) scale were measured before and after the 12-week RMT. Results. The 12-week RMT significantly increased forced vital capacity (FVC) from 77.9±12.6% to 83.8±17.7% (p=0.03), forced expiratory volume in one second (FEV1) from 75.2±18.3% to 83.3±19.0% (p=0.002), and 6-minute walking distance from 403.4±72.2 m to 466.1±68.5 m (p=0.003). The QMG score improved from 9.6±4.1 to 8.1±4.3 (p=0.04) and the MGC scale from 4.4±3.5 to 2.7±2.9 (p=0.02). The fatigue score (MFSI-SF) reduced from 17.1±14.7 to 13.5±16.9 (p=0.03). Conclusion. The home-based RMT is an effective pulmonary function training for MG patients. The RMT can not only improve short-term outcomes but also reduce fatigue in patients with mild to moderate generalized MG.

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Effects of long-term respiratory muscle endurance training on respiratory and functional outcomes in patients with Myasthenia gravis

Cited by 25 publications

References 39 publications

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Myasthenia Gravis and Physical Exercise: A Novel Paradigm

Respiratory Muscle Training Improves Functional Outcomes and Reduces Fatigue in Patients with Myasthenia Gravis: A Single-Center Hospital-Based Prospective Study

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