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Lodin K, Espinosa-Ortega F, Lundberg IE, Alexanderson H. The Role of Exercise to Improve Physiological, Physical and Psychological Health Outcome in Idiopathic Inflammatory Myopathies (IIM). J Inflamm Res 2024; 17:3563-3585. [PMID: 38855165 PMCID: PMC11162627 DOI: 10.2147/jir.s377102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/14/2024] [Indexed: 06/11/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIM) impact all aspects of health, physiological, physical, and psychological. Hallmark symptoms of IIM are muscle weakness, reduced muscle endurance and aerobic capacity. Recently, pain and fatigue as well as anxiety and depression have emerged as common and debilitating symptoms in patients with IIM. The aim of this scoping review is to, in a holistic way, describe how IIM impact patients' physiological, physical, and psychological health and how exercise has a role to treat as well as potentially counteract the effects of the disease. Inflammation induces non-immune response and organ damage. These changes with additional impact of physical inactivity lead to muscle impairment and reduced aerobic capacity. Pain, fatigue and low psychological well-being and overall quality of life are also common health aspects of IIM. Medical treatment can reduce inflammation but has in turn serious side effects such as muscle atrophy, type-II diabetes, and hypertension, which exercise has the potential to treat, and perhaps also counteract. In addition, exercise improves muscle function, aerobic capacity and might also reduce fatigue and pain. New evidence shows that reducing systemic inflammation may also improve patient-reported subjective health, quality of life and psychological well-being. Exercise in combination with medical treatment is becoming an important part of the treatment for patients with IIM as exercise has the potential to promote health aspects of various dimensions in patients with IIM.
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Affiliation(s)
- Karin Lodin
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Fabricio Espinosa-Ortega
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Alexanderson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Allied Health Professionals, Theme Women’s Health and Health Professionals, Karolinska University Hospital, Stockholm, Sweden
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Zhou K, Shang Z, Yuan C, Guo Z, Wang Y, Bao D, Zhou J. Can molecular hydrogen supplementation enhance physical performance in healthy adults? A systematic review and meta-analysis. Front Nutr 2024; 11:1387657. [PMID: 38903627 PMCID: PMC11188335 DOI: 10.3389/fnut.2024.1387657] [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: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background Physical exertion during exercise often leads to increased oxidative stress and inflammatory responses, significantly affecting physical performance. Current strategies to mitigate these effects are limited by their effectiveness and potential side effects. Molecular hydrogen (H₂) has gained attention for its antioxidant and anti-inflammatory properties. Studies have suggested that H2 supplementation contributes to antioxidant potential and anti-fatigue during exercise, but the variance in the observations and study protocols is presented across those studies. Objective This systematic review and meta-analysis aimed to comprehensively characterize the effects of H₂ supplementation on physical performance (i.e., endurance, muscular strength, and explosive power), providing knowledge that can inform strategies using H2 for enhancing physical performance. Methods We conducted a literature search of six databases (PubMed, Web of Science, Medline, Sport-Discus, Embase, and PsycINFO) according to the PRISMA guidelines. The data were extracted from the included studies and converted into the standardized mean difference (SMD). After that, we performed random-effects meta-analyses and used the I 2 statistic to evaluate heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of the evidence obtained from this meta-analysis. Results In total, 27 publications consisting of 597 participants were included. The search finally included aerobic endurance, anaerobic endurance, muscular strength, lower limb explosive power, rating of perceived exertion (RPE), blood lactate (BLA), and average heart rate (HRavg) in the effect size (ES) synthesis. The ES of H2 on aerobic endurance, including V̇O2max (SMD = 0.09, p = 0.394; I 2 = 0%) and aerobic endurance exercise (SMD = 0.04, p = 0.687; I 2 = 0%), were not significant and trivial; the ES of H2 on 30 s maximal anaerobic endurance (SMD = 0.19, p = 0.239; I 2 = 0%) was not significant and trivial; the ES of H2 on muscular strength (SMD = 0.19, p = 0.265; I 2 = 0%) was not significant and trivial; but the ES of H2 on lower limb explosive power (SMD = 0.30, p = 0.018; I 2 = 0%) was significant and small. In addition, H2 reduces RPE (SMD = -0.37, p = 0.009; I 2 = 58.0%) and BLA (SMD = -0.37, p = 0.001; I 2 = 22.0%) during exercise, but not HRavg (SMD = -0.27, p = 0.094; I 2 = 0%). Conclusion These findings suggest that H2 supplementation is favorable in healthy adults to improve lower limb explosive power, alleviate fatigue, and boost BLA clearance, but may not be effectively improving aerobic and anaerobic endurance and muscular strength. Future studies with more rigorous designs are thus needed to examine and confirm the effects of H2 on these important functionalities in humans. Systematic review registration http://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Kaixiang Zhou
- College of Physical Education and Health Science, Chongqing Normal University, Chongqing, China
| | - Zhangyuting Shang
- College of Physical Education and Health Management, Chongqing University of Education, Chongqing, China
| | - Chaoqun Yuan
- College of Sports and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenxiang Guo
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Yubo Wang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Bottoni G, Crisafulli O, Pisegna C, Serra M, Brambilla S, Feletti F, Cremonte G, D’Antona G. An 8-month adapted motor activity program in a young CMT1A male patient. Front Physiol 2024; 15:1347319. [PMID: 38645694 PMCID: PMC11026674 DOI: 10.3389/fphys.2024.1347319] [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: 11/30/2023] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
Background It is unclear whether prolonged periods of training can be well tolerated. In Charcot-Marie Tooth disease (CMT). We report the effects of an 8-month, adapted motor activity (AMA) program in a 16-years-old CMT1A male patient. The program included strength, mobility, and balance training (two sessions per week, 1 h per session). Measures Walking ability and walking velocity (Six-Minute Walking Test-6MWT, Ten Meters Walking Test-10 mW T), balance (Y-Balance Test-YBT, Berg Balance Scale-BBS), functional mobility (Short Physical Performance Battery-Short physical performance battery), fatigue (Checklist Individual strength questionnaire - CIS20R), health and quality of life (Short Form Health Survey 36 questionnaire-SF-36) were evaluated in three moments: before (T0), after 5 (T1) and 8 (T2) months of adapted motor activity. Dorsal and plantar foot flexion strength (Maximal Voluntary Contraction-maximum voluntary contraction) and neuromuscular functions (Electromyography-sEMG, interpolated twitch technique-ITT) were measured at T1 and T2. Results Relative to T0, an amelioration of walking ability (6MWT, +9,3%) and balance (with improvements on Y-balance composite normalized mean reach of the right and left limb of 15,3% and 8,5%, respectively) was appreciable. Relative to T1, an increase in foot strength in three out of four movements (right plantar flexion, +39,3%, left plantar flexion, +22,7%, left dorsal flexion, 11,5%) was observed. Concerning voluntary muscle activation, a greater recruitment in the left, unlike right, medial gastrocnemius was observed. Conclusion Results suggest the safety of an 8-month AMA program in a young patient affected by CMT1A.
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Affiliation(s)
- Giorgio Bottoni
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
| | - Oscar Crisafulli
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
| | - Caterina Pisegna
- Neurology Operative Unit, Civilian Hospital of Voghera, Voghera, Italy
| | - Marco Serra
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
| | - Sara Brambilla
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
| | - Fausto Feletti
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Cremonte
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
| | - Giuseppe D’Antona
- CRIAMS Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy
- Department of Public Health Experimental and Forensic Medicine, University of Pavia, Voghera, Italy
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Guglielmi V, Cheli M, Tonin P, Vattemi G. Sporadic Inclusion Body Myositis at the Crossroads between Muscle Degeneration, Inflammation, and Aging. Int J Mol Sci 2024; 25:2742. [PMID: 38473988 DOI: 10.3390/ijms25052742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Sporadic inclusion body myositis (sIBM) is the most common muscle disease of older people and is clinically characterized by slowly progressive asymmetrical muscle weakness, predominantly affecting the quadriceps, deep finger flexors, and foot extensors. At present, there are no enduring treatments for this relentless disease that eventually leads to severe disability and wheelchair dependency. Although sIBM is considered a rare muscle disorder, its prevalence is certainly higher as the disease is often undiagnosed or misdiagnosed. The histopathological phenotype of sIBM muscle biopsy includes muscle fiber degeneration and endomysial lymphocytic infiltrates that mainly consist of cytotoxic CD8+ T cells surrounding nonnecrotic muscle fibers expressing MHCI. Muscle fiber degeneration is characterized by vacuolization and the accumulation of congophilic misfolded multi-protein aggregates, mainly in their non-vacuolated cytoplasm. Many players have been identified in sIBM pathogenesis, including environmental factors, autoimmunity, abnormalities of protein transcription and processing, the accumulation of several toxic proteins, the impairment of autophagy and the ubiquitin-proteasome system, oxidative and nitrative stress, endoplasmic reticulum stress, myonuclear degeneration, and mitochondrial dysfunction. Aging has also been proposed as a contributor to the disease. However, the interplay between these processes and the primary event that leads to the coexistence of autoimmune and degenerative changes is still under debate. Here, we outline our current understanding of disease pathogenesis, focusing on degenerative mechanisms, and discuss the possible involvement of aging.
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Affiliation(s)
- Valeria Guglielmi
- Cellular and Molecular Biology of Cancer Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
- Immunity and Pathogenesis Program, Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Marta Cheli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Paola Tonin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Gaetano Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Ferraro F, Calafiore D, Curci C, Fortunato F, Carantini I, Genovese F, Lucchini G, Merlo A, Ammendolia A, de Sire A. Effects of intensive rehabilitation on functioning in patients with mild and moderate Charcot-Marie-Tooth disease: a real-practice retrospective study. Neurol Sci 2024; 45:289-297. [PMID: 37552411 PMCID: PMC10761523 DOI: 10.1007/s10072-023-06998-0] [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: 01/20/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Charcot-Marie-Tooth (CMT) disease is one of the most common inherited neuropathies and can lead to progressive muscular weakness, pes cavus, loss of deep tendon reflexes, distal sensory loss, and gait impairment. There are still no effective drugs or surgical therapies for CMT, and supportive treatment is limited to rehabilitative therapy and surgical treatment of skeletal deformities. Many rehabilitative therapeutic approaches have been proposed, but timing and cadence of rehabilitative intervention are not clearly defined, and long-term follow-up is lacking in literature. The aim of this real-practice retrospective study was to assess the effectiveness of an intensive neurorehabilitation protocol on muscle strength and functioning in CMT patients. We analyzed data of patients with diagnosis of mild to moderate CMT. The rehabilitation program lasted 2-4 h a day, 5 days a week, for 3 weeks and consisted of manual treatments, strengthening exercises, stretching, core stability, balance and resistance training, aerobic exercises, and tailored self-care training. Data were collected at baseline (T0), after treatment (T1), and at the 12-month mark (T2) in terms of the following outcome measures: muscle strength, pain, fatigue, cramps, balance, walking speed, and ability. We included 37 CMT patients with a median age of 50.72 ± 13.31 years, with different forms: demyelinating (n = 28), axonal (n = 8), and mixed (n = 1). After intensive rehabilitation treatment, all outcomes significantly improved. This improvement was lost at the 1-year mark. Taken together, these findings suggest that an intensive rehabilitation program improves short-term symptoms and functional outcomes in a cohort of inpatients affected by mild to moderate CMT.
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Affiliation(s)
- Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100, Catanzaro, Italy
| | - Irene Carantini
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
- ACMT-Rete per la malattia di Charcot-Marie-Tooth OdV Association, Rome, Italy
| | - Filippo Genovese
- ACMT-Rete per la malattia di Charcot-Marie-Tooth OdV Association, Rome, Italy
| | | | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio, Reggio Emilia, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University Hospital "Mater Domini", University of Catanzaro Magna Graecia, Via Campanella, 115-88100, Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University Hospital "Mater Domini", University of Catanzaro Magna Graecia, Via Campanella, 115-88100, Catanzaro, Italy.
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Roy D. Editorial on "Pain in individuals with idiopathic inflammatory myopathies, other systemic autoimmune rheumatic diseases, and without rheumatic diseases: A report from the COVAD study". Int J Rheum Dis 2023; 26:1904-1907. [PMID: 37807616 DOI: 10.1111/1756-185x.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Debaditya Roy
- Department of Clinical Immunology and Rheumatology, Institute of Postgraduate Medical Education & Research (IPGMER), Kolkata, India
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Coraci D, Romano M, Ragazzo L, Restivo DA, Cipriani M, Gottardello F, Pizzolato M, Maccarone MC, Masiero S. Rehabilitation of Peripheral Neuropathies: From Lexical Analysis of the Literature to Identification of Clinical Protocols. J Clin Med 2023; 12:5879. [PMID: 37762819 PMCID: PMC10531665 DOI: 10.3390/jcm12185879] [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: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Peripheral nervous system diseases are a complex and heterogenous group of diseases affecting the different nerves with various severity and impact on quality of life. The current literature does not provide a structured guide for the rehabilitation of these conditions. We performed a lexical literature evaluation based on graph theory to clarify this topic. We performed a search on PubMed and calculated the frequencies of the words indicating rehabilitation approaches, nerves, and diseases. We found the usefulness of exercises and different physical agents, like laser and ultrasound therapy and neuromuscular stimulation vibration therapy. Orthoses are useful for entrapment, trauma, and hereditary diseases. Correct knowledge and assessment of the neuropathies are fundamental for the therapeutic decision and to guide rehabilitation. Despite the usefulness shown by the different approaches to modulating pain, improving muscle strength and endurance, and ameliorating balance and the sensory system, further studies are needed to define the best-personalized protocols.
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Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Marcello Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90146 Palermo, Italy;
| | - Lisa Ragazzo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Domenico Antonio Restivo
- Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Martina Cipriani
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Federica Gottardello
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Martina Pizzolato
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Maria Chiara Maccarone
- Physical Medicine and Rehabilitation School, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy;
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
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Donlevy GA, Cornett KMD, Garnett SP, Shy R, Estilow T, Yum SW, Anderson K, Pareyson D, Moroni I, Muntoni F, Reilly MM, Finkel RS, Herrmann DN, Eichinger KJ, Shy ME, Burns J, Menezes MP. Association of Body Mass Index With Disease Progression in Children With Charcot-Marie-Tooth Disease. Neurology 2023; 101:e717-e727. [PMID: 37380432 PMCID: PMC10437011 DOI: 10.1212/wnl.0000000000207488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/20/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate the impact of body mass index (BMI) on disease progression over 2 years in children with Charcot-Marie-Tooth disease (CMT). METHODS BMI was classified in 242 participants aged 3-20 years with CMT enrolled in the Inherited Neuropathy Consortium, using the International Obesity Task Force (based on adult BMI values, kg/m2) criteria. Groups were categorized as severely underweight (BMI <17 kg/m2), underweight (BMI ≥17 to <18.5 kg/m2), healthy weight (BMI ≥18.5 to <25 kg/m2), overweight (BMI ≥25 to <30 kg/m2), and obese (BMI ≥30 kg/m2). Disease severity was assessed using the CMT Pediatric Scale (CMTPedS), a clinical outcome assessment of disability (0-44 points, mild to severe). RESULTS At baseline, compared with individuals being of a healthy weight (mean CMTPedS 15.48, SD 9.22), children who were severely underweight (mean CMTPedS difference 9.03, 95% CI 0.94-17.12; p = 0.02), underweight (mean CMTPedS difference 5.97, 95% CI 0.62-11.31; p = 0.02), or obese (mean CMTPedS difference 7.96, 95% CI 1.03-14.88; p = 0.015) exhibited greater disability. At 2 years, compared with individuals being of a healthy weight (mean CMTPedS 17.53, SD 9.41), children who were severely underweight exhibited greater disability (mean CMTPedS difference 9.27, 95% CI 0.90-17.64; p = 0.02). Over the 2-year periods, the mean CMTPedS for the whole sample deteriorated by 1.72 points (95% CI 1.09-2.38; p < 0.001), with severely underweight children progressing at the fastest rate (mean CMTPedS change of 2.3, 95% CI 1.53-6.13; p = 0.21). In children who did not have a change in BMI categories over 2 years (69% of sample), CMTPedS scores deteriorated faster in those who were severely underweight (mean CMTPedS change 6.40 points, 95% CI 2.42-10.38; p = 0.01) than those of healthy weight (mean CMTPedS change 1.79 points, 95% CI 0.93-2.69; p < 0.001). For children who changed BMI categories (31% of sample), CMTPedS scores deteriorated faster in children who became overweight/obese (mean CMTPedS change 2.76 points, 95% CI 0.11-5.41; p = 0.031). DISCUSSION Children with CMT who were severely underweight, underweight, or obese exhibited greater disability at baseline. Over the 2-year period in those whose BMI remained stable, severely underweight children deteriorated at the fastest rate. For children who changed BMI categories over the 2 years, CMTPedS scores deteriorated faster in children who became overweight/obese. Interventions that maintain or improve BMI toward healthy weight may reduce disability in children with CMT.
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Affiliation(s)
- Gabrielle A Donlevy
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY.
| | - Kayla M D Cornett
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Sarah P Garnett
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Rosemary Shy
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Timothy Estilow
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Sabrina W Yum
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Kimberly Anderson
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Davide Pareyson
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Isabella Moroni
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Francesco Muntoni
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Mary M Reilly
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Richard S Finkel
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - David N Herrmann
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Katy J Eichinger
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Michael E Shy
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Joshua Burns
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
| | - Manoj P Menezes
- From the Faculty of Medicine and Health & Children's Hospital at Westmead (G.A.D., K.M.D.C., S.P.G., J.B., M.P.M.), University of Sydney, Australia; Department of Neurology (R.S., M.E.S.), and Department of Pediatrics (T.E., S.W.Y.), Carver College of Medicine, University of Iowa, Iowa City; Division of Neurology (T.E., S.W.Y.), The Children's Hospital of Philadelphia, PA; Department of Neurology (T.E., S.W.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Occupational Therapy (K.A.), Children's Hospital of Philadelphia, PA; Fondazione IRCCS (D.P., I.M.), Istituto Neurologico Carlo Besta, Milan, Italy; University College London Institute of Child Health & Great Ormond Street Hospital (F.M.); Department of Neuromuscular Diseases (M.M.R.), University College London Institute of Neurology, Queen Square, United Kingdom; Center for Experimental Neurotherapeutics (Pediatrics) (R.S.F.), St. Jude Children's Research Hospital, Memphis, TN; and Department of Neurology (D.N.H., K.J.E.), University of Rochester, NY
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9
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Santos EJF, Farisogullari B, Dures E, Geenen R, Machado PM. Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2023; 9:e003350. [PMID: 37604639 PMCID: PMC10445356 DOI: 10.1136/rmdopen-2023-003350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs. METHODS Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses. RESULTS From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=-0.23, 95% CI=-0.37 to -0.1), systemic lupus erythematosus (SLE) (SMD=-0.54, 95% CI=-1.07 to -0.01) and spondyloarthritis (SMD=-0.94, 95% CI=-1.23 to -0.66); reduction of fatigue was not significant in Sjögren's syndrome (SMD=-0.83, 95% CI=-2.13 to 0.47) and systemic sclerosis (SMD=-0.66, 95% CI=-1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, 95% CI=-0.48 to -0.16), but not in SLE (SMD=-0.19, 95% CI=-0.46 to 0.09). Follow-up models in consultations (SMD=-0.05, 95% CI=-0.29 to 0.20) and multicomponent interventions (SMD=-0.20, 95% CI=-0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results. CONCLUSIONS Physica activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.
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Affiliation(s)
- Eduardo José Ferreira Santos
- School of Health, Polytechnic University, Viseu, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Emma Dures
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, Netherlands
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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10
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Zhou K, Liu M, Wang Y, Liu H, Manor B, Bao D, Zhang L, Zhou J. Effects of molecular hydrogen supplementation on fatigue and aerobic capacity in healthy adults: A systematic review and meta-analysis. Front Nutr 2023; 10:1094767. [PMID: 36819697 PMCID: PMC9934906 DOI: 10.3389/fnut.2023.1094767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Fatigue is oftentimes induced by high-intensity exercise potentially via the exceeded amount of reactive oxygen species, leading to diminished functions (e.g., aerobic capacity) and increased risk of injuries. Studies indicate that molecular hydrogen (H2), with antioxidant and anti-inflammatory properties, may be a promising strategy to alleviate fatigue and improve aerobic capacity. However, such effects have not been comprehensively characterized. Objective To systematically assess the effects of in taking H2 on fatigue and aerobic capacity in healthy adults. Methods The search was conducted in August 2022 in five databases. Studies with randomized controlled or crossover designs that investigated the rating of perceived exertion (RPE), maximal oxygen uptake (VO2max), peak oxygen uptake (VO2peak), and endurance performance were selected. The data (mean ± standard deviation and sample size) were extracted from the included studies and were converted into the standardized mean difference (SMD). Random-effects meta-analyses were performed. Subgroup analysis was used to analyze potential sources of heterogeneity due to intervention period, training status, and type of exercise. Results Seventeen publications (19 studies) consisting of 402 participants were included. The pooled effect sizes of H2 on RPE (SMDpooled = -0.38, 95%CI -0.65 to -0.11, p = 0.006, I 2 = 33.6%, p = 0.149) and blood lactate (SMDpooled = -0.42, 95% CI -0.72 to -0.12, p = 0.006, I 2 = 35.6%, p = 0.114) were small yet significant with low heterogeneity. The pooled effect sizes of H2 on VO2max and VO2peak (SMDpooled = 0.09, 95% CI -0.10 to 0.29, p = 0.333, I 2 = 0%, p = 0.998) and endurance performance (SMDpooled = 0.01, 95% CI -0.23 to 0.25, p = 0.946, I 2 = 0%, p > 0.999) were not significant and trivial without heterogeneity. Subgroup analysis revealed that the effects of H2 on fatigue were impacted significantly by the training status (i.e., untrained and trained), period of H2 implementation, and exercise types (i.e., continuous and intermittent exercises). Conclusions This meta-analysis provides moderate evidence that H2 supplementation alleviates fatigue but does not enhance aerobic capacity in healthy adults. Systematic review registration www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022351559.
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Affiliation(s)
- Kaixiang Zhou
- College of Sports and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Meng Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Yubo Wang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Haoyang Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China,*Correspondence: Dapeng Bao ✉
| | - Luyu Zhang
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China,Luyu Zhang ✉
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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11
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Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: A systematic review and meta-analysis. Ann Phys Rehabil Med 2023; 66:101637. [PMID: 35091111 DOI: 10.1016/j.rehab.2022.101637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aerobic exercise aims to improve aerobic capacity. OBJECTIVE To summarize the evidence on the efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases (NMDs). METHODS We searched the electronic databases MEDLINE, EMBASE, SPORTDiscus and Web of Science Conference Proceedings Index for articles published up to June 17, 2021, selecting randomized controlled trials that included adults with slowly progressive NMDs and compared aerobic exercise to no aerobic exercise. The primary outcome was peak oxygen uptake (VO2peak) directly post-intervention. Secondary outcomes included other peak test parameters, submaximal test parameters, long-term outcomes ≥8 weeks post-intervention, adherence and adverse events. Meta-analyses were performed for the primary outcome and for secondary outcomes when reported in more than 2 studies. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to GRADE. RESULTS Nine studies were included (195 participants with 8 different NMDs). Eight studies were rated at high risk of bias and 1 study was rated at some concerns. Duration of exercise programs ranged from 6 to 26 weeks, with 3 weekly training sessions of 20 to 40 min, based on maximal capacity. Meta-analyses revealed short-term moderate beneficial effects of aerobic exercise on VO2peak (standardized mean difference [SMD] 0.55, 95% CI 0.23; 0.86) and peak workload (SMD 0.61, 95% CI 0.24; 0.99). Long-term effects were not assessed. Most training sessions (83-97%) were completed, but time spent in target intensity zones was not reported. Included studies lacked detailed adverse event reporting. CONCLUSIONS There is low-quality evidence that aerobic exercise is safe and leads to moderate improvement of aerobic capacity directly post-intervention in slowly progressive NMDs, but the long-term efficacy remains unclear. Detailed information about the time spent in target intensity zones and adverse events is lacking. PROSPERO CRD42020200083.
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12
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Newman L, Fornusek C, Hackett D. An exploratory study of exercise behaviours and barriers to participation in people with Charcot-Marie-Tooth disease: a focus on resistance training. J Exerc Rehabil 2023; 19:35-44. [PMID: 36910678 PMCID: PMC9993004 DOI: 10.12965/jer.2346020.010] [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: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
The aim of this study was to explore and describe the exercise behaviours and barriers in people with Charcot-Marie-Tooth disease (CMT), with a particular focus on resistance training (RT). Ninety-four Australian adults with a diagnosis of CMT completed an online survey. Fifty-seven percent of respondents reported performing some form of RT each week. Those performing RT engaged in more aerobic activity (P≤0.01) and were involved in longer periods of structured exercise (P<0.01) compared to those not performing RT. The RT group was more likely to perceive their exercise levels as acceptable (P<0.01), that following a program was important (P=0.02), and that exercise is beneficial (P=0.04). The RT group were more likely to have been advised to exercise (P=0.02). Common barriers to exercise were fatigue (64.9%), pain (57.4%), motivation (51.1%), and time (46.8%). RT status did not influence the type of barriers experienced. Weekly RT time was positively associated with exercise satisfaction (r=0.43, P<0.01) and walking distance prior to resting (r=0.29, P=0.04). The findings suggest that positive exercise experiences, advice, assistance from a trainer, and potentially greater resources may influence participation in RT for people with CMT.
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Affiliation(s)
- Laura Newman
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Che Fornusek
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Daniel Hackett
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Playing Disability Rugby League with Charcot-Marie-Tooth Disease: A Case Study. Sports (Basel) 2023; 11:sports11020021. [PMID: 36828306 PMCID: PMC9964179 DOI: 10.3390/sports11020021] [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: 11/27/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Charcot-Marie-Tooth (CMT) disease is a common inherited neurological disorder that causes damage to peripheral nerves. Reports of CMT patients participating in team-based sports such as disability rugby league are scarce. The objective of this case report was to evaluate the benefits of participation in disability rugby league in a 50-year-old male with CMT. Leg muscle mass and strength was worse for the case subject compared to two age-matched CMT participants with an exercise history; however, evidence of greater function in the case subject was observed through better 6-min walk test performance. Performance in a series of sport specific tests was noticeably worse for the case subject compared to a fellow rugby league player (age matched) with cerebral palsy. Inferior in-game performance was observed for the case subject compared to his fellow rugby league player in terms of distance covered, top running speed, and intensity. However, the case subject may have assumed a different role when playing as evident by the different behaviours he displayed during the games (i.e., less player contacts, tackles, or touches, but more passes of the ball). This case study provides information concerning disability rugby league as an adjunctive mode of treatment for CMT populations.
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Leclair V, Tsui H, Hudson M. Pain in autoimmune inflammatory myopathies: a scoping review. RMD Open 2023; 9:rmdopen-2022-002591. [PMID: 36635001 PMCID: PMC9843184 DOI: 10.1136/rmdopen-2022-002591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pain is considered a priority for research by adult patients with autoimmune inflammatory myopathy (AIM) and their families. Our aim was to review the literature for studies reporting on pain in adult AIM and to summarise their findings. METHODS A scoping review was conducted searching for studies in PubMed and MEDLINE including more than five adult patients with AIM and assessing pain using a patient-reported outcome measure. Study population characteristics, pain measurement and clinical correlates of pain were extracted using a standardised protocol. RESULTS The search strategy identified 2831 studies with 33 meeting inclusion criteria. Most studies used visual analogue scales (n=14) and/or the Medical Outcomes Study 36-Item Short Form Bodily Pain Scale (n=17). Frequency of pain and/or myalgias ranged from 64% to 100%. Subjects with AIM had significantly more pain than the general population and comparable pain to other chronic rheumatic diseases. Insufficient results were available to identify significant clinical correlates of pain in AIM. CONCLUSION This review suggests that the burden of pain in AIM is considerable. Still, due to the heterogeneity and low quality of the evidence, significant knowledge gaps persist. Studies are needed to characterise pain trajectories of patients with AIM.
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Affiliation(s)
- Valérie Leclair
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Harmony Tsui
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, McGill University, Montreal, Quebec, Canada
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15
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Beloribi-Djefaflia S, Attarian S. Treatment of Charcot-Marie-Tooth neuropathies. Rev Neurol (Paris) 2023; 179:35-48. [PMID: 36588067 DOI: 10.1016/j.neurol.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/31/2022]
Abstract
Charcot-Marie-Tooth (CMT) is a heterogeneous group of inherited neuropathies that affect the peripheral nerves and slowly cause progressive disability. Currently, there is no effective therapy. Patients' management is based on rehabilitation and occupational therapy, fatigue, and pain treatment with regular follow-up according to the severity of the disease. In the last three decades, much progress has been made to identify mutations involved in the different types of CMT, decipher the pathophysiology of the disease, and identify key genes and pathways that could be targeted to propose new therapeutic strategies. Genetic therapy is one of the fields of interest to silence genes such as PMP22 in CMT1A or to express GJB1 in CMT1X. Among the most promising molecules, inhibitors of the NRG-1 axis and modulators of UPR or the HDACs enzyme family could be used in different types of CMT.
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Affiliation(s)
- S Beloribi-Djefaflia
- Reference center for neuromuscular disorders and ALS, AP-HM, CHU La Timone, Marseille, France
| | - S Attarian
- Reference center for neuromuscular disorders and ALS, AP-HM, CHU La Timone, Marseille, France; FILNEMUS, European Reference Network for Rare Diseases (ERN), Marseille, France; Medical Genetics, Aix Marseille Université-Inserm UMR_1251, 13005 Marseille, France.
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16
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Pisciotta C, Shy ME. Hereditary neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:609-617. [PMID: 37562889 DOI: 10.1016/b978-0-323-98818-6.00009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The hereditary neuropathies, collectively referred as Charcot-Marie-Tooth disease (CMT) and related disorders, are heterogeneous genetic peripheral nerve disorders that collectively comprise the commonest inherited neurological disease with an estimated prevalence of 1:2500 individuals. The field of hereditary neuropathies has made significant progress in recent years with respect to both gene discovery and treatment as a result of next-generation sequencing (NGS) approach. These investigations which have identified over 100 causative genes and new mutations have made the classification of CMT even more challenging. Despite so many different mutated genes, the majority of CMT forms share a similar clinical phenotype, and due to this phenotypic homogeneity, genetic testing in CMT is increasingly being performed through the use of NGS panels. The majority of patients still have a mutation in one the four most common genes (PMP22 duplication-CMT1A, MPZ-CMT1B, GJB1-CMTX1, and MFN2-CMT2A). This chapter focuses primarily on these four forms and their potential therapeutic approaches.
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Affiliation(s)
- Chiara Pisciotta
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Michael E Shy
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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17
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Kennedy RA, McKenzie G, Holmes C, Shields N. Social Support Initiatives That Facilitate Exercise Participation in Community Gyms for People with Disability: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:699. [PMID: 36613019 PMCID: PMC9819822 DOI: 10.3390/ijerph20010699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
People with disability report social support facilitates participation in physical activity. A scoping review explored social support strategies used to facilitate exercise participation for people with disability (aged ≥ 15 years) in community gym settings. Seven electronic databases were searched. Studies were screened for eligibility based on title and abstract followed by full-text review. Data were analysed using content analysis and narrative synthesis. Forty-two articles reporting data from 35 studies were included. Eight types of social support were identified: supervision (n = 30), peer support (n = 21), specialist support (n = 19), orientation (n = 15), education (n = 7), logistical support (n = 6), motivational support (n = 5) and organised social activities (n = 4). Direct supervision was typically provided 1:1 or in small groups by staff experienced working with people with disability. Peer support typically involved support from exercise group participants or a peer mentor. Specialist support was usually provided by a health or exercise professional either directly to people with disability or to the people providing support to them (e.g., trainer). Orientation to the gym environment, equipment and exercise program was usually provided over 1 or 2 sessions. Gym staff may use these strategies to guide the implementation of social supports within their facilities to promote social connectedness and participation for people with disability.
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Affiliation(s)
- Rachel A. Kennedy
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora 3086, Australia
| | - Georgia McKenzie
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora 3086, Australia
| | - Carlee Holmes
- CP Achieve Centre of Research Excellence, Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville 3052, Australia
| | - Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora 3086, Australia
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18
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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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19
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Connolly CM, Plomp L, Paik JJ, Allenbach Y. Possible future avenues for myositis therapeutics: DM, IMNM and IBM. Best Pract Res Clin Rheumatol 2022; 36:101762. [PMID: 35778272 DOI: 10.1016/j.berh.2022.101762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) represent a heterogeneous group of systemic autoimmune diseases characterized by immune-mediated muscle injury. As insights into pathogenesis of IIM evolve, novel therapeutic strategies have become available to optimize outcomes. Herein, we summarize novel and emerging strategies in the management of dermatomyositis (DM), immunemediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM).
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lotta Plomp
- Department of Internal Medicine and Clinical Immunology, Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié Salpêtrière Hospital, Sorbonne University, Paris, France.
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20
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Reash NF, James MK, Alfano LN, Mayhew AG, Jacobs M, Iammarino MA, Holsten S, Sakamoto C, Tateishi T, Yajima H, Duong T, de Wolf B, Gee R, Bharucha-Goebel DX, Bravver E, Mori-Yoshimura M, Bushby K, Rufibach LE, Straub V, Lowes LP. Comparison of strength testing modalities in dysferlinopathy. Muscle Nerve 2022; 66:159-166. [PMID: 35506767 DOI: 10.1002/mus.27570] [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: 10/08/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS Dysferlinopathy demonstrates heterogeneity in muscle weakness between patients, which can progress at different rates over time. Changing muscle strength due to disease progression or from an investigational product is associated with changing functional ability. The purpose of this study was to compare three methods of strength testing used in the Clinical Outcome Study (COS) for dysferlinopathy to understand which method and which muscle groups were most sensitive to change over time. METHODS Patients were evaluated at each study visit using functional scales, manual muscle testing, and handheld dynamometry (HHD) at all 15 sites. A fixed-frame system (Fixed) was used at a subset of seven sites. Screening and baseline visits were evaluated for reliability. Data over a 1-year period were analyzed to determine sensitivity to change among strength modalities and individual muscle groups. RESULTS HHD and Fixed captured significant change across 1 year in summed muscle strength score of four muscle groups (P < .01). Strength summed scores were significantly correlated with functional scales (rho = 0.68-0.92, P < .001). Individual muscle groups, however, showed high levels of variability between visits. DISCUSSION Although both HHD and Fixed demonstrate change over 12 months, HHD is a less expensive option that provides data on a continuous scale and may be easier to implement. Due to variability in strength measures, researchers should carefully consider use of strength testing as an outcome and may wish to select functional measures with less variability as clinical trial endpoints.
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Affiliation(s)
- Natalie F Reash
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lindsay N Alfano
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Anna G Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marni Jacobs
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC.,Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC
| | - Megan A Iammarino
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Scott Holsten
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, North Carolina
| | - Chikako Sakamoto
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takayuki Tateishi
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroyuki Yajima
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tina Duong
- Cooperative International Neuromuscular Research Group, Children's National Health System, Washington, DC.,Lucile Salter Packard Children's Hospital at Stanford, Neurology, Palo Alto, California.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Brittney de Wolf
- Cooperative International Neuromuscular Research Group, Children's National Health System, Washington, DC
| | - Richard Gee
- Lucile Salter Packard Children's Hospital at Stanford, Neurology, Palo Alto, California
| | - Diana X Bharucha-Goebel
- Department of Neurology Children's National Health System, Washington, DC.,National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Elena Bravver
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, North Carolina
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Linda P Lowes
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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21
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He J, Fu J, Zhao W, Ren C, Liu P, Chen L, Li D, Zhou L, Tang L, Liu X, Ye S, Liu X, Ma Y, Zhang Y, Ma X, Zhang L, Zhang G, Li N, Fan D. Exercise Physiology Impairments of Patients With Amyotrophic Lateral Sclerosis: Cardiopulmonary Exercise Testing Findings. Front Physiol 2022; 13:792660. [PMID: 35370778 PMCID: PMC8967153 DOI: 10.3389/fphys.2022.792660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective In amyotrophic lateral sclerosis (ALS), progressive weakness significantly limits the ability to exercise. However, measurements of the impaired exercise function and their practical value to assess disease progression in ALS are scarce. Cardiopulmonary exercise testing (CPET) is a non-invasive accurate method used to comprehensively quantify exercise physiology in a variety of diseases. This study aimed to evaluate the clinical value of CPET and to explore its association with disease severity and prognosis prediction in ALS. Methods A total of 319 participants were enrolled in this 3-year prospective study. After strict quality control, 109 patients with ALS and 150 age- and sex-matched healthy controls were included with comprehensive clinical assessment and follow-ups. The incremental ramp protocol for symptom-limited CPET was applied in both groups. The exercise physiology during peak effort exercise was systematically measured, including the overall aerobic capacity of exercise (VO2 peak) and the respective capacity of the exercise-involved organs [cardiac response (heart rate peak—HR peak), ventilatory efficiency (VE/VCO2 slope), breathing economy (VE/VO2 peak), and other relevant parameters]. Disease severity and progression were evaluated using recognized scales. Survival was monitored with regular follow-ups every 6 months. Results Decreased exercise capacity (VO2 peak < 16 ml/kg/min) occurred more frequently in patients with ALS than in controls (44.95% vs. 9.33%, p < 0.01). In patients with ALS, the average VO2 peak (16.16 ± 5.43 ml/kg/min) and HR peak [135 (112–153) bpm] were significantly lower (p < 0.01) than in controls [22.26 ± 7.09 ml/kg/min; 148 (135–164) bpm], but the VE/VCO2 slope was significantly higher [28.05 (25.03–32.16) vs. 26.72 (24.37–29.58); p = 0.03]. In patients with ALS, the VO2 peak and HR peak were significantly correlated with disease severity and progression scores (p < 0.05). Survival analyses revealed the VO2 peak and HR peak as protective indicators while the VE/VO2 peak as a detrimental indicator for the prognostic prediction in ALS (HR = 0.839, p = 0.001; HR = 0.967, p < 0.001; HR = 1.137, p = 0.028, respectively). Conclusion Our prospective study quantified the significantly decreased exercise capacity in ALS through non-invasive CPET. The impaired VO2 peak and HR peak closely correlated with disease severity and independently predicted a worse prognosis. Our findings identified the clinical value of CPET as an objective indicator of disease progression in ALS.
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Affiliation(s)
- Ji He
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dan Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lequn Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaolu Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yan Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xinran Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Li
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- *Correspondence: Dongsheng Fan,
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22
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Tolchin DW. Rehabilitation in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Govbakh I, Kyryk V, Ustymenko A, Rubtsov V, Tsupykov O, Bulgakova NV, Zavodovskiy DO, Sokolowska I, Maznychenko A. Stem Cell Therapy Enhances Motor Activity of Triceps Surae Muscle in Mice with Hereditary Peripheral Neuropathy. Int J Mol Sci 2021; 22:ijms222112026. [PMID: 34769453 PMCID: PMC8584487 DOI: 10.3390/ijms222112026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Impaired motor and sensory functions are the main features of Charcot-Marie-Tooth disease. Mesenchymal stem cell (MSCs) therapy is one of the possible treatments for this disease. It was assumed that MSCs therapy can improve the contractile properties of the triceps surae (TS) muscles in mice with hereditary peripheral neuropathy. Murine adipose-derived mesenchymal stromal cells (AD-MSCs) were obtained for transplantation into TS muscles of FVB-C-Tg(GFPU)5Nagy/J mice. Three months after AD-MSCs transplantation, animals were subjected to electrophysiological investigations. Parameters of TS muscle tension after intermittent high frequency electrical sciatic nerve stimulations were analyzed. It was found that force of TS muscle tension contraction in animals after AD-MSCs treatment was two-time higher than in untreated mice. Normalized values of force muscle contraction in different phases of electrical stimulation were 0.3 ± 0.01 vs. 0.18 ± 0.01 and 0.26 ± 0.03 vs. 0.13 ± 0.03 for treated and untreated animals, respectively. It is assumed that the two-fold increase in TS muscle strength was caused by stem cell therapy. Apparently, AD-MSCs therapy can promote nerve regeneration and partial restoration of muscle function, and thus can be a potential therapeutic agent for the treatment of peripheral neuropathies.
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Affiliation(s)
- Iryna Govbakh
- Department of General Practice-Family Medicine, Kharkiv Medical Academy of Postgraduate Education, 61000 Kharkiv, Ukraine;
| | - Vitalii Kyryk
- Cell and Tissue Technologies Department, State Institute of Genetic and Regenerative Medicine NAMS of Ukraine, 04114 Kyiv, Ukraine; (V.K.); (A.U.); (O.T.)
- Laboratory of Pathophysiology and Immunology, D. F. Chebotarev State Institute of Gerontology NAMS of Ukraine, 04114 Kyiv, Ukraine
| | - Alina Ustymenko
- Cell and Tissue Technologies Department, State Institute of Genetic and Regenerative Medicine NAMS of Ukraine, 04114 Kyiv, Ukraine; (V.K.); (A.U.); (O.T.)
- Laboratory of Pathophysiology and Immunology, D. F. Chebotarev State Institute of Gerontology NAMS of Ukraine, 04114 Kyiv, Ukraine
| | - Volodymyr Rubtsov
- Department of Cytology, Histology and Reproductive Medicine, Educational and Scientific Institute of Biology and Medicine, Taras Shevchenko National University of Kyiv, 03127 Kyiv, Ukraine;
| | - Oleg Tsupykov
- Cell and Tissue Technologies Department, State Institute of Genetic and Regenerative Medicine NAMS of Ukraine, 04114 Kyiv, Ukraine; (V.K.); (A.U.); (O.T.)
- Department of Cytology, Bogomoletz Institute of Physiology NAS of Ukraine, 01024 Kyiv, Ukraine
| | - Nataliya V. Bulgakova
- Department of Movement Physiology, Bogomoletz Institute of Physiology NAS of Ukraine, 01024 Kyiv, Ukraine; (N.V.B.); (D.O.Z.)
| | - Danylo O. Zavodovskiy
- Department of Movement Physiology, Bogomoletz Institute of Physiology NAS of Ukraine, 01024 Kyiv, Ukraine; (N.V.B.); (D.O.Z.)
| | - Inna Sokolowska
- Department of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Andriy Maznychenko
- Department of Movement Physiology, Bogomoletz Institute of Physiology NAS of Ukraine, 01024 Kyiv, Ukraine; (N.V.B.); (D.O.Z.)
- Department of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
- Correspondence: ; Tel.: +38-044-256-24-12
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24
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Physical exercise for the management of systemic autoimmune myopathies: recent findings, and future perspectives. Curr Opin Rheumatol 2021; 33:563-569. [PMID: 34456254 DOI: 10.1097/bor.0000000000000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to present the main pieces of evidence, recent literature and to present future perspectives on the use of exercise/physical training in the treatment and improvement of the quality of life of patients with systemic autoimmune myopathies. RECENT FINDINGS In the last decades, knowledge about the relevance of physical exercise training in preventing and treating chronic diseases and improving quality of life has grown. Following the global trend exemplified by the expression 'exercise is medicine', the importance of exercise/physical training has also grown in myopathies. However, the science of exercise has a lot to collaborate on and improve patients' quality of life with myopathies by appropriating new technological tools, including accessible and low-cost devices and smartphone apps. SUMMARY Physical exercise, as already consolidated in the literature, is an effective, well tolerated, and low-cost strategy for patients with myopathies. The use of wearable devices, smartphone apps, and online training prescriptions must accompany the global scenario, bringing new research fields and expanding the options for access to training for the individualized basis, and prescribed by qualified professionals.
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25
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Pisciotta C, Saveri P, Pareyson D. Challenges in Treating Charcot-Marie-Tooth Disease and Related Neuropathies: Current Management and Future Perspectives. Brain Sci 2021; 11:1447. [PMID: 34827446 PMCID: PMC8615778 DOI: 10.3390/brainsci11111447] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
There is still no effective drug treatment available for Charcot-Marie-Tooth neuropathies (CMT). Current management relies on rehabilitation therapy, surgery for skeletal deformities, and symptomatic treatment of pain; fatigue and cramps are frequent complaints that are difficult to treat. The challenge is to find disease-modifying therapies. Several approaches, including gene silencing, to counteract the PMP22 gene overexpression in the most frequent CMT1A type are under investigation. PXT3003 is the compound in the most advanced phase for CMT1A, as a second-phase III trial is ongoing. Gene therapy to substitute defective genes or insert novel ones and compounds acting on pathways important for different CMT types are being developed and tested in animal models. Modulation of the Neuregulin pathway determining myelin thickness is promising for both hypo-demyelinating and hypermyelinating neuropathies; intervention on Unfolded Protein Response seems effective for rescuing misfolded myelin proteins such as P0 in CMT1B. HDAC6 inhibitors improved axonal transport and ameliorated phenotypes in different CMT models. Other potential therapeutic strategies include targeting macrophages, lipid metabolism, and Nav1.8 sodium channel in demyelinating CMT and the P2X7 receptor, which regulates calcium influx into Schwann cells, in CMT1A. Further approaches are aimed at correcting metabolic abnormalities, including the accumulation of sorbitol caused by biallelic mutations in the sorbitol dehydrogenase (SORD) gene and of neurotoxic glycosphingolipids in HSN1.
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Affiliation(s)
| | | | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.P.); (P.S.)
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Ramdharry G, Buscemi V, Boaz A, Dawes H, Jaki T, Jones F, Marsden J, Paul L, Playle R, Randell E, Robling M, Rochester L, Busse M. Proposing a Core Outcome Set for Physical Activity and Exercise Interventions in People With Rare Neurological Conditions. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:705474. [PMID: 36188845 PMCID: PMC9397985 DOI: 10.3389/fresc.2021.705474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022]
Abstract
Rare neurological conditions (RNCs) encompass a variety of diseases that differ in progression and symptoms but typically include muscle weakness, sensory and balance impairment and difficulty with coordinating voluntary movement. This can limit overall physical activity, so interventions to address this are recommended. The aim of this study was to agree a core outcome measurement set for physical activity interventions in people living with RNCs. We followed established guidelines to develop core outcome sets. Broad ranging discussions in a series of stakeholder workshops led to the consensus that (1) physical well-being; (2) psychological well-being and (3) participation in day-to-day activities should be evaluated in interventions. Recommendations were further informed by a scoping review of physical activity interventions for people living with RNCs. Nearly 200 outcome measures were identified from the review with a specific focus on activities or functions (e.g, on lower limb function, ability to perform daily tasks) but limited consideration of participation based outcomes (e.g., social interaction, work and leisure). Follow on searches identified two instruments that matched the priority areas: the Oxford Participation and Activities Questionnaire and the Sources of Self-Efficacy for Physical Activity. We propose these scales as measures to assess outcomes that are particularly relevant to assess when evaluating physical activity interventions mong people with RNCs. Validation work across rare neurological conditions is now required to inform application of this core outcome set in future clinical trials to facilitate syntheses of results and meta-analyses.
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Affiliation(s)
- Gita Ramdharry
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Valentina Buscemi
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Annette Boaz
- Faculty of Health, Social Care and Education, St. George's, University of London, London, United Kingdom
| | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Thomas Jaki
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, United Kingdom
| | - Fiona Jones
- Faculty of Health, Social Care and Education, St. George's, University of London, London, United Kingdom
- Faculty of Health, Social Care and Education, Kingston University, Surrey, United Kingdom
| | - Jonathan Marsden
- Faculty of Health, Plymouth University, Plymouth, United Kingdom
| | - Lorna Paul
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Elizabeth Randell
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
- *Correspondence: Monica Busse
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Ramdharry GM, Wallace A, Hennis P, Dewar E, Dudziec M, Jones K, Pietrusz A, Reilly MM, Hanna MG. Cardiopulmonary exercise performance and factors associated with aerobic capacity in neuromuscular diseases. Muscle Nerve 2021; 64:683-690. [PMID: 34550609 DOI: 10.1002/mus.27423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION/AIMS Aerobic deconditioning, due to lower levels of physical activity, could impact independence for people with neuromuscular conditions. We report the maximal cardiopulmonary response in a cohort of people with Charcot Marie Tooth disease type 1A (CMT 1A) and inclusion body myositis (IBM). We also explored potential predictors of aerobic capacity with measures of physical impairment and functional performance. METHODS Participants underwent maximal cardiopulmonary exercise testing (CPET) using a semi-recumbent cycle ergometer. Data were analyzed to determine the peak O2 consumption (VO2 peak), anaerobic threshold (AT), maximum heart rate (MHR), ventilatory equivalent for CO2 slope (VE /VCO2 ), and respiratory exchange ratio (RER). Impairment, functional and patient reported measures were also recorded. Predicted CPET variables were calculated based on published normative data for age, gender, and weight. RESULTS Twenty-two people with CMT and 17 people with IBM were recruited. Both groups showed significantly lower VO2 peak, MHR, AT, and VE /VCO2 . The CMT group overall performed better than the IBM group, with significantly higher VO2 peak, MHR, and AT, but lower VE /VCO2. Linear regression analysis demonstrated that VO2 peak was related to body fat percentage and 6-min walk distance for both groups, and steps per day for the IBM group. DISCUSSION Lower than predicted CPET variables were observed that were not explained by cardiopulmonary limitations or reduced effort, implicating peripheral factors in limiting the cycling task. Regression analysis implied prediction of VO2 peak by body fat percentage and 6-min walk distance. Six-minute walk distance could be a potential proxy measure of cardiopulmonary fitness.
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Affiliation(s)
- Gita M Ramdharry
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Amanda Wallace
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Philip Hennis
- Institute of Sport, Exercise and Health, UCL, London, UK
| | - Elizabeth Dewar
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Magdalena Dudziec
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Institute of Sport, Exercise and Health, UCL, London, UK
| | - Katherine Jones
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Aleksandra Pietrusz
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
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Veenhuizen Y, Satink T, Graff MJ, Geurts AC, Groothuis JT, van Engelen BG, Nijhuis-van der Sanden MW, Cup EH. Mixed methods evaluation of a self-management group programme for patients with neuromuscular disease and chronic fatigue. BMJ Open 2021; 11:e048890. [PMID: 34433601 PMCID: PMC8388284 DOI: 10.1136/bmjopen-2021-048890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To obtain insight into experiences of patients with a neuromuscular disease and chronic fatigue and their healthcare professionals regarding content and delivery of a multidisciplinary outpatient self-management group programme to improve social participation. This will inform future implementation. DESIGN A mixed method study alongside a randomised controlled trial. SETTING University hospital, rehabilitation centre and community health centre. PARTICIPANTS 29 patients with a neuromuscular disease and chronic fatigue and 13 healthcare professionals participated in this mixed methods study. INTERVENTION Multidisciplinary group programme, called Energetic, consisted of a 4 months intervention with weekly meetings and covered four modules: (1) individually tailored aerobic exercise training; (2) education about aerobic exercise; (3) self-management training in applying energy conservation strategies and (4) implementation and relapse prevention in daily life. MAIN MEASURES Quantitative data were collected by a questionnaire measuring patients' (n=25, all completed the programme) satisfaction with the perceived results, content and delivery of the programme. Qualitative data were collected by individual and focus group interviews to gain insight in the experiences of patients (n=18), next of kin (n=2) and healthcare professionals (n=13) with facilitators and barriers to programme implementation. RESULTS Patients were satisfied with the number and length of the sessions, the different modules and the therapists. Analysis of the interviews led to five themes: (1) the combination of modules makes a complete picture, (2) the programme is physically and mentally intensive, (3) the group setting is valuable, (4) small variations in delivery occur in different settings, (5) therapists are coaches. Suggestions for programme improvement include a combination of face to face and e-health, enhancement of therapists' skills in guiding group interventions and inclusion of more booster sessions to evaluate and maintain self-management competencies. CONCLUSIONS The Energetic programme could be implemented in different healthcare settings and group settings, and a combination of modules proved to be a facilitator for improving self-management. TRIAL REGISTRATION NUMBER NCT02208687.
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Affiliation(s)
- Yvonne Veenhuizen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Ton Satink
- School of Occupational Therapy, HAN University of Applied Science, Nijmegen, The Netherlands
| | - Maud Jl Graff
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Alexander Ch Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Baziel Gm van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Edith Hc Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Unger L. Therapieoptionen und outcome bei idiopathischen entzündlichen Muskelerkrankungen. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1423-7579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie idiopathischen entzündlichen Muskelerkrankungen (IIM) sind eine sehr heterogene Gruppe, die sich immer besser differenzieren lässt. Damit eröffnen sich mehr Möglichkeiten für gezieltere Therapien, die zum einen auf die Veränderung pathogenetischer Faktoren gerichtet sind. Zum anderen sollen sie Krankheitsaktivität vermindern, Muskelaufbau fördern, Organschäden verhindern und Lebensqualität verbessern.Die folgende Übersichtsarbeit fasst die vorhandenen Daten zu bereits angewandten Behandlungen in der Praxis zusammen und gibt einen Ausblick auf zukünftige Alternativen.Für die Polymyositis (PM) und Dermatomyositis (DM) sind Glukokortikoide weiter unverzichtbarer Therapiebestandteil. Eine frühe Kombination mit konventionellen DMARDs hat sich durchgesetzt. Die ProDerm- Studie stellt für die Immunglobulintherapie in der Praxis eine gute Basis dar. Rituximab (RTX) löst Cyclophosphamid (CYC) bei schweren Verlaufsformen immer mehr ab.Für Abatacept, Jak-Kinase-Hemmer, Apremilast, Sifalimumab und Lenabasum müssen vielversprechende erste Ergebnisse durch weiter Studien untermauert werden. Anspruchsvoll ist die Behandlung bei extramuskulärer Beteiligung. Von großem Interesse ist der zukünftige Stellenwert von Nintedanib bei der interstitiellen Lungenerkrankung im Rahmen einer Myositis (IIM-ILD).Die Therapie der Einschlusskörperchen- Myositis (IBM) ist immer noch eine große Herausforderung. Zahlreiche Studien haben bisher nicht überzeugend zu einer Besserung der Prognose führen können. Spätestens bei therapierefraktärem Verlauf sollte an eine Malignom- assoziierte Myositis gedacht werden. Gelegentlich verbirgt sich auch eine hereditäre Myopathie hinter einer, zum Beispiel durch einen Infekt oder Überlastung getriggerten, Myositis.Komplikationen im Verlauf, wie Dysphagie, Infektionen, Myokardbeteiligung stellen keine Seltenheit dar. Häufig besteht Multimorbidität. Eine interdisziplinäre Zusammenarbeit in einem kompetenten Team, in dem erfahrene Physio-, Ergo- und Psychotherapeuten fester Bestandteil sind, ist unabdingbar für eine erfolgreiche Begleitung dieser Patienten.
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Affiliation(s)
- Leonore Unger
- Städtisches Klinikum Dresden, I. Medizinische Klinik, Dresden, Deutschland
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Špiritović M, Heřmánková B, Oreská S, Štorkánová H, Růžičková O, Vernerová L, Klein M, Kubínová K, Šmucrová H, Rathouská A, Česák P, Komarc M, Bunc V, Pavelka K, Šenolt L, Mann H, Vencovský J, Tomčík M. The effect of a 24-week training focused on activities of daily living, muscle strengthening, and stability in idiopathic inflammatory myopathies: a monocentric controlled study with follow-up. Arthritis Res Ther 2021; 23:173. [PMID: 34154634 PMCID: PMC8218432 DOI: 10.1186/s13075-021-02544-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The structural and functional changes of the skeletal muscles in idiopathic inflammatory myopathies (IIM) caused by inflammation and immune changes can be severely disabling. The objective of this study was to assess the effect of a 24-week program combining a supervised training of activities of daily living (ADL), resistance, and stability with home exercise for improving muscle function, compared to a daily home-based exercise representing the regular outpatient care. METHODS Fifty-seven patients with IIM were consecutively and non-selectively enrolled in an intervention (IG, n = 30) or control (CG, n = 27) group. Both groups were provided a standard-of-care pharmacological treatment and follow-up. Only the IG underwent the supervised intervention twice a week for 1 h per session. At baseline, 12, 24, and 48 weeks, all patients were assessed by an assessor blinded to the intervention for primary outcomes: muscle strength (Manual Muscle Testing of eight muscle groups [MMT-8]) and endurance (Functional Index-2 [FI-2]), and secondary outcomes: stability and body composition. Secondary outcomes also included questionnaires evaluating disability (Health Assessment Questionnaire [HAQ]), quality of life (Short Form 36 [SF-36]), depression (Beck's Depression Inventory-II [BDI-II]), and fatigue (Fatigue Impact Scale [FIS]), and analysis of the systemic and local inflammatory response and perceived exertion to assess the safety of the intervention. RESULTS Twenty-seven patients in the IG and 23 in the CG completed the entire program and follow-up. At week 24, compared to deterioration in the CG, we found a significant improvement in the IG in muscle strength (mean % improvement compared to baseline by 26%), endurance (135%), disability (39%), depression (26%), stability (11%), and basal metabolism (2%) and a stabilization of fitness for physical exercise. The improvement was clinically meaningful (a 24-week change by >20%) in most outcomes in a substantial proportion of patients. Although the improvement was still present at 48 weeks, the effect was not sustained during follow-up. No significant increase in the systemic or local expression of inflammatory markers was found throughout the intervention. CONCLUSIONS This 24-week supervised intervention focused on ADL training proved to be safe and effective. It not only prevented the progressive deterioration, but also resulted in a significant improvement in muscle strength, endurance, stability, and disability, which was clinically meaningful in a substantial proportion of patients. TRIAL REGISTRATION ISRCTN35925199 (retrospectively registered on 22 May 2020).
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Affiliation(s)
- Maja Špiritović
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Růžičková
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucia Vernerová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Šmucrová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Adéla Rathouská
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Petr Česák
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Václav Bunc
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic. .,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Jones K, Hawke F, Newman J, Miller JA, Burns J, Jakovljevic DG, Gorman G, Turnbull DM, Ramdharry G. Interventions for promoting physical activity in people with neuromuscular disease. Cochrane Database Syst Rev 2021; 5:CD013544. [PMID: 34027632 PMCID: PMC8142076 DOI: 10.1002/14651858.cd013544.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that people of all ages take regular and adequate physical activity. If unable to meet the recommendations due to health conditions, international guidance advises being as physically active as possible. Evidence from community interventions of physical activity indicate that people living with medical conditions are sometimes excluded from participation in studies. In this review, we considered the effects of activity-promoting interventions on physical activity and well-being in studies, as well as any adverse events experienced by participants living with inherited or acquired neuromuscular diseases (NMDs). OBJECTIVES: To assess the effects of interventions designed to promote physical activity in people with NMD compared with no intervention or alternative interventions. SEARCH METHODS On 30 April 2020, we searched Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, and ClinicalTrials.Gov. WHO ICTRP was not accessible at the time. SELECTION CRITERIA We considered randomised or quasi-randomised trials, including cross-over trials, of interventions designed to promote physical activity in people with NMD compared to no intervention or alternative interventions. We specifically included studies that reported physical activity as an outcome measure. Our main focus was studies in which promoting physical activity was a stated aim but we also included studies in which physical activity was assessed as a secondary or exploratory outcome. DATA COLLECTION AND ANALYSIS We used standard Cochrane procedures. MAIN RESULTS The review included 13 studies (795 randomised participants from 12 studies; number of participants unclear in one study) of different interventions to promote physical activity. Most studies randomised a minority of invited participants. No study involved children or adolescents and nine studies reported minimal entry criteria for walking. Participants had one of nine inherited or acquired NMDs. Types of intervention included structured physical activity support, exercise support (as a specific form of physical activity), and behaviour change support that included physical activity or exercise. Only one included study clearly reported that the aim of intervention was to increase physical activity. Other studies reported or planned to analyse the effects of intervention on physical activity as a secondary or exploratory outcome measure. Six studies did not report results for physical activity outcomes, or the data were not usable. We judged 10 of the 13 included studies at high or unclear risk of bias from incomplete physical activity outcome reporting. We did not perform a meta-analysis for any comparison because of differences in interventions and in usual care. We also found considerable variation in how studies reported physical activity as an outcome measure. The studies that reported physical activity measurement did not always clearly report intention-to-treat (ITT) analysis or whether final assessments occurred during or after intervention. Based on prespecified measures, we included three comparisons in our summary of findings. A physical activity programme (weight-bearing) compared to no physical activity programme One study involved adults with diabetic peripheral neuropathy (DPN) and reported weekly duration of walking during and at the end of a one-year intervention using a StepWatch ankle accelerometer. Based on the point estimate and low-certainty evidence, intervention may have led to an important increase in physical activity per week; however, the 95% confidence interval (CI) included the possibility of no difference or an effect in either direction at three months (mean difference (MD) 34 minutes per week, 95% CI -92.19 to 160.19; 69 participants), six months (MD 68 minutes per week, 95% CI -55.35 to 191.35; 74 participants), and 12 months (MD 49 minutes per week, 95% CI -75.73 to 173.73; 70 participants). Study-reported effect estimates for foot lesions and full-thickness ulcers also included the possibility of no difference, a higher, or lower risk with intervention. A sensor-based, interactive exercise programme compared to no sensor-based, interactive exercise programme One study involved adults with DPN and reported duration of walking over 48 hours at the end of four weeks' intervention using a t-shirt embedded PAMSys sensor. It was not possible to draw conclusions about the effectiveness of the intervention from the very low-certainty evidence (MD -0.64 hours per 48 hours, 95% CI -2.42 to 1.13; 25 participants). We were also unable to draw conclusions about impact on the Physical Component Score (PCS) for quality of life (MD 0.24 points, 95% CI -5.98 to 6.46; 35 participants; very low-certainty evidence), although intervention may have made little or no difference to the Mental Component Score (MCS) for quality of life (MD 5.10 points, 95% CI -0.58 to 10.78; 35 participants; low-certainty evidence). A functional exercise programme compared to a stretching exercise programme One study involved adults with spinal and bulbar muscular atrophy and reported a daily physical activity count at the end of 12 weeks' intervention using an Actical accelerometer. It was not possible to draw conclusions about the effectiveness of either intervention (requiring compliance) due to low-certainty evidence and unconfirmed measurement units (MD -8701, 95% CI -38,293.30 to 20,891.30; 43 participants). Functional exercise may have made little or no difference to quality of life compared to stretching (PCS: MD -1.10 points, 95% CI -5.22 to 3.02; MCS: MD -1.10 points, 95% CI -6.79 to 4.59; 49 participants; low-certainty evidence). Although studies reported adverse events incompletely, we found no evidence of supported activity increasing the risk of serious adverse events. AUTHORS' CONCLUSIONS We found a lack of evidence relating to children, adolescents, and non-ambulant people of any age. Many people living with NMD did not meet randomised controlled trial eligibility criteria. There was variation in the components of supported activity intervention and usual care, such as physical therapy provision. We identified variation among studies in how physical activity was monitored, analysed, and reported. We remain uncertain of the effectiveness of promotional intervention for physical activity and its impact on quality of life and adverse events. More information is needed on the ITT population, as well as more complete reporting of outcomes. While there may be no single objective measure of physical activity, the study of qualitative and dichotomous change in self-reported overall physical activity might offer a pragmatic approach to capturing important change at an individual and population level.
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Affiliation(s)
- Katherine Jones
- Cochrane Pain, Palliative and Supportive Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Mental Health and Neuroscience Network and Acute and Emergency Care Network, Cochrane, London, UK
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
| | - Jane Newman
- Wellcome Centre for Mitochondrial Research, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - James Al Miller
- c/o Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joshua Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
| | - Djordje G Jakovljevic
- Cardiovascular and Lifestyle Medicine Theme, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Grainne Gorman
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Douglass M Turnbull
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Gita Ramdharry
- Queen Square Centre for Neuromuscular Diseases, University College Hospital NHS Foundation Trust and UCL Institute of Neurology, London, UK
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32
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Zhang H, Liu Y, Ma J, Li Z. Systematic review of physical exercise for patients with idiopathic inflammatory myopathies. Nurs Health Sci 2021; 23:312-324. [PMID: 33511721 DOI: 10.1111/nhs.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 01/09/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are systemic autoimmune connective tissue diseases. The safety and effectiveness of exercise for patients with idiopathic inflammatory myopathies remains unclear. This study aimed to systematically review the evidence for physical exercise among patients with idiopathic inflammatory myopathies. Relevant experimental studies were identified through searching the PubMed, Cochrane, Embase, Scopus, and CINAHL databases, and studies involving any type of physical exercise for ≥1 month were considered. The primary outcome was muscle strength, and the secondary outcomes included aerobic fitness, functional performance, health status, quality of life, activities of daily living, pain, and fatigue. Eight randomized controlled trials and thirteen nonrandomized uncontrolled trials were reviewed. Physical exercise appeared safe, with several positive effects. However, selection or allocation biases and small sample sizes affected the certainty of the evidence. While physical exercise appeared safe for patients with idiopathic inflammatory myopathies with several positive effects, studies of a higher methodological quality and involving patients with active disease are needed. Furthermore, to design optimal exercise programs, consistent and sensitive outcome measures are needed to facilitate comparisons of results from different studies.
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Affiliation(s)
- Huan Zhang
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Yuanfei Liu
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Jingya Ma
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
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In Pursuit of an Effective Treatment: the Past, Present and Future of Clinical Trials in Inclusion Body Myositis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-020-00169-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of review
No clinical trial in sporadic inclusion body myositis (IBM) thus far has shown a clear and sustained therapeutic effect. We review previous trial methodology, explore why results have not translated into clinical practice, and suggest improvements for future IBM trials.
Recent findings
Early trials primarily assessed immunosuppressive medications, with no significant clinical responses observed. Many of these studies had methodological issues, including small participant numbers, nonspecific diagnostic criteria, short treatment and/or assessment periods and insensitive outcome measures. Most recent IBM trials have instead focused on nonimmunosuppressive therapies, but there is mounting evidence supporting a primary autoimmune aetiology, including the discovery of immunosuppression-resistant clones of cytotoxic T cells and anti-CN-1A autoantibodies which could potentially be used to stratify patients into different cohorts. The latest trials have had mixed results. For example, bimagrumab, a myostatin blocker, did not affect the 6-min timed walk distance, whereas sirolimus, a promotor of autophagy, did. Larger studies are planned to evaluate the efficacy of sirolimus and arimoclomol.
Summary
Thus far, no treatment for IBM has demonstrated a definite therapeutic effect, and effective treatment options in clinical practice are lacking. Trial design and ineffective therapies are likely to have contributed to these failures. Identification of potential therapeutic targets should be followed by future studies using a stratified approach and sensitive and relevant outcome measures.
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Abstract
Purpose of review The purpose of this paper is to comprehensively evaluate secondary causes of inflammatory myopathies (myositis) and to review treatment options. Recent findings This review highlights recent advancements in our understanding of known causes of myositis, including newer drugs that may cause myositis such as checkpoint inhibitors and viruses such as influenza, HIV, and SARS-CoV2. We also discuss treatment for malignancy-associated myositis and overlap myositis, thought to be a separate entity from other rheumatologic diseases. Summary Infections, drugs, rheumatologic diseases, and malignancies are important causes of myositis and are important to diagnose as they may have specific therapies beyond immunomodulatory therapy.
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Affiliation(s)
- Sarah H Berth
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Thomas E Lloyd
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
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Coordination of Locomotor Activity in Transgenic C57Bl/6 Mice with Hereditary Neuropathy. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Glaubitz S, Zeng R, Schmidt J. New insights into the treatment of myositis. Ther Adv Musculoskelet Dis 2020; 12:1759720X19886494. [PMID: 31949477 PMCID: PMC6950531 DOI: 10.1177/1759720x19886494] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
The myositis syndromes include polymyositis, dermatomyositis (DM), necrotizing myopathy, inclusion body myositis (IBM), antisynthetase syndrome and overlap syndromes with myositis. These syndromes mostly occur in middle-aged patients, while juvenile DM occurs in children and adolescents. Patients mostly show a subacute weakness and myalgia in the upper and lower limbs, the diagnosis is based upon these clinical findings in combination with muscle biopsy results and specific serum autoantibodies. In recent years, research achieved a better understanding about the molecular mechanism underlying the myositis syndromes, as well as disease progress and extramuscular organ manifestations, such as interstitial lung disease and association with neoplasias. Treatment mainly consists of glucocorticosteroids and immunosuppressants. IBM is usually refractory to treatments. This review provides an overview of the current standards of treatment and new treatment options like monoclonal antibodies and new molecular therapies and their first results from clinical trials.
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Affiliation(s)
- Stefanie Glaubitz
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - Rachel Zeng
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Robert-Koch-Sr. 40, 37075 Göttingen, Germany
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Ramdharry G, Bull K, Jeffcott R, Frame A. An expert opinion: Rehabilitation options for people with polyneuropathy. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2020. [DOI: 10.47795/euni7797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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