Tailored Exercise Training Counteracts Muscle Disuse and Attenuates Reductions in Physical Function in Individuals With Amyotrophic Lateral Sclerosis

Abstract

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by the progressive loss of motor neurons, which leads to a reduction in strength and exercise capacity. Although the concept of "Exercise is Medicine" is accepted for many diseases, the role of exercise in individuals with ALS is still debated. The aim of this study was to propose a tailored exercise training program that was both safe and effective for individuals with ALS, and to evaluate the effects of this combined, moderateintensity, aerobic and strength training program on aerobic capacities, strength, and physical function. Sixteen individuals with ALS were randomly assigned to either a training (three times a week for 12 weeks; TRAIN, n = 8) or usual care (continued their usual standard of care and served as control; UC, n = 8) group. Peak power, peak oxygen uptake, as well as the gas exchange threshold (GET) during a cardiopulmonary exercise test (CPET) on a cycle ergometer, and the maximal strength (1RM) of the knee extensor muscles, were evaluated before and after 12 weeks. Participants also performed the "Timed Up and Go" (TUG) and the "6-min walking" (6MWT) tests. The ALS Functional Rating Scale revisited (ALSFRS-R), the ALS Severity Scale (ALS-SS), and the McGill quality of life (QoL) questionnaire were also measured. The GET increased from 0.94 ± 0.08 to 1.06 ± 0.10 L min −1 in TRAIN (p = 0.009) and decreased from 0.79 ± 0.17 to 0.72 ± 0.17 L min −1 in UC (p = 0.001). There was a significant difference between groups for changes in TUG (9.1 ± 5.5% improvement in TRAIN and 56.8 ± 18.5% worsening in UC, p = 0.002), ALSFRS-R (4.7 ± 2.6% decrease in TRAIN and 23.0 ± 5.6% decrease in UC, p = 0.007), and for the ALS-SS (2.2 ± 2.1% decrease in TRAIN and 12.4 ± 4.4% decrease in UC, p = 0.04). Even if the 1RM of the knee-extensor muscles showed a tendency to increase in TRAIN (70.1 ± 30.0%, p = 0.07), there was not a statistically significant difference (p = 0.57) with respect to the

The Effectiveness of Therapeutic Physical Exercise in Patients with Amyotrophic Lateral Sclerosis in Relation to the Alsfrs-R Functionality Scale: A Systematic Review

“…It was also observed that there were scores on the functionality scale that decreased more than in the rest of the studies that carried out the measurement at 3 months and that their cases and controls obtained very different results, since the points in the usual care control patients dropped from 35 to 23 and dropped from 40 to 35 in the motor rehabilitation patients. However, this can be justified with the fact that they started with 40 points, significantly more than the controls [12]. Regarding the large drop in this study in just 3 months in the score on the ALSFRS-R scale, it could be reflected on whether the age of the patients in this trial had an influence compared to the rest, since the mean age in this study was 53 and 61 in the other studies (Table 2).…”

“…Some of the therapeutic physical exercise interventions consisted of aerobic exercise [9,10], moderate-high intensity strength and endurance exercises [5,[11][12][13], functional training or stretching [14,15]. Frequencies ranged from highest to lowest [10] according to the study, and the intervention time was a minimum of 2 weeks and a maximum of 6 months.…”

“…It seems that, within 3 months, significant differences begin to be seen between the groups treated with therapeutic exercise and those treated with passive conventional treatment [12,15,17]. In all of them, the ALSFRS-R scores decreased between 2 [17] and 7 points [12] in the training group compared to those in the control and passive therapy groups, which had a decrease in the greater functionality score. However, a different perspective was also reflected in which a group trained less frequently (two sessions/week) obtained better results than the group that performed the exercises five times/week [10].…”

“…For example, a braking of muscular atrophy that is normally caused by progressive inactivity that gives the involutional character of this disease [11]. In addition, aerobic fitness and respiratory function are benefited [12,14]. It is even inferred that it could influence factors such as appetite, sleep or mood [29].…”

Skeletal Muscle in ALS: An Unappreciated Therapeutic Opportunity?

“…Overall, the data have highlighted the need to adapt the type and intensity of physical activity to each patient. For instance, Ferri and colleagues showed that a training program combining moderate-intensity aerobic and strength training improved the patients’ aerobic capacity and physical function when tailored to their individual needs [ 220 ].…”