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Jawdat O, Rucker J, Nakano T, Takeno K, Statland J, Pasnoor M, Dimachkie MM, Sabus C, Badawi Y, Hunt SL, Tomioka NH, Gunewardena S, Bloomer C, Wilkins HM, Herbelin L, Barohn RJ, Nishimune H. Resistance exercise in early-stage ALS patients, ALSFRS-R, Sickness Impact Profile ALS-19, and muscle transcriptome: a pilot study. Sci Rep 2024; 14:21729. [PMID: 39289471 PMCID: PMC11408620 DOI: 10.1038/s41598-024-72355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) patients lack effective treatments to maintain motor and neuromuscular function. This study aimed to evaluate the effect of a home-based exercise program on muscle strength, ALS scores, and transcriptome in ALS patients, Clinical Trials.gov #NCT03201991 (28/06/2017). An open-label, non-randomized pilot clinical trial was conducted in seven individuals with early-stage ALS. Participants were given 3 months of home-based resistance exercise focusing on the quadriceps muscles. The strength of exercised muscle was evaluated using bilateral quadriceps strength with manual muscle testing, handheld dynamometers, five times sit-to-stand, and Timed-Up-and-Go before and after the exercise program. In addition, changes in the Sickness Impact Profile ALS-19 (SIP/ALS-19) as the functional outcome measure and the transcriptome of exercised muscles were compared before and after the exercise. The primary outcome of muscle strength did not change significantly by the exercise program. The exercise program maintained the SIP/ALS-19 and the ALS Functional Rating Scale-Revised (ALSFRS-R). Transcriptome analysis revealed that exercise reverted the expression level of genes decreased in ALS, including parvalbumin. Three months of moderately intense strength and conditioning exercise maintained muscle strength of the exercised muscle and ALSFRS-R scores and had a positive effect on patients' muscle transcriptome.
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Affiliation(s)
- Omar Jawdat
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Jason Rucker
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, USA
| | - Tomoki Nakano
- Laboratory of Neurobiology of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
- Department of Applied Biological Science, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
| | - Kotaro Takeno
- Laboratory of Neurobiology of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Jeffery Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Carla Sabus
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, USA
- Department of Rehabilitation Science, Tufts University School of Medicine, Boston, USA
| | - Yomna Badawi
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, USA
| | - Suzanne L Hunt
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, USA
| | - Naoko H Tomioka
- Laboratory of Neurobiology of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Sumedha Gunewardena
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, USA
| | - Clark Bloomer
- Genome Sequencing Facility, University of Kansas Medical Center, Kansas City, USA
| | - Heather M Wilkins
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
- Department of Neurology, University of Missouri, School of Medicine, 1 Hospital Dr, Columbia, MO, 65201, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA.
- Department of Neurology, University of Missouri, School of Medicine, 1 Hospital Dr, Columbia, MO, 65201, USA.
| | - Hiroshi Nishimune
- Laboratory of Neurobiology of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan.
- Department of Applied Biological Science, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan.
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, USA.
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Tsitkanou S, Lindsay A, Abbott G, Foletta V, Walker AK, Russell AP, Della Gatta PA. Exercise training induces mild skeletal muscle adaptations without altering disease progression in a TDP-43 mouse model. J Appl Physiol (1985) 2024; 137:728-745. [PMID: 39008617 DOI: 10.1152/japplphysiol.00192.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
Exercise training is considered a nonpharmacological therapeutic approach for many diseases. Mild-to-moderate endurance exercise training is suggested to improve the mental and physical state of people with amyotrophic lateral sclerosis (ALS). The aim of the present study was to determine the capacity of symptomatic rNLS8 mice, which develop ALS-reminiscent TAR DNA-binding protein 43 (TDP-43) pathology and motor dysfunction, to perform mild-to-moderate intensity treadmill exercise training and to evaluate the effects of this training on skeletal muscle health and disease progression. Symptomatic rNLS8 mice were able to complete 4 wk of mild-to-moderate treadmill running (30 min at 6-13 m/min, 3 days a week). Exercise training induced an increase in the percentage of type IIA fibers in the tibialis anterior muscle as well as minor adaptations in molecular markers of myogenic, mitochondrial, and neuromuscular junction health in some forelimb and hindlimb muscles. However, this exercise training protocol did not attenuate the loss in motor function or delay disease progression. Alternative exercise regimens need to be investigated to better understand the role exercise training may play in alleviating symptoms of ALS.NEW & NOTEWORTHY This is the first study to investigate the capacity of symptomatic rNLS8 mice, which develop ALS-reminiscent TDP-43 pathology and motor dysfunction, to perform exercise training. We demonstrate that despite the ALS-reminiscent aggressive disease progression characterizing the rNLS8 mouse model, rNLS8 mice are capable of performing mild-to-moderate endurance treadmill training for at least 3-4 wk. We demonstrate that exercise training induces several minor skeletal muscle adaptations without delaying disease progression in rNLS8 mice.
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Affiliation(s)
- Stavroula Tsitkanou
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Cachexia Research Laboratory, Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, United States
| | - Angus Lindsay
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- School of Biological Sciences, Faculty of Science, University of Canterbury, Christchurch, New Zealand
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Victoria Foletta
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Adam K Walker
- Neurodegeneration Pathobiology Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
| | - Aaron P Russell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Paul A Della Gatta
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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3
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Hotz I, Mildner S, Stampfer-Kountchev M, Slamik B, Blättner C, Türtscher E, Kübler F, Höfer C, Panzl J, Rücker M, Brenneis C, Seebacher B. Robot-assisted gait training in patients with various neurological diseases: A mixed methods feasibility study. PLoS One 2024; 19:e0307434. [PMID: 39190743 DOI: 10.1371/journal.pone.0307434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 07/01/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Walking impairment represents a relevant symptom in patients with neurological diseases often compromising social participation. Currently, mixed methods studies on robot-assisted gait training (RAGT) in patients with rare neurological diseases are lacking. This study aimed to explore the feasibility, acceptability, goal attainment and preliminary effects of RAGT in patients with common and rare neurological diseases and understand the intervention context and process. METHODS A mixed-methods feasibility study was conducted at an Austrian rehabilitation centre. Twenty-eight inpatients after stroke in the subacute and chronic phases, with multiple sclerosis, Parkinson's disease, spinal cord injury, spinocerebellar ataxia, acute/chronic inflammatory demyelinating polyneuropathy and motor neuron disease were included. Patients received RAGT for 45 minutes, 4x/week, for 4 weeks. Baseline and post-intervention assessments included gait parameters, walking and balance, and questionnaires. Semi-structured observations were conducted twice during the intervention period and analysed using thematic analysis. Descriptive statistics within the respective disease groups and calculation of effect sizes for the total sample were performed. Triangulation was employed to develop a deeper understanding of the research topic. RESULTS Data from 26 patients (mean age 61.6 years [standard deviation 13.2]) were analysed. RAGT was highly accepted by patients and feasible, indicated by recruitment, retention, and adherence rates of 84.8% (95% confidence interval, CI 0.7-0.9), 92.2% (95% CI 0.7-1.0) and 94.0% (95% CI 91.4-96.2), respectively. Goal attainment was high, and only mild adverse events occurred. Improvements in walking speed (10-Metre Walk Test, effect size r = 0.876), walking distance (6-Minute Walk Test, r = 0.877), functional mobility (Timed Up and Go, r = 0.875), gait distance (r = 0.829) and number of steps (r = 0.834) were observed. Four themes were identified: familiarising with RAGT; enjoyment and acceptance through a trusting therapeutic relationship; actively interacting; and minimising dissatisfaction. DISCUSSION Sufficiently powered randomised controlled trials are needed to validate our results. TRIAL REGISTRATION German Clinical Trials Register, DRKS00027887.
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Affiliation(s)
- Isabella Hotz
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Sarah Mildner
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | | | - Bianca Slamik
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christoph Blättner
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Elisabeth Türtscher
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Franziska Kübler
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Clemens Höfer
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Johanna Panzl
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Michael Rücker
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Barbara Seebacher
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Fenili G, Scaricamazza S, Ferri A, Valle C, Paronetto MP. Physical exercise in amyotrophic lateral sclerosis: a potential co-adjuvant therapeutic option to counteract disease progression. Front Cell Dev Biol 2024; 12:1421566. [PMID: 39156974 PMCID: PMC11327861 DOI: 10.3389/fcell.2024.1421566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 08/20/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal disorder characterized by the selective degeneration of upper and lower motor neurons, leading to progressive muscle weakness and atrophy. The mean survival time is two to five years. Although the hunt for drugs has greatly advanced over the past decade, no cure is available for ALS yet. The role of intense physical activity in the etiology of ALS has been debated for several decades without reaching a clear conclusion. The benefits of organized physical activity on fitness and mental health have been widely described. Indeed, by acting on specific mechanisms, physical activity can influence the physiology of several chronic conditions. It was shown to improve skeletal muscle metabolism and regeneration, neurogenesis, mitochondrial biogenesis, and antioxidant defense. Interestingly, all these pathways are involved in ALS pathology. This review will provide a broad overview of the effect of different exercise protocols on the onset and progression of ALS, both in humans and in animal models. Furthermore, we will discuss challenges and opportunities to exploit physiological responses of imposed exercise training for therapeutic purposes.
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Affiliation(s)
- Gianmarco Fenili
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Laboratory of Molecular and Cellular Neurobiology, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Silvia Scaricamazza
- Laboratory of Metabolomics, Fondazione Santa Lucia IRCCS, Rome, Italy
- Institute of Translational Pharmacology (IFT), Consiglio Nazionale Delle Ricerche (CNR), Rome, Italy
| | - Alberto Ferri
- Laboratory of Metabolomics, Fondazione Santa Lucia IRCCS, Rome, Italy
- Institute of Translational Pharmacology (IFT), Consiglio Nazionale Delle Ricerche (CNR), Rome, Italy
| | - Cristiana Valle
- Laboratory of Metabolomics, Fondazione Santa Lucia IRCCS, Rome, Italy
- Institute of Translational Pharmacology (IFT), Consiglio Nazionale Delle Ricerche (CNR), Rome, Italy
| | - Maria Paola Paronetto
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Laboratory of Molecular and Cellular Neurobiology, Fondazione Santa Lucia IRCCS, Rome, Italy
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5
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Bjelica B, Bartels MB, Hesebeck-Brinckmann J, Petri S. Non-motor symptoms in patients with amyotrophic lateral sclerosis: current state and future directions. J Neurol 2024; 271:3953-3977. [PMID: 38805053 PMCID: PMC11233299 DOI: 10.1007/s00415-024-12455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the progressive degeneration of both upper and lower motor neurons. A defining histopathological feature in approximately 97% of all ALS cases is the accumulation of phosphorylated trans-activation response (TAR) DNA-binding protein 43 protein (pTDP-43) aggregates in the cytoplasm of neurons and glial cells within the central nervous system. Traditionally, it was believed that the accumulation of TDP-43 aggregates and subsequent neurodegeneration primarily occurs in motor neurons. However, contemporary evidence suggests that as the disease progresses, other systems and brain regions are also affected. Despite this, there has been a limited number of clinical studies assessing the non-motor symptoms in ALS patients. These studies often employ various outcome measures, resulting in a wide range of reported frequencies of non-motor symptoms in ALS patients. The importance of assessing the non-motor symptoms reflects in a fact that they have a significant impact on patients' quality of life, yet they frequently go underdiagnosed and unreported during clinical evaluations. This review aims to provide an up-to-date overview of the current knowledge concerning non-motor symptoms in ALS. Furthermore, we address their diagnosis and treatment in everyday clinical practice.
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Affiliation(s)
- Bogdan Bjelica
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany.
| | - Maj-Britt Bartels
- Precision Neurology of Neuromuscular and Motoneuron Diseases, University of Luebeck, Lübeck, Germany
| | - Jasper Hesebeck-Brinckmann
- Neurology Department, Division for Neurodegenerative Diseases, University Medicine Mannheim, Heidelberg University, Mannheim Center for Translational Medicine, Mannheim, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany
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6
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Vignolo M, Zuccarino R, Truffelli R, Gemelli C, Giove E, Ferraro PM, Manunza D, Trinchero C, Cipollina I, Lungu M, Lizio A, Gragnano G, Cabona C, Pardini M, Caponnetto C, Rao F. Dog-assisted physiotherapy in amyotrophic lateral sclerosis: a randomized controlled pilot study. Eur J Phys Rehabil Med 2024; 60:470-476. [PMID: 38743390 PMCID: PMC11258906 DOI: 10.23736/s1973-9087.24.08343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Animal-assisted therapy (AAT) is an intervention in which the animal acts as a co-therapist. It has been mainly used in the context of patients with dementia, showing positive effects on psychological symptoms, but its potential as a physiotherapy treatment for patients with neuromuscular disorders, amyotrophic lateral sclerosis (ALS) in particular, has not yet been investigated. AIM The aim of the study was to evaluate the impact of AAT, specifically of dog-assisted therapy, on motor functions and psychological status in patients with ALS. DESIGN This study was a randomized controlled pilot study. SETTING The study was carried out at the Rehabilitation Unit NEuroMuscular Omnicenter (NEMO) of Arenzano, Genoa. POPULATION Sixty hospitalized ALS patients were enrolled. METHODS All patients ran a regular two-weeks neurorehabilitation program twice a day. For three days a week, in place of the morning traditional treatment, the AAT group performed a rehabilitation session with a simultaneous interaction with the therapy-dog, while the control group performed a traditional rehabilitation session. The outcome measures were the Timed Up and Go Test, the Short Physical Performance Battery (SPPB), the Six Minutes Walk Test, the Ten Meters walking Test and the Hospital Anxiety and Depression Scale. RESULTS Both groups showed an amelioration in motor scales. However, SPPB subscales as well as HADS scores showed a statistically significant improvement only in the AAT group (P values from <0.0001 to 0.0004). Additionally, across almost all motor and psychological measures, post-treatments values were significantly better for the AAT group (P values from <0.0001 to 0.01). CONCLUSIONS The obtained results not only suggest that AAT is comparable to traditional physiotherapy treatments, but also evidence that this type of treatment has greater beneficial effects on motor and psychological symptoms in patients with ALS. CLINICAL REHABILITATION IMPACT This study provides first evidence that AAT is a powerful rehabilitation strategy in patients with ALS, improving both motor and psychological symptoms, and therefore possibly ameliorating quality of life.
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Affiliation(s)
- Manuela Vignolo
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy -
- Azienda Sanitaria Locale ASL4 Chiavarese, Chiavari, Genoa, Italy -
| | - Riccardo Zuccarino
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Romina Truffelli
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Chiara Gemelli
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Giove
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Pilar M Ferraro
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Manunza
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Clotilde Trinchero
- Attività Socio Assistenziali e Servizi con Animali (A.S.SE.A.) ONLUS, Carrù, Cuneo, Italy
| | - Iacopo Cipollina
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Mirela Lungu
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | - Andrea Lizio
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Gaia Gragnano
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
| | | | | | | | - Fabrizio Rao
- NEuroMuscular Omnicenter (NEMO), Fondazione Serena Onlus, Arenzano, Genoa, Italy
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Papadopoulou M, Papapostolou A, Dimakopoulos R, Salakou S, Koropouli E, Fanouraki S, Bakola E, Moschovos C, Tsivgoulis G. Non-Pharmacological Interventions on Pain in Amyotrophic Lateral Sclerosis Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:770. [PMID: 38610192 PMCID: PMC11011838 DOI: 10.3390/healthcare12070770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs; thus, ALS is considered a multisystemic disorder. Pain is an important nonmotor symptom. Observational and case-control studies report high frequency of pain in ALS patients and it has been correlated with depression and quality of life. There are no specific scales for the assessment of pain and no randomized controlled trials (RCTs) regarding the drug management of pain in ALS. AIM To systematically review the evidence for the nonpharmacological interventions (NPIs) in relieving pain in ALS, on March 2024, we searched the following databases: Pubmed, Scopus, Web of Science, and Cochrane. We also checked the bibliographies of trials identified to include further published or unpublished trials. MAIN RESULTS A total of 1003 records were identified. Finally, five RCTs including 131 patients (64 in the intervention group and 67 in the control group) were included for meta-analysis. The interventions of the included RCTs consisted of muscle exercise, combined aerobics-strength intervention, and osteopathic manual treatment. The meta-analysis did not find a statistically significant difference in favor of NPIs for alleviating pain in ALS patients. CONCLUSIONS ALS has a fulminant course and irreversibly leads to death. Pain in ALS patients, although a common nonmotor symptom, is often unrecognized and undertreated, and this is underlined by the lack of any RCTs on drug therapy for pain. Albeit NPIs are considered safe, as adverse effects are rarely reported, this systematic review did not provide sufficient evidence for a beneficial effect on pain. The scarceness of relevant literature highlights the need for future studies, with larger samples, more homogeneous in terms of interventions and population characteristics (stage of disease), and better choice of measurement scales to further investigate the efficacy, if any, of various pain interventions in ALS patients.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, University of West Attica, Ag. Spyridonos Str., 12243 Athens, Greece;
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Apostolos Papapostolou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Rigas Dimakopoulos
- Department of Physiotherapy, University of West Attica, Ag. Spyridonos Str., 12243 Athens, Greece;
| | - Stavroula Salakou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Eleftheria Koropouli
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Stella Fanouraki
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Eleni Bakola
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Christos Moschovos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
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8
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A meta-analysis of post-exercise outcomes in people with amyotrophic lateral sclerosis. eNeurologicalSci 2023; 31:100452. [PMID: 36875937 PMCID: PMC9982645 DOI: 10.1016/j.ensci.2023.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
Objective To systematically evaluate post-exercise outcomes related to function and quality of life in people with ALS. Methods PRISMA guidelines were used for identifying and extracting articles. Levels of evidence and quality of articles were judged based on The Oxford Centre for Evidence-based Medicine Levels of Evidence and the QualSyst. Outcomes were analyzed with Comprehensive Meta-Analysis V2 software, random effects models, and Hedge's G. Effects were examined at 0-4 months, up to 6 months, and > 6 months. Pre-specified sensitivity analyses were performed for 1) controlled trials vs. all studies and 2) ALSFRS-R bulbar, respiratory, and motor subscales. Heterogeneity of pooled outcomes was computed with the I2 statistic. Results 16 studies and seven functional outcomes met inclusion for the meta-analysis. Of the outcomes explored, the ALSFRS-R demonstrated a favorable summary effect size and had acceptable heterogeneity and dispersion. While FIM scores demonstrated a favorable summary effect size, heterogeneity limited interpretations. Other outcomes did not demonstrate a favorable summary effect size and/or could not be reported due to few studies reporting outcomes. Conclusions This study provides inconclusive guidance regarding exercise regimens to maintain function and quality of life in people with ALS due to study limitations (e.g., small sample size, high attrition rate, heterogeneity in methods and participants, etc.). Future research is warranted to determine optimal treatment regimens and dosage parameters in this patient population.
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Key Words
- 25FWT, (25 Feet Walk Test)
- 6MWT, (6 Minute Walk Test)
- ALS, (amyotrophic lateral sclerosis)
- ALSFRS-R, (ALS Functional Rating Scale-Revised)
- Amyotrophic lateral sclerosis
- DIGEST, (Dynamic Imaging Grade of Swallowing Toxicity)
- EAT-10, (Eating Assessment Tool)
- EMST, (Expiratory muscle strength training)
- Exercise
- FAC, (Functional Ambulation Categories)
- FIM, (Functional Independence Measurement)
- FOIS, (Functional Oral Intake Scale)
- FSS, (Fatigue Severity Scale)
- FVC, (forced vital capacity)
- IMST, (Inspiratory muscle strength training)
- ITT, (intention-to-treat)
- KEMS, (knee extension muscle strength)
- MEP, (maximum expiratory pressure)
- MIP, (maximum inspiratory pressure)
- MND, (motor neuron disease)
- MVIC, (maximum voluntary isometric contraction)
- Motor neuron disease
- Outcome measures
- PAS, (Penetration Aspiration Scale)
- PEF, (peak expiratory flow)
- PRISMA-2009, (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
- RCTs, (randomized controlled trials)
- RPE, (rating of perceived exertion)
- Rehabilitation
- SNIP, (sniff nasal inspiratory pressure)
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9
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Zhu Y, Xu Y, Xuan R, Huang J, István B, Fekete G, Gu Y. Mixed Comparison of Different Exercise Interventions for Function, Respiratory, Fatigue, and Quality of Life in Adults With Amyotrophic Lateral Sclerosis: Systematic Review and Network Meta-Analysis. Front Aging Neurosci 2022; 14:919059. [PMID: 35898325 PMCID: PMC9309467 DOI: 10.3389/fnagi.2022.919059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAmyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease whose primary hallmark is the progressive degeneration of motor neurons in the brainstem, spinal cord, and cerebral cortex that leads to weakness, spasticity, fatigue, skeletal muscle atrophy, paralysis, and even death. Exercise, as a non-pharmacological tool, may generally improve muscle strength, cardiovascular function, and quality of life. However, there are conflicting reports about the effect of exercise training in adults with ALS.AimsThis systematic review and network meta-analysis aim to conduct a mixed comparison of different exercise interventions for function, respiratory, fatigue, and quality of life in adults with ALS.MethodsRandomized controlled trials with ALS participants were screened and included from the databases of PubMed, Medline, and Web of Science. Physical exercise interventions were reclassified into aerobic exercise, resistance training, passive exercise, expiratory muscle exercise, and standard rehabilitation. Patient-reported outcome measures would be reclassified from perspectives of function, respiratory, fatigue, and quality of life. The effect size would be transferred into the percentage change of the total score.ResultThere were 10 studies included, with the agreement between authors reaching a kappa-value of 0.73. The network meta-analysis, which was conducted under the consistency model, identified that a combined program of aerobic exercise, resistance exercise, and standard rehabilitation showed the highest potential to improve quality of life (0.64 to be the best) and reduce the fatigue (0.39 to be the best) for ALS patients, while exercise program of aerobic and resistance training showed the highest potential (0.51 to be the best) to improve ALS patients' physical function. The effect of exercise on the respiratory was still unclear.ConclusionA multi-modal exercise and rehabilitation program would be more beneficial to ALS patients. However, the safety and guide for practice remain unclear, and further high-quality randomized controlled trials (RCTs) with a larger sample are still needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021253442, CRD42021253442.
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Affiliation(s)
- Yining Zhu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yining Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Rongrong Xuan
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Rongrong Xuan
| | - Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Bíró István
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary
- Yaodong Gu
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10
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Sznajder J, Barć K, Kuźma-Kozakiewicz M. Physical activity in patients with amyotrophic lateral sclerosis: Prevalence, patients’ perspectives and relation to the motor performance. NeuroRehabilitation 2022; 50:433-443. [DOI: 10.3233/nre-210312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: There are no recommendations for physical activity in amyotrophic lateral sclerosis (ALS) patients. OBJECTIVE: (i) To describe the prevalence and pattern of physical activity (PA) in ALS patients; (ii) to explore patients’ attitude towards PA; and (iii) to investigate the relationship between PA at home environment and the rate of functional decline. METHODS: 96 ALS patients were followed for 6 months at 3-month intervals and assessed by site of disease onset, disease duration, diagnosis delay, functional status, muscle strength, fatigue and prevalence of PA. RESULTS: Over 70% of patients performed regular exercise and reported a positive effect of PA on functional status and mood. Regularly exercising individuals showed a higher ALSFRS-R bulbar score (11.0 vs 9.0, p = 0.011) and a lower decline of respiratory sub-score of ALSFRS-R compared to non-regularly exercising patients (0 vs 1.0, p = 0.026). Bulbar onset was a negative prognostic factor for regular exercise (odds ratio [OR]: 5.2, p = 0.004). CONCLUSION: The majority of ALS patients perform regular PA and find it positively influence their motor performance and mood. Bulbar disease onset, but not functional status, is a negative prognostic factor for regular exercise in ALS patients. Regular mild PA may result in a slower deterioration of functional status, especially the respiratory function.
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Affiliation(s)
- Jan Sznajder
- Department of Rehabilitation, Józef Piłsudski University of Physical Education inWarsaw, Warsaw, Poland
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Barć
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Kuźma-Kozakiewicz
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland
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11
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Rahmati M, Malakoutinia F. Aerobic, resistance and combined exercise training for patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis. Physiotherapy 2021; 113:12-28. [PMID: 34555670 DOI: 10.1016/j.physio.2021.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to assess the effect of aerobic, resistance and combined exercise training in patients with ALS. DATA SOURCE A comprehensive systematic search of CENTRAL, CINAHL, SPORTDiscuss, Embase, Scopus, ProQuest was performed from inception to February 2021. ELIGIBILITY CRITERIA The systematic review included all studies that examined the effect of exercise training in ALS patients. Meta-analysis was also carried out on randomized controlled trials (RCTs). DATA EXTRACTION AND DATA SYNTHESIS Data related to primary outcomes (functional ability, respiratory function, fatigue, pain, quality of life, upper-body strength, lower-body strength and Vo2peak) and secondary outcomes (adverse events and feasibility of exercises) was extracted from all studies and systematically reviewed. RESULTS 16 trials including 532 patients met the inclusion criteria; of these, eight studies were included in this meta-analysis. The meta-analysis found a statistically significant difference in favor of exercise in functional ability (P=0.001), overall quality of life (P=0.03) and Vo2peak (P=0.01). The included trials were generally of poor quality and had a risk of bias. However, the results of sensitivity analysis, after omitting studies with high risk of bias, showed no statistically significant difference in functional ability (P=0.05), overall quality of life (P=0.12) and Vo2peak (P=0.13). Finally, no significant difference was found in respiratory function, fatigue, pain, and upper-body and lower-body strength. CONCLUSIONS The safety and effectiveness of exercise therapy in ALS patients remains unclear and further high quality RCTs with larger sample size are needed. Systematic Review Registration Number PROSPERO CRD42019140011.
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Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran.
| | - Fatemeh Malakoutinia
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
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12
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Angelini C, Siciliano G. An updated review on the role of prescribed exercise in the management of Amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:871-879. [PMID: 34237230 DOI: 10.1080/14737175.2021.1951706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Amyotrophic Lateral Sclerosis is a group of sporadic or familial disorders, characterized by upper and lower motor neuron involvement, with variable progression.Areas covered: The authors present the role of exercise in counteracting muscle disuse, particularly on limb weakness, that might antagonize denervation. The persistence of inactivity can affect many systems and the patient can develop deconditioning, muscle joint tightness, which causes contractures and pain. The main area of the review is the evaluation of the studies done on ALS exercise rehabilitation protocols, this was done by the evaluation of outcome function and patient independence exerting a positive psychological impact on both patients and caregivers. A second target is underlying differences between endurance and resistance exercise protocols, which may throw light on the biological mechanism of skeletal muscle repair, functional performance, and metabolism. The authors present not only exercise trials but also molecular biomarkers that might help define changes induced by physical rehabilitation. Our findings might help to achieve the best rehabilitation program. A standardized rehabilitation protocol is important: the instructed patients may continue therapy at home or be followed by telemedicine.Expert opinion: This review evaluates exercise rehabilitation, a controversial issue, evidence is weak and non-conclusive but represents the art status.
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Affiliation(s)
- Corrado Angelini
- Neuromuscular Lab - Department of Neurosciences, University of Padova, Padova, Italy
| | - Gabriele Siciliano
- Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
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13
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Scaricamazza S, Salvatori I, Ferri A, Valle C. Skeletal Muscle in ALS: An Unappreciated Therapeutic Opportunity? Cells 2021; 10:525. [PMID: 33801336 PMCID: PMC8000428 DOI: 10.3390/cells10030525] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by the selective degeneration of upper and lower motor neurons and by the progressive weakness and paralysis of voluntary muscles. Despite intense research efforts and numerous clinical trials, it is still an incurable disease. ALS had long been considered a pure motor neuron disease; however, recent studies have shown that motor neuron protection is not sufficient to prevent the course of the disease since the dismantlement of neuromuscular junctions occurs before motor neuron degeneration. Skeletal muscle alterations have been described in the early stages of the disease, and they seem to be mainly involved in the "dying back" phenomenon of motor neurons and metabolic dysfunctions. In recent years, skeletal muscles have been considered crucial not only for the etiology of ALS but also for its treatment. Here, we review clinical and preclinical studies that targeted skeletal muscles and discuss the different approaches, including pharmacological interventions, supplements or diets, genetic modifications, and training programs.
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Affiliation(s)
- Silvia Scaricamazza
- Fondazione Santa Lucia IRCCS, c/o CERC, 00143 Rome, Italy; (S.S.); (I.S.)
- Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Illari Salvatori
- Fondazione Santa Lucia IRCCS, c/o CERC, 00143 Rome, Italy; (S.S.); (I.S.)
- Department of Experimental Medicine, University of Rome “La Sapienza”, 00161 Rome, Italy
| | - Alberto Ferri
- Fondazione Santa Lucia IRCCS, c/o CERC, 00143 Rome, Italy; (S.S.); (I.S.)
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy
| | - Cristiana Valle
- Fondazione Santa Lucia IRCCS, c/o CERC, 00143 Rome, Italy; (S.S.); (I.S.)
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy
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14
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Kato N, Hashida G, Kobayashi M, Hattori N. Lower limb muscle strengthening exercises in patients with early-stage amyotrophic lateral sclerosis: a case series study. J Phys Ther Sci 2020; 32:615-620. [PMID: 33132518 PMCID: PMC7590854 DOI: 10.1589/jpts.32.615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We investigated whether patients with early-stage amyotrophic lateral sclerosis can improve their voluntary strength with a physical therapy program. [Participants and Methods] This retrospective case series study at a single university hospital included 13 patients with amyotrophic lateral sclerosis (amyotrophic lateral sclerosis functional rating scale-revised ≥35, modified functional ambulation categories score ≥4). Physical therapy was performed for 3 weeks. We investigated knee extension muscle strength and modified functional ambulation categories scores at the start and end of the therapy and calculated the improvement rate of knee extension muscle strength. We performed a regression analysis of the relationship between knee extension muscle strength at the start of the study and the improvement rate. [Results] The knee extension muscle strength improved significantly; however, the effect size was small (0.13). The modified functional ambulation categories scores did not improve significantly. The knee extension muscle strength at the start of the therapy was negatively correlated with the improvement rate (logarithmic transformed linear regression: adjusted R2=0.27). [Conclusion] A short-duration exercise program improved lower limb muscle strength in patients with early-stage amyotrophic lateral sclerosis. Additionally, we found that patients with weaker lower limb muscle strength at the start of the therapy demonstrated greater improvement at the end of the therapy.
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Affiliation(s)
- Naoki Kato
- Department of Rehabilitation, Osaka University Medical Hospital: 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Goichi Hashida
- Department of Rehabilitation, Osaka University Medical Hospital: 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mizuki Kobayashi
- Department of Rehabilitation, Osaka University Medical Hospital: 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Noriaki Hattori
- Department of Rehabilitation, Faculty of Medicine, Academic Assembly, University of Toyama, Japan
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15
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Memon AA, Coleman JJ, Amara AW. Effects of exercise on sleep in neurodegenerative disease. Neurobiol Dis 2020; 140:104859. [PMID: 32243913 PMCID: PMC7497904 DOI: 10.1016/j.nbd.2020.104859] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/22/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
As the population ages, the incidence and prevalence of neurodegenerative disorders will continue to increase. Persons with neurodegenerative disease frequently experience sleep disorders, which not only affect quality of life, but potentially accelerate progression of the disease. Unfortunately, pharmacological interventions are often futile or have adverse effects. Therefore, investigation of non-pharmacological interventions has the potential to expand the treatment landscape for these disorders. The last decade has observed increasing recognition of the beneficial role of exercise in brain diseases, and neurodegenerative disorders in particular. In this review, we will focus on the therapeutic role of exercise for sleep dysfunction in four neurodegenerative diseases, namely Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Available data suggest that exercise may have the potential to improve sleep disorders and attenuate neurodegeneration, particularly in Alzheimer's disease and Parkinson's disease. However, additional research is required in order to understand the most effective exercise therapy for these indications; the best way to monitor the response to interventions; the influence of exercise on sleep dysfunction in Huntington's disease and amyotrophic lateral sclerosis; and the mechanisms underlying exercise-induced sleep modifications.
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Affiliation(s)
- Adeel A Memon
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Juliana J Coleman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America; UAB Center for Exercise Medicine, Birmingham, AL 35205, United States of America; UAB Sleep and Circadian Research Core, United States of America.
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16
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Siciliano G, Chico L, Lo Gerfo A, Simoncini C, Schirinzi E, Ricci G. Exercise-Related Oxidative Stress as Mechanism to Fight Physical Dysfunction in Neuromuscular Disorders. Front Physiol 2020; 11:451. [PMID: 32508674 PMCID: PMC7251329 DOI: 10.3389/fphys.2020.00451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Neuromuscular diseases (NMDs) are a group of often severely disabling disorders characterized by dysfunction in one of the main constituents of the motor unit, the cardinal anatomic-functional structure behind force and movement production. Irrespective of the different pathogenic mechanisms specifically underlying these disease conditions genetically determined or acquired, and the related molecular pathways involved in doing that, oxidative stress has often been shown to play a relevant role within the chain of events that induce or at least modulate the clinical manifestations of these disorders. Due to such a putative relevance of the imbalance of redox status occurring in contractile machinery and/or its neural drive in NMDs, physical exercise appears as one of the most important conditions able to positively interfere along an ideal axis, going from a deranged metabolic cell homeostasis in motor unit components to the reduced motor performance profile exhibited by the patient in everyday life. If so, it comes out that it would be important to identify a proper training program, suitable for load and type of exercise that is able to improve motor performance in adaptation and response to such a homeostatic imbalance. This review therefore analyzes the role of different exercise trainings on oxidative stress mechanisms, both in healthy and in NMDs, also including preclinical studies, to elucidate at which extent these can be useful to counteract muscle impairment associated to the disease, with the final aim of improving physical functions and quality of life of NMD patients.
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Affiliation(s)
- Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Lucia Chico
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Annalisa Lo Gerfo
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Costanza Simoncini
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Erika Schirinzi
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
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17
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Lewis KEA, Bennett W, Blizzard CL, West AK, Chung RS, Chuah MI. The influence of metallothionein treatment and treadmill running exercise on disease onset and survival in SOD1 G93A amyotrophic lateral sclerosis mice. Eur J Neurosci 2020; 52:3223-3241. [PMID: 31954073 DOI: 10.1111/ejn.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 11/27/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, characterised by the degeneration of motor neurons innervating skeletal muscle. The mechanisms underlying neurodegeneration in ALS are not yet fully elucidated, and with current therapeutics only able to extend lifespan by a matter of months there is a clear need for novel therapies to increase lifespan and patient quality of life. Here, we evaluated whether moderate-intensity treadmill exercise and/or treatment with metallothionein-2 (MT2), a neuroprotective protein, could improve survival, behavioural or neuropathological outcomes in SOD1G93A familial ALS mice. Six-week-old female SOD1G93A mice were allocated to one of four treatment groups: MT2 injection, i.m.; moderate treadmill exercise; neither MT2 nor exercise; or both MT2 and exercise. MT2-treated mice survived around 3% longer than vehicle-treated mice, with this mild effect reaching statistical significance in Cox proportional hazards analysis once adjusted for potential confounders. Mixed model body weight trajectories over time indicated that MT2-treated mice, with or without exercise, reached maximum body weight at a later age, suggesting a delay in disease onset of around 4% compared to saline-treated mice. Exercise alone did not significantly increase survival or delay disease onset, and neither exercise nor MT2 substantially ameliorated gait abnormalities or muscle strength loss. We conclude that neither exercise nor MT2 treatment was detrimental in female SOD1G93A mice, and further study could determine whether the mild effect of peripheral MT2 administration on disease onset and survival could be improved via direct administration of MT2 to the central nervous system.
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Affiliation(s)
- Katherine E A Lewis
- School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - William Bennett
- School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
| | | | - Adrian K West
- School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Roger S Chung
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Meng Inn Chuah
- School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
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18
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Tsitkanou S, Della Gatta P, Foletta V, Russell A. The Role of Exercise as a Non-pharmacological Therapeutic Approach for Amyotrophic Lateral Sclerosis: Beneficial or Detrimental? Front Neurol 2019; 10:783. [PMID: 31379732 PMCID: PMC6652799 DOI: 10.3389/fneur.2019.00783] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease, involves the rapid deterioration of motor neurons resulting in severe muscle atrophy and respiratory insufficiency. It is considered a "multisystemic" disease with many potential mechanisms responsible for its pathology. Currently, there is no cure for ALS. Exercise training is suggested as a potential approach to reduce ALS pathology, but its beneficial role remains controversial. This review provides an overview of the effects of exercise training in ALS-affected mice and patients. It will compare the intensity, duration, and type of exercise on the health of SOD1G93A mice, a mouse model of familial ALS, and review clinical studies involving ALS patients undergoing both endurance and resistance training. In summary, mild-to-moderate swimming-based endurance training appears the most advantageous mode of exercise in SOD1G93A mice, improving animal survival, and delaying the onset and progression of disease. Furthermore, clinical studies show that both endurance and resistance training have an advantageous impact on the quality of life of ALS patients without extending life expectancy. However, small sample sizes, non-representative control populations, heterogeneous disease stage of patients, and the presence of confounders often exist in the exercise studies conducted with ALS patients. This raises concerns about the interpretation of these findings and, therefore, these results should be considered with caution. While promising, more pre-clinical and clinical studies with improved experimental design and fewer limitations are still necessary to confirm the impact of exercise training on the health of ALS patients.
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Affiliation(s)
- Stavroula Tsitkanou
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Paul Della Gatta
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Victoria Foletta
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Aaron Russell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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19
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Zucchi E, Vinceti M, Malagoli C, Fini N, Gessani A, Fasano A, Rizzi R, Sette E, Cavazza S, Fiocchi A, Buja S, Faccioli T, Storani S, Mandrioli J. High-frequency motor rehabilitation in amyotrophic lateral sclerosis: a randomized clinical trial. Ann Clin Transl Neurol 2019; 6:893-901. [PMID: 31139687 PMCID: PMC6529833 DOI: 10.1002/acn3.765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/19/2019] [Accepted: 03/03/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Exercise may be physically and psychologically important for people with ALS, especially in the earlier stages of the disease, and, as a consequence, current ALS clinical management includes individualized rehabilitation as part of multidisciplinary care because. However, while recent studies focused on which type of exercise is more indicated to ALS patients, there is no evidence at which frequency training sessions should be performed. Methods We performed an assessor blinded randomized clinical trial to investigate the superiority of two different frequencies of exercise on rate of progression in ALS. We enrolled 65 patients in two groups: intensive exercise regimen (IER, five sessions/week) versus usual exercise regimen (UER, two sessions/week). The primary aim was to assess if IER decreased disease progression, measured through Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised, with respect to UER. Secondary aims included assessment of adverse events, tracheostomy‐free survival, motor and respiratory functions, fatigue, quality of life and caregiver burden. Treatment regimen consisted for both groups of the same kind of exercise including aerobic training, endurance training, stretching or assisted active mobilization, differing for frequency of intervention. Results No significant changes in disease progression were found in patients under IER versus UER. At the end of the study, there were no significant differences between the two groups in survival, respiratory function, time to supporting procedures, and quality of life. Adverse events, fatigue, and caregiver burden were not different between the two treatment regimens. Conclusions Despite some limitations, our trial demonstrated that high‐frequency physical exercise was not superior to UER on ALSFRS‐R scores, motor and respiratory functions, survival, fatigue, and quality of life of ALS patients.
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Affiliation(s)
- Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.,Department of Epidemiology Boston University School of Public Health Boston Massachusetts
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Nicola Fini
- Neurology Unit Department of Neurosciences Azienda Ospedaliero Universitaria di Modena Modena Italy
| | - Annalisa Gessani
- Neurology Unit Department of Neurosciences Azienda Ospedaliero Universitaria di Modena Modena Italy
| | - Antonio Fasano
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Romana Rizzi
- Neurology Unit Department of Neuro-Motor Diseases Local Health Authority of Reggio Emilia-IRCCS Reggio Emilia Reggio Emilia Italy
| | - Elisabetta Sette
- Neurology Unit Department of Neurosciences-Rehabilitation St. Anna Hospital Ferrara Italy
| | - Stefano Cavazza
- Unit of Rehabilitation Medicine Department of Neurosciences Azienda Ospedaliero-Universitaria di Modena Modena Italy
| | - Alena Fiocchi
- Unit of Rehabilitation Medicine Local Health Authority of Reggio Emilia Reggio Emilia Italy
| | - Sergio Buja
- Unit of Rehabilitation Medicine Azienda Ospedaliero-Universitaria di Ferrara Ferrara Italy
| | - Tiziana Faccioli
- Unit of Rehabilitation Medicine Azienda USL di Ferrara Ferrara Italy
| | - Simone Storani
- Primary Health Care Local Health Authority of Reggio Emilia-IRCCS Reggio Emilia Reggio Emilia Italy
| | - Jessica Mandrioli
- Neurology Unit Department of Neurosciences Azienda Ospedaliero Universitaria di Modena Modena Italy
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20
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Sivaramakrishnan A, Madhavan S. Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: a pilot study. Neurol Sci 2019; 40:971-978. [PMID: 30719583 DOI: 10.1007/s10072-019-03736-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Aerobic exercise can promote neuroplastic responses in the healthy and injured brain. Although the role of exercise in amyotrophic lateral sclerosis (ALS) is debated, new evidence suggests that exercise may reduce disease progression. While common exercise modalities such as the treadmill and cycle ergometer have been explored in ALS, the safety and feasibility of a total body recumbent stepper have not been investigated. Additionally, the functional and neurophysiological effects of recumbent stepping in ALS are still unknown. Here, we investigated the safety and feasibility of a 4-week recumbent stepping program to slow disease progression in ALS and possibly facilitate neuroplasticity. METHOD Nine individuals with ALS performed moderate intensity recumbent stepping for four weeks. Outcomes included participation satisfaction questionnaire, ALS Functional Rating Scale Revised (ALSFRS-R), clinical tests of walking and endurance, fatigue severity scale, Beck depression inventory, SF-12, and transcranial magnetic stimulation-induced motor evoked potentials (MEPs). All measurements were collected at baseline, post-intervention, and at the 1-month follow-up. RESULTS Eight participants completed the study without any adverse events. The ALSFRS-R scores were similar at the end of the study and at follow-up. No significant differences were noted for any of the clinical outcomes. MEPs were present only in two participants and changes in corticomotor excitability after exercise were minimal. CONCLUSIONS Results from this preliminary study support the safety and feasibility of 12 sessions of total body recumbent stepping in individuals with ALS.
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Affiliation(s)
- Anjali Sivaramakrishnan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL, 60612, USA.,Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL, 60612, USA.
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21
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Plowman EK, Tabor-Gray L, Rosado KM, Vasilopoulos T, Robison R, Chapin JL, Gaziano J, Vu T, Gooch C. Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham-controlled trial. Muscle Nerve 2018; 59:40-46. [DOI: 10.1002/mus.26292] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/26/2018] [Accepted: 07/01/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Emily K. Plowman
- Swallowing Systems Core; University of Florida; Gainesville Florida USA
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions; University of Florida; P.O. Box 117420, Gainesville Florida, 32610 USA
- Department of Neurology; University of Florida; Gainesville Florida USA
| | - Lauren Tabor-Gray
- Swallowing Systems Core; University of Florida; Gainesville Florida USA
| | | | - Terrie Vasilopoulos
- Department of Anesthesiology; University of Florida; Gainesville Florida USA
| | - Raele Robison
- Swallowing Systems Core; University of Florida; Gainesville Florida USA
| | | | - Joy Gaziano
- Joy McCann Culverhouse Center for Swallowing Disorders; University of South Florida; Tampa Florida USA
| | - Tuan Vu
- Department of Neurology; University of South Florida; Tampa Florida USA
| | - Clifton Gooch
- Department of Neurology; University of South Florida; Tampa Florida USA
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22
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Kato N, Hashida G, Konaka K. Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis: A 2-patient case series study. Medicine (Baltimore) 2018; 97:e11145. [PMID: 29924018 PMCID: PMC6024467 DOI: 10.1097/md.0000000000011145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Exercise for patients with amyotrophic lateral sclerosis (ALS) can be expected to improve function at the early stage of disease, but improvement cannot be expected at the late stage. However, no report has investigated the correlation between the effect of exercise and time since onset. This study examined the relevance between the effect of muscle strengthening exercise and time since onset in patients with ALS.This study is a retrospective nonconsecutive case series study at a single university hospital. We included 2 patients with ALS who were admitted twice. Case 1 was a 60-year-old man with the bulbar type. He was hospitalized 10 months (ALS functional rating scale-revised, 42 points) and 1 year and 8 months (33 points) after onset. Case 2 was a 52-year-old man with the lower limb type. He was hospitalized 1 year and 3 months (44 points) and 1 year and 8 months (33 points) after onset. Physical therapy was implemented daily on weekdays for approximately 30 minutes. The intervention period was 2 weeks. Lower limb muscle strengthening exercises were mainly performed and exercise intensity was adjusted to a modified Borg Scale score of 5 (lower limbs). The study investigated knee extension muscle strength (KEMS) by using a hand-held dynamometer and Functional Ambulation Categories (FAC) at the start and end of physical therapy during each hospitalization.KEMS improved during the initial hospitalization in both patients, and FAC improved in Case 2; neither KEMS nor FAC improved during rehospitalization in either patient. In Case 1, KEMS was maintained for 10 months.The current results suggest that the positive effect of muscle strengthening exercise is greater at the early stage and may be maintained in patients with bulbar type ALS. In addition, improvement can be achieved approximately 1 year after onset and in patients with an ALSFRS-R score of 40 points or more. Therefore, it is necessary to initiate and continue exercise earlier after onset.
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Affiliation(s)
- Naoki Kato
- Department of Rehabilitation, Osaka University Medical Hospital
| | - Goichi Hashida
- Department of Rehabilitation, Osaka University Medical Hospital
| | - Kuni Konaka
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Osaka, Japan
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23
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Gibbons C, Pagnini F, Friede T, Young CA. Treatment of fatigue in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2018; 1:CD011005. [PMID: 29293261 PMCID: PMC6494184 DOI: 10.1002/14651858.cd011005.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is terminal, progressive neurological condition for which there are no curative treatments. Among people with ALS/MND, fatigue is a common and debilitating symptom, which is characterised by reversible motor weakness and whole-body tiredness that is only partially relieved by rest. The effectiveness of pharmacological or non-pharmacological treatments for fatigue in ALS/MND is not yet established. OBJECTIVES To assess the effects of pharmacological and non-pharmacological interventions for fatigue in ALS/MND. SEARCH METHODS We searched the following databases on 5 September 2017: Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL Plus, and ERIC. We also searched two clinical trials registries. SELECTION CRITERIA We selected randomised and quasi-randomised controlled trials of any intervention which sought to reduce fatigue for people with ALS/MND. We included studies if reduction in fatigue was a primary or secondary outcome of the trial. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included one pharmacological (modafinil) study and three non-pharmacological studies (resistance exercise, respiratory exercise, and repetitive transcranial magnetic stimulation (rTMS)), involving a total of 86 participants with ALS/MND. None of the included studies were free from risk of bias. Since there was only one trial for each intervention, no meta-analysis was possible. All studies assessed fatigue using the Fatigue Severity Scale (FSS; scale from 9 to 63, higher scores indicate more fatigue). Information for assessing bias was often lacking in study reports, making the risk of bias unclear across several domains in all trials. Blinding of participants was not possible in exercise trials, but the outcome assessment was blinded.We found very low-quality evidence suggesting possible improvements in fatigue for modafinil treatment versus placebo (MD -11.00, 95% CI -23.08 to 1.08), respiratory exercise versus a sham intervention (MD -9.65, 95% CI -22.04 to 2.73), and rTMS versus sham rTMS (data not provided), which warrant further investigation to clarify the efficacy of these treatments for fatigue in ALS/MND. We found no clear improvements in fatigue for resistance exercise versus usual care (MD 0.20, 95% CI -10.98 to 11.38; very low-quality evidence).Three participants in the modafinil group dropped out of the modafinil study, two citing issues with headache and one with chest tightness; other adverse effects were anxiety, nausea, dizziness, and sialorrhoea (probably ALS-related). The trials reported no adverse effects of exercise or rTMS.We cannot be certain about the effects of any of the interventions studied because of imprecision (small numbers of participants, wide CI), and possible study limitations. AUTHORS' CONCLUSIONS It is impossible to draw firm conclusions about the effectiveness of interventions to improve fatigue for people with ALS/MND as there are few randomised studies, and the quality of available evidence is very low.
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Affiliation(s)
- Chris Gibbons
- University of CambridgeThe Primary Care UnitForvie SiteRobinson WayCambridgeCambridgeshireUKCB2 0SR
| | - Francesco Pagnini
- Università Cattolica del Sacro CuoreDepartment of PsychologyVia Nirone 15,MilanoItaly20123
- Harvard UniversityDepartment of PsychologyCambridgeMassachusettsUSA
| | - Tim Friede
- University Medical Center GoettingenDepartment of Medical StatisticsGoettingenGermany
| | - Carolyn A Young
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
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24
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Clawson LL, Cudkowicz M, Krivickas L, Brooks BR, Sanjak M, Allred P, Atassi N, Swartz A, Steinhorn G, Uchil A, Riley KM, Yu H, Schoenfeld DA, Maragakis NJ. A randomized controlled trial of resistance and endurance exercise in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:250-258. [PMID: 29191052 DOI: 10.1080/21678421.2017.1404108] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluate the safety and tolerability of resistance and endurance exercise in ALS participants as measured by their ability to complete this six-month study. METHODS Participants were randomized to Resistance, Endurance, or Stretching/Range of Motion (SROM the exercise regimen prescribed for most ALS patients) exercises. All exercises were performed at home with an individualized regimen designed by a physical therapist trained in ALS management. Primary outcome measures were tolerability of the exercises at 24 weeks defined by 50% of participants completing at least 50% of the prescribed exercise regimen. Secondary outcome measures included the ALSFRS-R, pulmonary FVC, and other measures of ALS function. RESULTS At 12 and 24 weeks, all three exercise regimens were tolerated according to our pre-specified criteria. Compliance to the prescribed exercise regimen was the highest in the resistance and SROM arms of the study. All three forms of exercise were considered safe as there were no differences in the rates of disease progression among groups. There were no differences in the secondary outcome measures and feasibility for evaluating these measures was successful. In a post-hoc analysis, there was a trend towards fewer falls in the Resistance and Endurance groups. CONCLUSIONS This study demonstrates that SROM, resistance, and endurance exercise are all safe to be performed with the specified regimen without any worsening of outcomes as related to ALS function. All three forms of exercise were tolerated with resistance and SROM exercises showing the highest compliance over the 24 week-period.
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Affiliation(s)
- Lora L Clawson
- a Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Merit Cudkowicz
- b Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Lisa Krivickas
- c Department of Physical Medicine and Rehabilitation , Harvard University , Boston , MA , USA
| | - Benjamin R Brooks
- d Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Neuroscience and Spine Institute , Carolinas HealthCare System , Charlotte , NC , USA , and
| | - Mohammed Sanjak
- d Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Neuroscience and Spine Institute , Carolinas HealthCare System , Charlotte , NC , USA , and
| | - Peggy Allred
- e Department of Neurology, Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Nazem Atassi
- b Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Amy Swartz
- b Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Gabrielle Steinhorn
- a Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Alpa Uchil
- a Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Kristen M Riley
- a Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Hong Yu
- b Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - David A Schoenfeld
- b Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Nicholas J Maragakis
- a Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
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25
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Kato N, Hashida G, Kobayashi M, Konaka K. Physical therapy improves lower limb muscle strength but not function in individuals with amyotrophic lateral sclerosis: A case series study. Ann Phys Rehabil Med 2017; 61:108-110. [PMID: 29132971 DOI: 10.1016/j.rehab.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Naoki Kato
- Department of Rehabilitation, Osaka University Medical Hospital, Suita city, Japan.
| | - Goichi Hashida
- Department of Rehabilitation, Osaka University Medical Hospital, Suita city, Japan
| | - Mizuki Kobayashi
- Department of Rehabilitation, Osaka University Medical Hospital, Suita city, Japan
| | - Kuni Konaka
- Department of Rehabilitation, Osaka University Medical Hospital, Suita city, Japan; Department of Neurology, Osaka University Graduate School of Medicine, Suita city, Japan
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26
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Sanjak M, Langford V, Holsten S, Rozario N, Patterson CGM, Bravver E, Bockenek WL, Brooks BR. Six-Minute Walk Test as a Measure of Walking Capacity in Ambulatory Individuals With Amyotrophic Lateral Sclerosis. Arch Phys Med Rehabil 2017; 98:2301-2307. [DOI: 10.1016/j.apmr.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022]
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27
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van Groenestijn AC, Verschuren O, Schröder CD, van den Berg LH, Visser-Meily JM. The Åstrand-Ryhming Test is not a Feasible Measure in Ambulatory Patients with Amyotrophic Lateral Sclerosis. J Neuromuscul Dis 2016; 3:539-544. [DOI: 10.3233/jnd-160182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annerieke C. van Groenestijn
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Carin D. Schröder
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M.A. Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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28
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Santos CL, Noronha DO, Lessa PIF, Camatti JR, Victor de Oliveira Fernandes IA, Barbosa Paixão A, Sá KN, Baptista AF, de Lucena RDCS. Active Hip Flexion is a predictor of mobility in Amyotrophic Lateral Sclerosis. NeuroRehabilitation 2016; 38:395-400. [PMID: 27061167 DOI: 10.3233/nre-161330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Muscle Force (MF) and amplitude of active movement (AAM) are progressively affected in amyotrophic lateral sclerosis (ALS). These measurements are correlated with mobility but influence it in a distinct manner. OBJECTIVE To determine the influence of MF and AAM on the mobility of the subjects with ALS. METHODS The formula for identifying the covariables and scale of mobility of the Amyotrophic Lateral Sclerosis Assessment Questionnaire were applied to 23 subjects with ALS. The MF data of the knee and ankle flexors and extensors were collected in the most affected limb. In conjunction, the AAM of hip and knee flexion were captured. Multiple linear regressions were used, considering alpha ≤0.05. RESULTS MF and AAM interfered in mobility and are responsible for 63.6% of the variation in mobility. The variable that explained this variation was the AAM of hip flexion. The stage of disease was considered a covariable. CONCLUSION AAM of hip flexion is a safe predictor of mobility in ALS. Retarding loss of this AAM may maintain these subjects functional for a longer time. It was not possible to use MF of the muscles evaluated to predict mobility.
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Affiliation(s)
- Cleber Luz Santos
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil.,Federal University of Bahia, University Hospital of the Federal University of Bahia, Salvador, Brazil
| | - Diana Oliveira Noronha
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil.,Federal University of Bahia, University Hospital of the Federal University of Bahia, Salvador, Brazil
| | - Paulo Itamar Ferraz Lessa
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil
| | | | | | - Alaí Barbosa Paixão
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil
| | - Kátia Nunes Sá
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil.,Bahian School of Medicine and Public Health, Salvador, Brazil
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Biomorphology Department, Federal University of Bahia, Salvador, Brazil.,Federal University of Rio de Janeiro, Salvador, Brazil
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29
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Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, Richter J, Vu T, Gooch C. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:48-53. [PMID: 26599236 DOI: 10.1002/mus.24990] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/08/2015] [Accepted: 11/20/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We evaluated the feasibility and impact of expiratory muscle strength training (EMST) on respiratory and bulbar function in persons with amyotrophic lateral sclerosis (ALS). METHODS Twenty-five ALS patients participated in this delayed intervention open-label clinical trial. Following a lead-in period, patients completed a 5-week EMST protocol. Outcome measures included: maximum expiratory pressure (MEP); physiologic measures of swallow and cough; and penetration-aspiration scale (PAS) scores. RESULTS Of participants who entered the active phase of the study (n = 15), EMST was well tolerated and led to significant increases in MEPs and maximum hyoid displacement during swallowing post-EMST (P < 0.05). No significant differences were observed for PAS scores or cough spirometry measures. CONCLUSIONS EMST was feasible and well tolerated in this small cohort of ALS patients and led to improvements in expiratory force-generating pressures and swallow kinematics. Further investigation is warranted to confirm these preliminary findings. Muscle Nerve 54: 48-53, 2016.
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Affiliation(s)
- Emily K Plowman
- Department of Speech, Language and Hearing Sciences, University of Florida, P.O. Box 117420, Gainesville, Florida, 32610, USA.,Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, Florida, USA.,Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - Stephanie A Watts
- Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - Lauren Tabor
- Department of Speech, Language and Hearing Sciences, University of Florida, P.O. Box 117420, Gainesville, Florida, 32610, USA.,Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, Florida, USA
| | - Raele Robison
- Department of Speech, Language and Hearing Sciences, University of Florida, P.O. Box 117420, Gainesville, Florida, 32610, USA.,Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, Florida, USA
| | - Joy Gaziano
- Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - Amanda S Domer
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, Florida, USA
| | - Joel Richter
- Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - Tuan Vu
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Clifton Gooch
- Department of Neurology, University of South Florida, Tampa, Florida, USA
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30
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Dahlqvist JR, Vissing J. Exercise Therapy in Spinobulbar Muscular Atrophy and Other Neuromuscular Disorders. J Mol Neurosci 2015; 58:388-93. [PMID: 26585990 DOI: 10.1007/s12031-015-0686-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
There is no curative treatment for most neuromuscular disorders. Exercise, as a treatment for these diseases, has therefore received growing attention. When executed properly, exercise can maintain and improve health and reduce the risk of cardiovascular disease, obesity, and diabetes. In persons with muscle wasting due to neuromuscular conditions, however, a common belief has been that physical activity could accelerate degeneration of the diseased muscle and a careful approach to training has therefore been suggested. In this review, we describe the current knowledge about physical training in patients with neuromuscular diseases associated with weakness and wasting. We review studies that have investigated different types of exercise in both myopathies and motor neuron diseases, with particular emphasis on training of persons affected by spinobulbar muscular atrophy (SBMA). Finally, we provide suggestions for future investigations of training in this condition.
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Affiliation(s)
- Julia Rebecka Dahlqvist
- Copenhagen Neuromuscular Center, Section 3342, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - John Vissing
- Copenhagen Neuromuscular Center, Section 3342, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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31
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Plowman EK. Is There a Role for Exercise in the Management of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:1151-1166. [PMID: 26091205 DOI: 10.1044/2015_jslhr-s-14-0270] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 06/05/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The role of exercise in the management of people with amyotrophic lateral sclerosis (PALS) is controversial and currently unclear. The purpose of this review article is to review literature examining the impact of limb, respiratory, and oral motor exercise on function, disease progression, and survival in PALS and the transgenic ALS animal model. METHOD A literature review was conducted to examine relevant studies published in peer-reviewed journals between 1960 and 2014. All studies were appraised for quality of research and were assigned a level of evidence, and treatment outcomes were classified as either positive, negative, or neutral. RESULTS A total of 18 exercise-based intervention studies on limb (13), respiratory (3), or speech (2) function were identified. Of the human clinical trials, 6 were experimental and 4 were exploratory. No experimental studies were identified examining the impact of targeted exercise on speech or swallowing function. Mild to moderate intensity limb or respiratory exercise, applied early in the disease, was noted to have a beneficial impact on motor function and survival. CONCLUSION Insufficient data exist to support or refute the role of exercise in the management of bulbar dysfunction in PALS. This represents a critical area of future investigation.
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32
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Funke A, Grehl T, Großkreutz J, Münch C, Walter B, Kettemann D, Karnapp C, Gajewski N, Meyer R, Maier A, Gruhn K, Prell T, Kollewe K, Abdulla S, Kobeleva X, Körner S, Petri S, Meyer T. Hilfsmittelversorgung bei der amyotrophen Lateralsklerose. DER NERVENARZT 2015. [DOI: 10.1007/s00115-015-4398-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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van der Kleij LA, Jones AR, Steen IN, Young CA, Shaw PJ, Shaw CE, Leigh PN, Turner MR, Al-Chalabi A. Regionality of disease progression predicts prognosis in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:442-7. [DOI: 10.3109/21678421.2015.1051987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lisa A. van der Kleij
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Ashley R. Jones
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - I Nick Steen
- Institute of Health and Society, University of Newcastle, UK
| | | | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Christopher E. Shaw
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - P. Nigel Leigh
- Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, Falmer, Brighton, UK
| | - Martin R. Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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34
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Panitz S, Kornhuber M, Hanisch F. The checklist individual strength (CIS20-R) in patients with amyotrophic lateral sclerosis - a longitudinal study. Acta Neurol Scand 2015; 131:372-80. [PMID: 25639482 DOI: 10.1111/ane.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fatigue may be underestimated symptom in amyotrophic lateral sclerosis (ALS). The self-administered checklist individual strength (CIS20-R) was used to measure both physical and mental fatigue in ALS. MATERIALS AND METHODS Fatigue was measured in 51 consecutive patients with ALS using the fatigue severity scale (FSS) and the CIS20-R (four dimensions: subjective fatigue experience, concentration, motivation, activity). The questionnaire scores were compared with disease and progression parameters [revised ALS functional rating scale (ALS-FRS-R), MRC sum score, slow vital capacity (slow VC)]. Patients had follow-ups at six and 12 months. RESULTS At baseline (mean age: 57.9 years ± 12.3, mean disease duration: 15.8 months ± 12.7) clinical relevant fatigue was seen in 49% in FSS and 40% in CIS20-R. FSS and CIS20-R (except the subscale for concentration) were steadily increasing in the course of the disease. CIS1 (subjective fatigue) but not FSS showed a correlation to the ALS-FRS-R and the progression of the ALS-FRS-R after 12 months. There was a moderate positive correlation between FSS and CIS20-R. CONCLUSIONS The CIS20-R is a sensitive tool to detect clinically relevant fatigue in early stages of ALS. Both physical and mental (motivation) dimensions of fatigue steadily increase during the course of the disease in ALS.
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Affiliation(s)
- S. Panitz
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
| | - M. Kornhuber
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
| | - F. Hanisch
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
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Kamide N, Asakawa T, Shibasaki N, Kasahara Y, Tamada Y, Kitano K, Kikuchi Y, Yorimoto K, Kobayashi Y, Komori T. Identification of the type of exercise therapy that affects functioning in patients with early-stage amyotrophic lateral sclerosis: A multicenter, collaborative study. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ncn3.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Naoto Kamide
- School of Allied Health Sciences; Kitasato University; Sagamihara Japan
- Graduate School of Medicine; Kitasato University; Sagamihara Kanagawa Japan
| | - Takashi Asakawa
- Department of Rehabilitation; Yoshino Neurology Clinic; Ichikawa Chiba Japan
| | - Nobuhiko Shibasaki
- Department of Rehabilitation; Sayama Neurological Hospital; Sayama Saitama Japan
| | - Yoshio Kasahara
- Department of Rehabilitation; Tokyo Metropolitan Neurological Hospital; Futyu Tokyo Japan
| | - Yoshiki Tamada
- Department of Rehabilitation; Kohnodai Hospital; National Center for Global Health and Medicine; Ichikawa Chiba Japan
| | - Kosuke Kitano
- Department of Rehabilitation; Murakami Karindoh Hospital; Fukuoka Fukuoka Japan
| | - Yutaka Kikuchi
- Department of Rehabilitation; Mihara Memorial Hospital; Isesaki Gunma Japan
| | - Keisuke Yorimoto
- Department of Rehabilitation; National Center of Neurology and Psychiatry; Kodaira Tokyo Japan
| | - Yoko Kobayashi
- Department of Rehabilitation; National Center of Neurology and Psychiatry; Kodaira Tokyo Japan
| | - Testuo Komori
- Department of Neurology; National Hakone Hospital; Odawara Kanagawa Japan
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Carilho R, de Carvalho M, Swash M, Pinto S, Pinto A, Costa J. Vascular endothelial growth factor and amyotrophic lateral sclerosis: the interplay with exercise and noninvasive ventilation. Muscle Nerve 2014; 49:545-50. [PMID: 23868282 DOI: 10.1002/mus.23955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 06/09/2013] [Accepted: 07/06/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We evaluated plasma vascular endothelial growth factor (VEGF) levels in patients with amyotrophic lateral sclerosis (ALS) with reference to the effects of respiratory failure, noninvasive ventilation (NIV), and exercise. METHODS We studied plasma VEGF levels in 83 ALS patients, 20 healthy controls, and 10 patients with other disorders. There were 4 groups of ALS patients: G1, 27 patients without respiratory problems; G2, 14 patients stabilized on nocturnal NIV; G3, 30 patients presenting with respiratory failure; G4, 12 patients on an aerobic exercise protocol. RESULTS VEGF plasma levels did not differ significantly between ALS patients and controls, or between ALS groups. In G3, the mean VEGF levels increased 75% during NIV. In G4, the mean VEGF level increased by 300% during the exercise program. VEGF levels did not change during the course of the disease. CONCLUSIONS VEGF levels in ALS depend on changes in ventilation and exercise but are probably not affected by the disease process itself.
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Affiliation(s)
- Rita Carilho
- Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
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Young CA, Gibbons C, Pagnini F, Friede T. Treatment for fatigue in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). Hippokratia 2014. [DOI: 10.1002/14651858.cd011005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carolyn A Young
- The Walton Centre for Neurology and Neurosurgery; Lower Lane Fazakerley Liverpool UK L9 7LJ
| | - Chris Gibbons
- University of Manchester; Collaboration for Leadership in Applied Health Research and Care (CLAHRC); School of Community Based Medicine, Williamson Building, Oxford Road, Manchester UK M13 9PL
| | - Francesco Pagnini
- Catholic University of Milan; Department of Psychology; Via Nirone 15, Milano Italy 20123
| | - Tim Friede
- Universitätsmedizin Göttingen; Institut für Medizinische Statistik; Humboldtallee 32 Göttingen Germany 37073
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Pinto S, Carvalho MD. Breathing new life into treatment advances for respiratory failure in amyotrophic lateral sclerosis patients. Neurodegener Dis Manag 2014; 4:83-102. [DOI: 10.2217/nmt.13.74] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY In the last three decades, improvements in respiratory management are responsible for increasing survival and improving quality of life for amyotrophic lateral sclerosis (ALS) patients. Nowadays, ALS patients with respiratory involvement are offered a support treatment other than the traditional respiratory palliative care. Knowledge about available respiratory support potentialities is essential for appropriate, customized and effective treatment of ALS, which should probably be started sooner than the conventional approach. There is evidence supporting that respiratory support has a larger impact than riluzole on survival. Noninvasive ventilation is essential in the treatment of ALS patients with respiratory involvement. In this article methods to determine respiratory failure in ALS, mechanical invasive and noninvasive ventilation, telemetry, diaphragm pacing, cough aids and respiratory exercise are reviewed, after a brief overlook of respiratory insufficiency in ALS.
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Affiliation(s)
- Susana Pinto
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, 1648-028 Lisbon, Portugal
| | - Mamede de Carvalho
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, 1648-028 Lisbon, Portugal
- Neuroscience Department, Santa Maria Hospital, Lisbon, Portugal
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THEME 5 IMPROVING DIAGNOSIS, PROGNOSIS AND DISEASE PROGRESSION. Amyotroph Lateral Scler Frontotemporal Degener 2013. [DOI: 10.3109/21678421.2013.838419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turner-Stokes L, Thu A, Williams H, Casey R, Rose H, Siegert RJ. The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation. Disabil Rehabil 2013; 36:23-31. [PMID: 23721497 PMCID: PMC3906250 DOI: 10.3109/09638288.2013.775360] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To examine the construct validity and inter-rater reliability of the Neurological Impairment Scale (NIS) and compare ratings by medical and multidisciplinary teams in a mixed neurorehabilitation sample. To assess its concurrent and predictive validity as a predictor of outcome and functional gains during inpatient rehabilitation. Methods The NIS was rated in a consecutive cohort of patients (n = 428) recruited from nine specialist neurorehabilitation units in London. Dimensionality and internal consistency were explored through principal components analysis with Varimax rotation. Inter-rater reliability and the relationship between NIS and functional outcome (UK Functional Assessment Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre. Results Factor analysis identified two principal domains (“Physical” and “Cognitive”) together accounting for 35% of the variance: their Cronbach’s alpha values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95 (95% CI = 0.91–0.97)) and acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI = 0.88–0.95)). Change in NIS-physical score predicted 29% of the variance in functional gain (FIM + FAM change). Conclusion These findings provide the first formal evidence for the validity and reliability of the NIS as a measure of neurological impairment for use in general neuro-rehabilitation settings. Its further application and exploration are now warranted. Implications for Rehabilitation
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Affiliation(s)
- Lynne Turner-Stokes
- School of Medicine, Department of Palliative Care Policy and Rehabilitation, King's College London , London , UK
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Abstract
In this review, we present an overview of the role of exercise in neuromuscular disease (NMD). We demonstrate that despite the different pathologies in NMDs, exercise is beneficial, whether aerobic/endurance or strength/resistive training, and we explore whether this benefit has a similar mechanism to that of healthy subjects. We discuss further areas for study, incorporating imaginative and novel approaches to training and its assessment in NMD. We conclude by suggesting ways to improve future trials by avoiding previous methodological flaws and drawbacks in this field.
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Affiliation(s)
- Yaacov Anziska
- Department of Neurology, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, New York, 11203, USA.
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160th ENMC International Workshop (First ENMC practical care workshop) Exercise training in patients with muscle diseases. Neuromuscul Disord 2013; 23:182-7. [DOI: 10.1016/j.nmd.2012.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Indexed: 02/02/2023]
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Neuromuscular junction protection for the potential treatment of amyotrophic lateral sclerosis. Neurol Res Int 2012; 2012:379657. [PMID: 22919482 PMCID: PMC3423938 DOI: 10.1155/2012/379657] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease characterized by the progressive degeneration of upper and lower motor neurons (MNs), leading to muscular atrophy and eventual respiratory failure. ALS research has primarily focused on mechanisms regarding MN cell death; however, degenerative processes in the skeletal muscle, particularly involving neuromuscular junctions (NMJs), are observed in the early stages of and throughout disease progression. According to the "dying-back" hypothesis, NMJ degeneration may not only precede, but actively cause upper and lower MN loss. The importance of NMJ pathology has relatively received little attention in ALS, possibly because compensatory mechanisms mask NMJ loss for prolonged periods. Many mechanisms explaining NMJ degeneration have been proposed such as the disruption of anterograde/retrograde axonal transport, irregular cellular metabolism, and changes in muscle gene and protein expression. Neurotrophic factors, which are known to have neuroprotective and regenerative properties, have been intensely investigated for their therapeutic potential in both the preclinical and clinical setting. Additional research should focus on the potential of preserving NMJs in order to delay or prevent disease progression.
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Gibbons CJ, Young CA. Assessing and managing depression and fatigue in motor neuron disease. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SUMMARY This review evaluates strategies for assessing and treating depression and fatigue for patients diagnosed with motor neuron disease. A summary is given of questionnaire, interview and laboratory methods of assessment, including disease-specific techniques. The unique physical demands of the disease may preclude accurate measurement using generic questionnaire measures and disease-validated measures should be used, where available. There is an urgent need to develop psychological therapies for depression that can cater for the needs of motor neuron disease patients and their carers. Currently, no evidence-based treatment exists for fatigue and further work is warranted to systematically evaluate current evidence and develop novel treatments for this burdensome symptom.
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Affiliation(s)
- Chris J Gibbons
- The Walton Centre for Neurology & Neurosurgery, Liverpool, L9 7LJ, UK
- NIHR Collaboration for Leadership in Applied Health Research & Care, University of Manchester, Manchester, UK
| | - Carolyn A Young
- The Walton Centre for Neurology & Neurosurgery, Liverpool, L9 7LJ, UK
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Chan YM, Brown SC, Lu Q. Second International Workshop for Glycosylation Defects in Muscular Dystrophies, 11-12 November, 2010, Charlotte, USA. Brain Pathol 2011; 21:699-704. [DOI: 10.1111/j.1750-3639.2011.00494.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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