Responsiveness to exercise training in juvenile dermatomyositis: a twin case study

Abstract

BackgroundPatients with juvenile dermatomyositis (JDM) often present strong exercise intolerance and muscle weakness. However, the role of exercise training in this disease has not been investigated.Purposethis longitudinal case study reports on the effects of exercise training on a 7-year-old patient with JDM and on her unaffected monozygotic twin sister, who served as a control.MethodsBoth the patient who was diagnosed with JDM as well as her healthy twin underwent a 16-week exercise training program comprising aerobic and strengthening exercises. We assessed one repetition-maximum (1-RM) leg-press and bench-press strength, balance, mobility and muscle function, blood markers of inflammation and muscle enzymes, aerobic conditioning, and disease activity scores. As a result, the healthy child had an overall greater absolute strength, muscle function and aerobic conditioning compared to her JDM twin pair at baseline and after the trial. However, the twins presented comparable relative improvements in 1-RM bench press, 1-RM leg press, VO2peak, and time-to-exhaustion. The healthy child had greater relative increments in low-back strength and handgrip, whereas the child with JDM presented a higher relative increase in ventilatory anaerobic threshold parameters and functional tests. Quality of life, inflammation, muscle damage and disease activity scores remained unchanged.Results and Conclusionthis was the first report to describe the training response of a patient with non-active JDM following an exercise training regimen. The child with JDM exhibited improved strength, muscle function and aerobic conditioning without presenting an exacerbation of the disease.

Proposal for a Candidate Core Set of Fitness and Strength Tests for Patients with Childhood or Adult Idiopathic Inflammatory Myopathies

“…The modified Bruce protocol (2, 21-23) and the incremental cycle ergometer test (24) were the two maximal aerobic fitness tests that were included in the core-set for both adults and children after the first four stages of the Delphi survey. Both tests were chosen based on expert opinion rather than on their clinimetric properties.…”

Physical (in)activity and its influence on disease-related features, physical capacity, and health-related quality of life in a cohort of chronic juvenile dermatomyositis patients

“…Among these, physical inactivity is likely one of the most important preventable factors associated with clinical abnormalities in JDM. In fact, despite the paucity of data in literature, there is evidence that a supervised exercise program can lead to marked improvements in muscle strength and function, aerobic conditioning, bone mass, disease activity, and health-related quality of life in JDM patients with active and non-active disease [9,10]. These findings point out the relevance of evaluating, monitoring, and promoting physical activity levels in order to improve general health and well-being in this disease.…”

Musculoskeletal pain in obese adolescents

“…Um programa de atividade física supervisionada ou em grupo pode melhorar a dor, propiciar fortalecimento muscular, melhorar a autoestima e a qualidade de vida, conforme evidenciado em outras doenças crônicas pediá-tricas pelo mesmo grupo 29,30 . Orientações de ergonomia e relaxamento muscular devem também ser ensinadas no ambiente escolar 23 .…”