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Rockette-Wagner B, Aggarwal R. A review of the evidence for the utility of physical activity monitor use in patients with idiopathic inflammatory myopathies. Rheumatology (Oxford) 2024; 63:1815-1824. [PMID: 38243707 DOI: 10.1093/rheumatology/keae004] [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: 09/19/2023] [Revised: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024] Open
Abstract
Few proven therapies exist for patients with idiopathic inflammatory myopathies (IIMs), partly due to the lack of reliable and valid outcome measures for assessing treatment responses. The current core set measures developed by the International Myositis Assessment and Clinical Studies group were developed to standardize assessments of disease activity and treatment effect. None of the current measures address functional improvement in muscle weakness. Therefore, supplemental measures to more objectively assess physical activity levels and fatiguability in free-living settings are needed to assess disease activity more comprehensively. Validated physical activity monitors (PAMs) have the potential to serve as an objective functional outcome measure in clinical trials and observational studies. This review examines the current evidence for the use of body-worn PAMs in clinical settings with IIM patients. A practical overview of methods for PAM use in clinical patient populations (including measurement details and data processing) that focuses on IIM patients is also presented.
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Affiliation(s)
- Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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2
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Sánchez-Rosales AI, Posadas-Calleja JG, Serralde-Zúñiga AE, Quiroz-Olguín G. Nutritional interventions as modulators of the disease activity for idiopathic inflammatory myopathies: a scoping review. J Hum Nutr Diet 2024; 37:772-787. [PMID: 38324396 DOI: 10.1111/jhn.13287] [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: 05/13/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
Idiopathic inflammatory myopathies (IIMs) are chronic, autoimmune connective tissue diseases associated with significant morbidity and disability. Nutrients can activate the immune system and contribute to chronic low-grade inflammation (LGI). Chronic muscle inflammation leads to imbalanced pro-inflammatory and anti-inflammatory cytokines, causing inadequate nutrition, weight loss and muscle weakness during a negative cycle. Owing to its potential to modulate LGI in various diseases, the Mediterranean diet (Med Diet) has been extensively studied. This scoping review explores the nutritional implications and recommendations of the Med Diet as a treatment for immune-mediated diseases, focusing on the gaps in IIM nutritional interventions. A comprehensive literature search of the MEDLINE and EBSCO databases between September 2018 and December 2022 was performed. We identified that the Med Diet and its specific components, such as omega-3 (nω3) fatty acids, vitamin D and antioxidants, play a role in the dietary treatment of connective tissue-related autoimmune diseases. Nutritional interventions have demonstrated potential for modulating disease activity and warrant further exploration of IIMs through experimental studies. This review introduces a dietary therapeutic approach using the Med Diet and related compounds to regulate chronic inflammatory processes in IIMs. However, further clinical studies are required to evaluate the efficacy of the Med Diet in patients with IIMs. Emphasising a clinical-nutritional approach, this study encourages future research on the anti-inflammatory effects of the Med Diet on IIMs. This review highlights potential insights for managing and treating these conditions using a holistic approach.
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Affiliation(s)
- Abril I Sánchez-Rosales
- School of Public Health, Instituto Nacional de Salud Pública, Universidad No. 655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, Mexico
| | | | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Gabriela Quiroz-Olguín
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
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Poleur M, Markati T, Servais L. The use of digital outcome measures in clinical trials in rare neurological diseases: a systematic literature review. Orphanet J Rare Dis 2023; 18:224. [PMID: 37533072 PMCID: PMC10398976 DOI: 10.1186/s13023-023-02813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Developing drugs for rare diseases is challenging, and the precision and objectivity of outcome measures is critical to this process. In recent years, a number of technologies have increasingly been used for remote monitoring of patient health. We report a systematic literature review that aims to summarize the current state of progress with regard to the use of digital outcome measures for real-life motor function assessment of patients with rare neurological diseases. Our search of published literature identified 3826 records, of which 139 were included across 27 different diseases. This review shows that use of digital outcome measures for motor function outside a clinical setting is feasible and employed in a broad range of diseases, although we found few outcome measures that have been robustly validated and adopted as endpoints in clinical trials. Future research should focus on validation of devices, variables, and algorithms to allow for regulatory qualification and widespread adoption.
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Affiliation(s)
- Margaux Poleur
- Department of Neurology, Liege University Hospital Center, Liège, Belgium.
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium.
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium.
| | - Theodora Markati
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium
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Pugliese C, Delgado AF, Kozu KT, Campos LMDA, Aikawa NE, Silva CA, Maluf Elias A. Body Composition and Phase Angle: How to Improve Nutritional Evaluation in Juvenile Dermatomyositis Patients. Nutrients 2023; 15:3057. [PMID: 37447383 PMCID: PMC10347122 DOI: 10.3390/nu15133057] [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: 06/16/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: This study aimed to assess body composition (BC) using bioelectrical impedance and food intake in juvenile dermatomyositis (JDM) patients. Associations between BC and physical activity, disease activity/cumulative damage and health-related quality of life parameters were also evaluated; (2) Methods: This was a cross-sectional study with 30 consecutive JDM patients (18 female and 12 male) and 24 healthy volunteers (14 female and 10 male) of both sexes followed at our pediatric rheumatology unit. The gathering of anthropometric and dietary data, and the performance of physical activity and bioelectrical impedance were undertaken in face-to-face meetings and through questionnaires. Clinical and therapeutic data were collected from medical records according to information from routine medical appointments; (3) Results: The frequency of high/very high body fat was significantly higher in controls compared with JDM patients (66.7% vs. 91.7%; p = 0.046). The median phase angle was significantly lower in patients compared with controls (5.2 ± 1.3 vs. 6.1 ± 1.0; p = 0.016). Body fat and lean mass were positively correlated with disease duration (rs = +0.629, p < 0.001 and rs = +0.716, p < 0.001, respectively) and phase angle (PhA) (rs = +0.400, p = 0.029 and rs = +0.619, p < 0.001, respectively). JDM patients with PhA ≥ 5.5 presented higher lean mass when compared with patients with PhA < 5.5 (p = 0.001); (4) Conclusions: Bioelectrical impedance can be a useful auxiliary exam in the medical and nutritional follow-up of JDM patients, because it seems to impact functional ability. These findings may assist professionals when advising JDM patients about the importance of physical activity and healthy eating in the preservation of lean mass.
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Affiliation(s)
- Camila Pugliese
- Nutrition Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Artur Figueiredo Delgado
- Intensive Care Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Katia Tomie Kozu
- Rheumatology Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Lucia Maria de Arruda Campos
- Rheumatology Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Clovis Artur Silva
- Rheumatology Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
| | - Adriana Maluf Elias
- Rheumatology Unit, Children and Adolescent’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647-Cerqueira César, São Paulo 05403-000, SP, Brazil
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Weitzman ER, Gaultney A, von Scheven E, Ringold S, Mann CM, Magane KM, Lin L, Leverty R, Dennos A, Hernandez A, Lippmann SJ, Dedeoglu F, Marin AC, Cox R, Reeve BB, Schanberg LE. Construct validity of Patient-Reported Outcomes Measurement Information System Paediatric measures in juvenile idiopathic arthritis and systemic lupus erythematosus: cross-sectional evaluation. BMJ Open 2023; 13:e063675. [PMID: 36707118 PMCID: PMC9884859 DOI: 10.1136/bmjopen-2022-063675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Evaluate construct validity of Patient-Reported Outcomes Measurement Information System (PROMIS) Paediatric measures of symptoms and functioning against measures of disease activity among youth with juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). DESIGN Cross-sectional associations among PROMIS measures and clinical metrics of disease activity were estimated. SETTING Seven clinical sites of the Childhood Arthritis and Rheumatology Alliance (CARRA) in the USA. PARTICIPANTS Youth aged 8-17 years enrolled in the CARRA Registry. INTERVENTION PROMIS measures were collected and associations with clinical measures of disease activity estimated, by condition, in bivariate and multivariable analyses with adjustment for sociodemographics, insurance status, medications and disease duration. MAIN OUTCOME MEASURES PROMIS Paediatric measures of mobility, physical activity, fatigue, pain interference, family relationships, peer relationships, depressive symptoms, psychological stress, anxiety, and meaning and purpose, and clinical metrics of disease. RESULTS Among 451 youth (average age 13.8 years, 71% female), most (n=393, 87%) had a JIA diagnosis and the remainder (n=58, 13%) had SLE. Among participants with JIA, those with moderate/high compared with low/inactive disease had, on average, worse mobility (multivariable regression coefficient and 95% CIs) (-7.40; -9.30 to -5.50), fatigue (3.22; 1.02 to 5.42), pain interference (4.76; 3.04 to 6.48), peer relationships (-2.58; -4.52 to -1.64), depressive symptoms (3.00; 0.96 to 5.04), anxiety (2.48; 0.40 to 4.56) and psychological stress (2.52; 0.68 to 4.36). For SLE, youth with active versus inactive disease had on average worse mobility (-5.07; -10.15 to 0.01) but PROMIS Paediatric measures did not discriminate participants with active and inactive disease in adjusted analyses. CONCLUSIONS Seven PROMIS Paediatric measures discriminated between active and inactive disease in youth with JIA. Results advance the usefulness of PROMIS for understanding well-being and improving interventions for youth with JIA, but larger studies are needed to determine utility in SLE cohorts. TRIAL REGISTRATION NUMBER National Institute of Arthritis and Musculoskeletal and Skin Diseases (U19AR069522).
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy Gaultney
- Pediatric Rheumatology, Children's Hospital of Orange County, Orange, California, USA
| | - Emily von Scheven
- Pediatric Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Ringold
- Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Courtney M Mann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Li Lin
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Renee Leverty
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anne Dennos
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexy Hernandez
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven J Lippmann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Fatma Dedeoglu
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bryce B Reeve
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura E Schanberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Ramdharry GM, Anderson M. Exercise in myositis: What is important, the prescription or the person? Best Pract Res Clin Rheumatol 2022; 36:101772. [PMID: 35927155 DOI: 10.1016/j.berh.2022.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our aim for this narrative review was to undertake a search of studies into exercise for people living with Idiopathic Inflammatory myopathies (IIM). We explored the strength of existing evidence with a particular consideration for the implications for people living with IIM and what is important to them. The search strategy from the 2021 Cochrane Physical Activity review in neuromuscular disease was used, and we selected articles that included people with IIM, including Dermatomyositis (DM), Inclusion Body Myositis (IBM), Immune Mediated Necrotising Myopathy (IMNM) [also known as necrotizing autoimmune myopathy (NAM)], and Polymyositis (PM). 2967 records were screened and 16 were included in this review. Safety of exercise was demonstrated in nine articles, using a range of measures of disease activity, serum creatine kinase, indicators of inflammation, pain, or fatigue. Two studies that took muscle biopsies showed no evidence of increased inflammation. Aerobic exercise protocols were used in 8 studies across conditions and demonstrated improvements in cardiorespiratory fitness or exercise capacity. Six studies of strength training observed improvements in muscle function, with two studies reporting muscle biopsy results of amplified immune response and up regulation of genes related to recycling of damaged proteins. Nine of 13 studies that measures functional outcomes showed significant improvements, and evidence for behaviour change was observed in a study of a self-management intervention. The evidence of safety and effect of training is reassuring and welcome, and we now need to explore how we support people to incorporate exercise and physical activity longer term into active lifestyles.
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Affiliation(s)
- Gita M Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK; Department of Neuromuscular Diseases, UCL Institute of Neurology, London, UK.
| | - Martin Anderson
- Business Consultant and Director of Directed Evolution LTD and Directed Evolution, Resilience LTD, with 18 Years of Experience Managing Immune-Mediated Necrotising Myopathy (IMNM), UK
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Lui S, Hind T, Moon E, de Souza A, Broad K, Fairbairn J, Schreiber R, Armstrong K, Blydt-Hansen TD. Self-reported physical activity and lack of association with health-related quality of life in a pediatric solid-organ transplant population. Pediatr Transplant 2021; 25:e14093. [PMID: 34296505 DOI: 10.1111/petr.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/20/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity (PA) has been shown to have benefits, including improving health-related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its relationship with HRQOL in a pediatric solid-organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators. METHODS A retrospective cross-sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ-C/PAQ-A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected. RESULTS There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0-18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6-3.2), PedsQL total score was 77 (65-91), and PedsQL physical functioning score was 88 (72-97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031). CONCLUSION Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores.
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Affiliation(s)
- Samantha Lui
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tatsuma Hind
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Moon
- Psychology, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Astrid de Souza
- Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Katherine Broad
- Social Work, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Julie Fairbairn
- Physiotherapy, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Richard Schreiber
- Pediatric Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kathryn Armstrong
- Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Pediatric Nephrology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Abstract
Cardiovascular disease risk is evident during childhood for patients with juvenile systemic lupus erythematosus, juvenile dermatomyositis, and juvenile idiopathic arthritis. The American Heart Association defines cardiovascular health as a positive health construct reflecting the sum of protective factors against cardiovascular disease. Disease-related factors such as chronic inflammation and endothelial dysfunction increase cardiovascular disease risk directly and through bidirectional relationships with poor cardiovascular health factors. Pharmacologic and nonpharmacologic interventions to improve cardiovascular health and long-term cardiovascular outcomes in children with rheumatic disease are needed.
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Astley C, Sieczkowska SM, Marques IG, Ihara BP, Lindoso L, Lavorato SSM, Campos LMA, Pereira RMR, Elias AM, Aikawa NE, Kozu K, Iraha AY, Franco TC, Roschel H, Queiroz LB, Polanczyk GV, Silva CA, Gualano B. Home-based exercise program for adolescents with juvenile dermatomyositis quarantined during COVID-19 pandemic: a mixed methods study. Pediatr Rheumatol Online J 2021; 19:159. [PMID: 34774060 PMCID: PMC8590116 DOI: 10.1186/s12969-021-00646-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Exercise has been suggested to prevent deterioration of health-related quality of life (HRQL) and overall health in pediatric rheumatologic diseases during the COVID-19 pandemic. Herein we describe the effects of a 12-week, home-based, exercise program on overall health and quality of life among quarantined patients with juvenile dermatomyositis (JDM). METHOD This prospective, quasi-experimental, mixed methods (qualitative and quantitative) study was conducted between July and December 2020, during the most restricted period of COVID-19 pandemic in Brazil. The home-based exercise program consisted of a 12-week, three-times-a-week, aerobic and strengthening (bodyweight) training program. Qualitative data were systematically evaluated. Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory (PedsQOL) and Pittsburgh Sleep Quality Index (PSQI) evaluate symptoms of mental health disorder, HRQL, and quality of sleep. FINDINGS 11 patients (out of 27) met the inclusion criteria (91% female; mean ± SD age: 13.5 ± 3.2 years). Adherence to the intervention was 72.6%. Barriers to exercise involved poor internet connectivity, excessive weekly sessions, and other commitments. Even though not statistically significant, Self-report SDQ subscales Total Difficulties Score, Emotional Problems Score, and PedsQOL School Functioning Score improved after intervention (- 2.4; 95%confidence interval [CI] -5.1; 0.2, p = 0.06; - 1.0; 95%CI -2.2; 0.2, p = 0.09 and; 11.7; 95%CI -2.5; 25.8, p = 0.09, respectively). Remaining SDQ subscales were not altered. Six themes emerged from patients' and parents' comments (qualitative results). Patients engaged in exercise reported other health-related benefits including increased motivation, concentration and strength. INTERPRETATION A home-based exercise program was associated with qualitative perceptions of improvements in overall health and HRQL by quarantined adolescents with JDM during COVID-19 pandemic. Lessons from this trial may help developing interventions focused on tackling physical inactivity in JDM.
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Affiliation(s)
- Camilla Astley
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Isabela Gouveia Marques
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Bianca Pires Ihara
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Livia Lindoso
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Sofia Simão Martins Lavorato
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Adriana Maluf Elias
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Katia Kozu
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Amanda Yuri Iraha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Tathiane Christine Franco
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
| | - Ligia Bruni Queiroz
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | | | - Clovis Artur Silva
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil.
- Food Research Center, Universidade de São Paulo, São Paulo, Brazil.
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Tarakcı E, Kısa EP, Arman N, Albayrak A. Physical activity and exercise in patients with pediatric rheumatic disease: A systematic search and review. Turk Arch Pediatr 2021; 56:179-186. [PMID: 34104906 DOI: 10.5152/turkarchpediatr.2021.21034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 01/20/2023]
Abstract
Childhood rheumatic diseases are a group of diseases that can affect many organs and systems, resulting in pain, joint stiffness, muscle atrophy and weakness. Physical inactivity has been reported in many childhood rheumatic diseases. There are many studies in the literature comparing the effectiveness of exercise programs in children with juvenile idiopathic arthritis. Exercise and physical activity are considered major parts of the treatment of children with rheumatic disease. The aim of this review is to systematically present studies on physical activity and exercise programs in children with rheumatism from the last 5 years. An internet-based search of three databases-PubMed, PEDro and Medline- was conducted to find relevant studies. Two reviewers individually identified studies on the basis of their title, abstract or full text-as necessary-to determine their eligibility. Differences of opinion between the two examiners were resolved by discussion. Scientific studies of children with different rheumatic diagnoses have shown that physical activity and exercise have a significant effect on reducing the symptoms of the disease. However, the duration, frequency, method and evaluation of the exercises are still being discussed in the literature.
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Affiliation(s)
- Ela Tarakcı
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Eylül Pınar Kısa
- Division of Physiotherapy and Rehabilitation, Biruni University, Faculty of Health Science, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nilay Arman
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Asya Albayrak
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
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11
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Astley C, Gil S, Clemente G, Terreri MT, Silva CA, Campos LMA, Aikawa NE, de Sá Pinto AL, Pereira RMR, Roschel H, Gualano B. Poor physical activity levels and cardiorespiratory fitness among patients with childhood-onset takayasu arteritis in remission: a cross-sectional, multicenter study. Pediatr Rheumatol Online J 2021; 19:39. [PMID: 33752674 PMCID: PMC7986021 DOI: 10.1186/s12969-021-00519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/04/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It is currently unknown whether patients with childhood-onset Takayasu disease (c-TA) are prone to physical inactivity and poor aerobic capacity. In this study, we assessed physical activity levels and cardiorespiratory fitness along with health-related quality of life (HRQL) and various traditional and non-traditional risk factors in patients with c-TA vs. healthy controls. METHODS c-TA patients with non-active disease (n = 17) and age- and sex-matched healthy controls (n = 17) were enrolled in the study. We assessed physical activity levels, aerobic capacity, body composition, systemic inflammation, cardiometabolic markers, disease-related parameters, and HRQL. RESULTS c-TA patients showed greater time spent in sedentary behavior (P = 0.010), and lower moderate-to-vigorous physical activity (P > 0.001) and lower step counts per day (P > 0.001). VO2peak (P < 0.001) and chronotropic response (P = 0.016) were significantly lower in patients with c-TA and they had worse HRQL in physical domain (P < 0.001), lower bone mineral content and density, and higher insulin levels vs. healthy controls (all P ≤ 0.05). CONCLUSIONS c-TA patients exhibited reduced physical activity levels and aerobic capacity, worse cardiometabolic risk factors and HRQL parameter compared with healthy peers. Physical inactivity and aerobic deconditioning emerge as potentially novel risk factors for c-TA. The role of physical activity interventions in preventing poor outcomes and improving HRQL in c-TA remains to be explored.
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Affiliation(s)
- Camilla Astley
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Saulo Gil
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
| | - Gleice Clemente
- Division of Paediatric Rheumatology, Department of Paediatrics, Federal University of Sao Paulo, SP, Sao Paulo, Brazil
| | - Maria Teresa Terreri
- Division of Paediatric Rheumatology, Department of Paediatrics, Federal University of Sao Paulo, SP, Sao Paulo, Brazil
| | - Clovis Artur Silva
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucia Maria Arruda Campos
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nadia Emi Aikawa
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lúcia de Sá Pinto
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa Maria R Pereira
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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12
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Rockette-Wagner B, Saygin D, Moghadam-Kia S, Oddis C, Landon-Cardinal O, Allenbach Y, Dzanko S, Koontz D, Neiman N, Aggarwal R. Reliability, Validity and Responsiveness of Physical Activity Monitors in Patients with Inflammatory Myopathy. Rheumatology (Oxford) 2021; 60:5713-5723. [PMID: 33714992 DOI: 10.1093/rheumatology/keab236] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/23/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIM) cause proximal muscle weakness, which affect activities of daily living. Wearable physical activity monitors (PAMs) objectively assess continuous activity with potential clinical usefulness in IIM assessment. We examined the psychometric characteristics for PAM outcomes in IIM. METHODS Adult IIM patients were prospectively evaluated (baseline, 3 and 6-months) in an observational study. A waist-worn PAM (ActiGraph GT3X-BT) assessed average step counts/min, peak 1-min cadence, and vector magnitude/min. Validated myositis core set measures (CSM) including manual muscle testing (MMT), physician global disease activity (MD global), patient global disease activity (Pt global), extra-muscular disease activity (Ex-muscular global), HAQ-DI, muscle enzymes, and patient-reported physical function were evaluated. Test-retest reliability, construct validity, and responsiveness were determined for PAM measures and CSM using Pearson correlations and other appropriate analyses. RESULTS 50 adult IIM patients enrolled [mean (SD) age, 53.6 (±14.6); 60% female, 94% Caucasian]. PAM measures showed strong test-retest reliability, moderate-to-strong correlations at baseline with MD global (r=-0.37- -0.48), Pt-global (r=-0.43- -0.61), HAQ-DI (r=-0.47- -0.59) and MMT (r = 0.37-0.52), and strong discriminant validity for categorical MMT and HAQ-DI. Longitudinal association with MD global (r=-0.38- -0.44), MMT (r = 0.50-0.57), HAQ-DI (r=-0.45- -0.55), and functional tests (r = 0.30-0.65) were moderate-to-strong. PAM measures were responsive to MMT improvement (≥10%) and moderate-to-major improvement on ACR/EULAR myositis response criteria. Peak 1-min cadence had the largest effect size and Standardized Response Means (SRMs). CONCLUSION PAM measures showed promising construct validity, reliability, and longitudinal responsiveness; especially peak 1-min cadence. PAMs provide valid outcome measures for future use in IIM clinical trials.
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Affiliation(s)
- Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Didem Saygin
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chester Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Océane Landon-Cardinal
- Department of Internal Medicine and Clinical Immunology and Inflammation-Immunopathology-Biotherapy Department (I2B), Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, East Paris Neuromuscular Diseases Reference Center, Inserm U974, Sorbonne Université, Paris 6, Paris, France.,Department of Medicine, University of Montreal; Division of Rheumatology and Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology and Inflammation-Immunopathology-Biotherapy Department (I2B), Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, East Paris Neuromuscular Diseases Reference Center, Inserm U974, Sorbonne Université, Paris 6, Paris, France.,Institute of Myology, Neuromuscular Investigation Center, Pitié-Salpêtrière University Hospital, Paris, France
| | - Sedin Dzanko
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicole Neiman
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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13
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Astley C, Pinto AJ, Bonfá E, da Silva CAA, Gualano B. Gaps on rheumatologists' knowledge of physical activity. Clin Rheumatol 2021; 40:2907-2911. [PMID: 33438081 DOI: 10.1007/s10067-020-05540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
To assess the rheumatologists' knowledge and willingness to prescribe physical activity, we conducted a nationwide survey. All adult and paediatric rheumatologist members of the Brazilian Rheumatology Society were invited to fulfil a questionnaire on their knowledge and willingness to promote physical activity. Four hundred twenty-eight rheumatologists participated in the survey, representing approximately 25% of the society's members. Forty-five percent of the rheumatologists reported having had training to prescribe physical activity, and 68% believe that physical activity is a part of patients' treatment. Most reported assessing physical activity levels (86%) and recommending physical activity (98%) always or most of the time. However, 48% do not know the minimum physical activity recommendations for health maintenance, nor do they know how much vigorous activity should be done in replacement of moderate activity. In addition, only 20% are aware of physical activity recommendation for paediatric patients, whereas 31% know that very light-intensity physical activity promotes health-related beneficial effects. Year of graduation, having been trained on physical activity prescription, and regularly recommending physical activity to patients did not associate with the overall score of correct answers (OR: 1.00 [0.99, 1.02], p = 0.391; OR: 0.99 [0.69, 1.44], p = 983; OR: 0.90 [0.61, 1.32], p = 0.576; respectively). Rheumatologists are highly willing to promote physical activity, but major gaps in their knowledge were identified. Given the widespread recognition of physical activity as a key element on the management of rheumatic patients, these data hint to the need of incorporating physical activity in the rheumatologist' training. Key Points • This survey showed that rheumatologists are highly prone to promote physical activity. • However, rheumatologists have major gaps in knowledge of physical activity. • Adding physical activity to rheumatologist's training programs is key to improve physical activity promotion.
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Affiliation(s)
- Camilla Astley
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, Sao Paulo, SP, 01246-903, Brazil
| | - Ana Jessica Pinto
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, Sao Paulo, SP, 01246-903, Brazil
| | - Eloisa Bonfá
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis Artur Almeida da Silva
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, Sao Paulo, SP, 01246-903, Brazil. .,Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. .,Food Research Center, University of Sao Paulo, Sao Paulo, SP, Brazil.
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14
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Berntsen KS, Raastad T, Marstein H, Kirkhus E, Merckoll E, Cumming KT, Flatø B, Sjaastad I, Sanner H. Functional and Structural Adaptations of Skeletal Muscle in Long-Term Juvenile Dermatomyositis: A Controlled Cross-Sectional Study. Arthritis Rheumatol 2019; 72:837-848. [PMID: 31746550 DOI: 10.1002/art.41174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/19/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare muscle strength and endurance of the knee extensors between patients with long-term juvenile dermatomyositis (DM) and controls and between patients with active disease and those with inactive disease, and to explore associations between strength/endurance and 1) clinical parameters, 2) physical activity, and 3) humoral/structural adaptation in the skeletal muscle of patients. METHODS In a cross-sectional study (44 patients and 44 age- and sex-matched controls), we tested isometric muscle strength (peak torque, in Nm) and dynamic muscle endurance (total work, in Joules) of the knee extensors, physical activity (measured by accelerometer), and serum myokine levels (by enzyme-linked immunosorbent assay). Patients were examined with validated tools (clinical muscle tests and measures of disease activity/damage and inactive disease) and using magnetic resonance imaging of the thigh muscles, which included evaluation of the quadriceps cross-sectional area (CSA). Needle biopsy samples of the vastus lateralis muscle (obtained from 12 patients ages ≥18 years) were assessed by histochemistry. RESULTS After a mean ± SD disease duration of 21.8 ± 11.8 years, peak torque was lower in patients with juvenile DM compared to controls (mean difference 29 Nm, 95% confidence interval 13-46; P = 0.001). Similarly, total work of the knee extensors was lower in patients compared to controls (median 738J [interquartile range 565-1,155] versus 1,249J [interquartile range 815-1,665]; P < 0.001). Both peak torque and total work were lower in patients with active juvenile DM compared to those with inactive disease (both P < 0.019); in analyses controlled for quadriceps CSA, only total work remained lower in patients with active disease. Moreover, peak torque and total work correlated with findings from clinical muscle tests in patients with active disease (r = 0.57-0.84). Muscle biopsy results indicated that the fiber type composition was different, but capillary density was similar, between patients with active disease and those with inactive disease. CONCLUSION In patients with long-term juvenile DM, both muscle strength and endurance of the knee extensors were lower when compared to matched controls, and also lower in patients with active disease compared to those with inactive disease. Our results indicate a need for more sensitive muscle tests in this clinical setting. We hypothesize that impaired muscle endurance in patients with active juvenile DM may be influenced by structural/functional adaptations of muscle tissue independent of muscle size.
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Affiliation(s)
| | | | | | - Eva Kirkhus
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Else Merckoll
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Berit Flatø
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Helga Sanner
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Rikshospitalet, and Bjørknes University College, Oslo, Norway
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15
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Oldroyd A, Little MA, Dixon W, Chinoy H. A review of accelerometer-derived physical activity in the idiopathic inflammatory myopathies. BMC Rheumatol 2019; 3:41. [PMID: 31660533 PMCID: PMC6805320 DOI: 10.1186/s41927-019-0088-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background The idiopathic inflammatory myopathies (IIMs) are a group of rare conditions characterised by muscle inflammation (myositis). Accurate disease activity assessment is vital in both clinical and research settings, however, current available methods lack ability to quantify associated variation of physical activity, an important consequence of myositis. This study aims to review studies that have collected accelerometer-derived physical activity data in IIM populations, and to investigate if these studies identified associations between physical and myositis disease activity. Methods A narrative review was conducted to identify original articles that have collected accelerometer-derived physical activity data in IIM populations. The following databases were searched from February 2000 until February 2019: Medline via PubMed, Embase via OVID and Scopus. Results Of the 297 publications screened, eight studies describing accelerometer use in 181 IIM cases were identified. Seven out of the eight studies investigated juvenile dermatomyositis (JDM) populations and only one reported on an adult-onset population. Population sizes, disease duration, accelerometer devices used, body placement sites, and study duration varied between each study. Accelerometer-derived physical activity levels were reduced in IIM cohorts, compared to healthy controls, and studies reported improvement of physical activity levels following exercise programme interventions, thus demonstrating efficacy. Higher levels of accelerometer-derived physical activity measurements were associated with shorter JDM disease duration, current glucocorticoid use and lower serum creatine kinase. However, no clear association between muscle strength and accelerometer-derived physical activity measures was identified. Conclusions The use of accelerometer-derived physical activity in IIM research is in its infancy. Whilst knowledge is currently limited to small studies, the opportunities are promising and future research in this area has the potential to improve disease activity assessment for clinical and research applications.
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Affiliation(s)
- Alexander Oldroyd
- 1Centre for Epidemiology Versus Arthritis, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT UK.,2NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,3Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,4Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Max A Little
- 5School of Computer Science, University of Birmingham, Birmingham, UK.,6MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA USA
| | - William Dixon
- 1Centre for Epidemiology Versus Arthritis, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT UK.,2NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,3Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,4Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hector Chinoy
- 1Centre for Epidemiology Versus Arthritis, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT UK.,2NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,3Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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16
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Berntsen KS, Edvardsen E, Hansen BH, Flatø B, Sjaastad I, Sanner H. Cardiorespiratory fitness in long-term juvenile dermatomyositis: a controlled, cross-sectional study of active/inactive disease. Rheumatology (Oxford) 2019; 58:492-501. [PMID: 30508195 DOI: 10.1093/rheumatology/key342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare cardiorespiratory fitness (CRF) expressed as maximal oxygen uptake (VO2max) between patients with long-term JDM and controls and between patients with active and inactive disease, as well as to explore exercise limiting factors and associations between CRF and disease variables. METHODS JDM patients (n = 45) and age- and gender-matched controls (n = 45) performed a cardiopulmonary exercise test (CPET) on a treadmill until exhaustion. Physical activity was measured by accelerometers. Disease activity, damage and muscle strength/function were assessed by validated tools. Clinically inactive disease was defined according to PRINTO criteria. RESULTS The mean disease duration was 20.8 (s.d. 11.9) years and 29/45 (64%) patients had inactive disease. A low VO2max was found in 27% of patients vs 4% of controls (P = 0.006). The mean VO2max and maximal ventilation (VEmax) were lower in patients with active and inactive disease compared with controls. Patients with active disease also had lower maximal voluntary ventilation (MVV) compared with controls and lower VEmax and MVV compared with those with inactive disease. Patients with inactive disease had lower physical activity levels compared with controls. VO2max correlated negatively with disease damage in patients with inactive disease and positively with muscle strength/function in patients with active disease. CONCLUSION CRF was lower in JDM patients, both with active and inactive disease, compared with controls after a mean 20 years disease duration. Cardiopulmonary exercise test results suggested different limiting factors contributing to the reduced CRF according to disease activity, including deconditioning in inactive disease and reduced ventilatory capacity in active disease. Further research is needed to verify this.
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Affiliation(s)
| | - Elisabeth Edvardsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Ullevål, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Norway
| | - Bjørge Herman Hansen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Ullevål, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Rikshospitalet, Norway
- Bjørknes University College, Oslo, Norway
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17
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Physical activity for paediatric rheumatic diseases: standing up against old paradigms. Nat Rev Rheumatol 2017; 13:368-379. [DOI: 10.1038/nrrheum.2017.75] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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