Strictly monitored exercise programs reduce motor deterioration in ALS: preliminary results of a randomized controlled trial

Abstract

The objective of our study was to perform a randomized controlled trial (RCT) aimed to evaluate the effects of three strictly monitored exercise programs(SMEP) compared to "usual care" (UCP) in a cohort of ALS patients. We included patients with definite and probable ALS and disease duration ≤24 months. Patients were randomized to receive a SMEPs or a UCP. SMEPs included three subgroups of treatment: active exercises associated with cycloergometer activity (1A), only active (1B) and passive (1C) exercises, respectively. Moreover, SMEP patients and their caregivers were trained to a daily home-based passive exercise program. The UCP group was treated with passive and stretching exercises twice weekly. The treatment period for both groups was 6 months (T180), and patients were assessed by revised ALS Functional Rating Scale (ALSFRS-R), % Forced Vital Capacity (FVC %), and McGill Quality of Life (MGQoL) questionnaire. ALSFRS-R score was also evaluated at 6 months after the treatment period (T360). Sixty ALS patients were randomly assigned to one of two arms: SMEP Group included 30 patients, ten subjects for each subgroup (1A, 1B, and 1C); 30 patients were included in the UCP Group.At T180 and T360, SMEPs group had significantly higher ALSFRS-R score compared to the UCP group (32.8 ± 6.5 vs 28.7 ± 7.5, p = 0.0298; 27.5 ± 7.6 vs 23.3 ± 7.6, p = 0.0338, respectively). No effects of SMEPs on survival, respiratory decline and MGQol were found. In conclusion, although no effect on survival was demonstrated,our data suggest that a strictly monitored exercise program may significantly reduce motor deterioration in ALS patients.

Influence of Resistance Training on Neuromuscular Function and Physical Capacity in ALS Patients

“…The same study suggests a change of 20% or greater in the slope of the ALSFRS-R to be clinically meaningful [23], indicating that the resistance training in our study had no attenuating effect; rather it might have had a worsening effect. This observation differs from three previous studies, reporting positive effects on ALSFRS-R scores following resistance training using different regimes [9–11]. In one of these studies the training period was 6 months rather than 12 weeks as in our study.…”

“…Previous studies using progressive resistance training programs similar to the present have proven effective in improving muscle strength and functionality in frail older individuals [2, 4, 24]. Resistance training interventions in ALS patients reporting positive results have used individualized moderate-intense exercises yet without providing more specific details on the exercises, intensity, progression, and so on [6, 9–11]. These aspects probably explain some of the discrepancy in previous findings compared to the present findings, along with the heterogeneity and size of the ALS study populations.…”

“…In addition to an early case report showing positive effects of resistance training in ALS patients [6], it was first reported that exercise could improve the clinical course (Spinal Norris scores) and the performance in respiratory functional tests following exercise [7, 8]. Very recently it was reported in a randomized controlled trial that 6 months combined resistance and aerobic training led to improvements in the revised ALSFRS (ALS functional rating scale) [9]. Other observations in small cohorts include improved ALSFRS scores, quality of life, and maximal muscle strength measured by the Quantitative Muscle Assessment system following three months combined resistance type and flexibility training [10] and improved ALSFRS and decreased muscle spasticity following three months resistance type training [11].…”

New Therapeutics to Modulate Mitochondrial Function in Neurodegenerative Disorders

“…In a small, randomized trial, resistance exercise improved patient outcomes when measured using the ALS Functional Rating Scale (ALSFRS-R) and upper and lower extremity subscale scores [311]. Another randomized controlled trial of exercise in ALS showed no benefits to survival or quality of life, but did report a positive outcome for the ALSFRS-R score [312]. A recent review of exercise trials for ALS has concluded more studies are needed to determine the risks and benefits of exercise in ALS [313].…”

Intentions of Canadian health professionals towards recommending exercise to people living with ALS

“…The most recent Cochrane review on the topic points out the need for more rigorous randomized controlled trials (RCT) while acknowledging the moderate benefit of exercise and lack of reported adverse effects in existing RCTs [14]. Since that review, but prior to our survey, two trials have been completed that found a moderate intensity (60% of maximal power output) exercise program reduced the rate of motor deterioration in pALS [15] and that resistance and endurance exercise are safe for pALS [16]. While the evidence for modest beneficial effects of exercise on the progression of ALS accumulates, the lack of reported adverse effects in RCTs is consistent.…”