Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial

Current state of research on exercise for the treatment of myasthenia gravis: A scoping review

OBJECTIVE

To provide a comprehensive overview of existing evidence, research gaps, and future research priorities concerning the treatment of myasthenia gravis (MG) using exercise therapies.

METHOD

Clinical studies on exercise treatment for MG were searched in nine databases to conduct a scoping review. Two independent researchers screened the literature and comprehensively analyzed the characteristics and limitations of the included articles.

RESULTS

A total of 5725 studies were retrieved, of which 24 were included. The included studies were conducted in 16 different countries/regions and 456 patients were enrolled. Study designs included both interventional and observational studies. Exercise interventions included aerobic exercise, resistance exercise, balance training, and stretch training, and are typically administered in conjunction with medication, usual care, or some other interventions. The intensity, frequency, and duration of exercise interventions varied hugely among studies. Six-minute walk test, adverse events, muscle strength, MG quality of life-15 scale, forced vital capacity, quantitative MG scale, and MG activities of daily living scale were the most frequently used outcomes. All studies reported results in favor of the efficacy and safety of exercise in MG, and exercise-related adverse events were reported in two studies.

CONCLUSION

This scoping review provides an overview of the evidence concerning exercise treatment for MG. Key gaps in evidence include a limited number of participants, complex interventions, variability in outcome selection, and insufficient reporting in publications. The promotion of exercise treatment for MG still encounters several obstacles. A larger population, rigorous study design and conduction, standardized interventions and outcomes, and standardized reporting are essential.

Effect of Exercise on β-Endorphin and Its Receptors in Myasthenia Gravis Patients

This is a prospective observational study evaluating the change in β-endorphin (BE) and its receptors following exercise in patients with myasthenia gravis (MG) and their association with clinical improvement. Fifteen patients with mild to moderate MG, aged 16-70 years, who were able to do 6-Minute Walk Test (6-MWT) and had MG Quality of Life-15 (MGQoL-15) ≤ 45 without any contraindication for exercise were included. The patients walked 30 min daily for 3 months. The primary outcome at 3 months was > 50% improvement in MGQoL-15 from the baseline, and the secondary outcomes were MG Activities of Daily Living (MGADL), Hospital Anxiety and Depression Scale (HADS), number of steps, and distance covered on 6-MWT and adverse events. Plasma BE level, μ-opioid receptor (MOR), and δ-opioid receptor (DOR) were measured on admission and at 1 and 3 months. Twelve age- and gender-matched healthy controls who were not on regular exercise were included for comparison of BE, MOR, and DOR levels. Plasma BE level (P = 0.007) and DOR expression (P = 0.001) were lower in MG patients compared to the healthy controls. After 3 months of exercise, 6 patients improved. Plasma BE, MOR, and DOR levels increased in the first and decreased in the third month. MGQoL-15 (P < 0.001), HADS (P < 0.0001), number of steps (P < 0.007), distance (P = 0.030), and MGADL (P < 0.001) significantly improved compared to baseline. At 3 months, MGQoL-15 was associated with HADS score (P = 0.001), reduced depression (P = 0.013), MGADL (P = 0.035), and distance travelled on the 6-WMW test (P = 0.050). The improvement in depression was associated with higher BE level.

Physical Activity and Sedentary Behaviour in People with Myasthenia Gravis: A Cross-Sectional Study

BACKGROUND

Despite improvements in the medical management of myasthenia gravis (MG) in recent years, patients continue to report poor health and wellbeing outcomes such as high levels of fatigue, reduced quality of life (QoL), walking limitation and lowered balance confidence. Physical activity has been shown to be associated with these outcomes in other populations, however, there has been limited research in adults with MG.

OBJECTIVE

To describe physical activity and sedentary behaviour in adults with MG and to explore associations between these behaviours and fatigue, QoL, balance confidence and walking limitation.

METHODS

A self-report online survey was used to assess physical activity, sedentary behaviour, fatigue, QoL, balance confidence and walking limitation in adults with MG. Multiple linear regression was used to examine associations and descriptive statistics were used to analyse participant characteristics, physical activity, and sedentary behaviour.

RESULTS

Eighty-five adults with MG were included (mean age 48±16 years). Over half of participants (n = 53, 62.4%) reported sufficient physical activity to meet public health guidelines. Participants reported an average of 9 h/day of sedentary time (mean 9.0±3.5). Physical activity and fatigue (R2 = 0.196), QoL (R2 = 0.330), walking limitation (R2 = 0.305) and balance confidence (R2 = 0.304) were significantly (p <  0.05) and positively correlated, with no associations found for sedentary behaviour. When patterns of physical activity and sedentary behaviour were combined, lower fatigue (R2 = 0.213), higher QoL (R2 = 0.364), reduced walking limitation (R2 = 0.341) and higher balance confidence (R2 = 0.279) was observed in patients who had greater physical activity levels (>  150 mins/week) and lower sedentary time (<  10 h/day).

CONCLUSIONS

Higher physical activity and lower sedentary behaviour is associated with favorable health and wellbeing outcomes in adults with MG. Further research is required to ascertain whether these behaviours may be an appropriate target intervention to improve outcomes in this population.