Muscular dystrophy is an umbrella term for a group of conditions which are progressive inherited diseases caused by mutations in genes which are involved in muscle function. Examples include Duchenne Muscular Dystrophy and Becker muscular dystrophy.
The muscular dystrophy’s can vary greatly in ethology and presentation however the majority of forms cause muscle weakness and muscular atrophy which causes fatigue and limitations to daily life.
Currently there is no known cure for any of the muscular dystrophies with a focus on symptom management and delaying the onset or progression of symptoms. Often exercise and rehabilitation forms the mainstay of a persons treatment however it is debated as to how beneficial this is.
The role of exercise and strength training is controversial because there are two plausible yet conflicting answers. Muscular dystrophy results in a progressive loss of muscle mass and strength, exercise may then be considered harmful because it can induce damage, inflammation and failure of the muscles to repair themselves. That being said the lack of physical activity may lead to functional loss, weight gain, fatigue and an exacerbation and an acceleration of the effects of muscular dystrophy.
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Randomized control trials investigating the effects of exercise programmes for those living with muscular dystrophies largely have inconclusive outcomes and tend to be limited in size and scope due to the rarity of the conditions as well as the variation in the conditions themselves limiting applicability.
A new systematic review has been published in Frontiers of Neurology with the aim of seeing if there is any further developments in our understanding of the beneficial or negative effects of exercise as a treatment option for those living is muscular dystrophies.
PROSPERO registered and PRISMA guidelines were adhered to. Only RCTs were searched for involving Duchenne’s muscular dystrophy, Becker’s muscular dystrophy, limb-girdle dystrophy, facio-scapula-numeral dystrophy and myotonic dystrophy.
Exercise could be any form of strength training or exercise expressed as peak torque, endurance or fatigue. Studies were only included if the control was usual care or no caste at all. If it was suspected that the control influenced the exercise arm the study was excluded. This included the cross-education phenomenon.
It is great to see that language was not a eligibility restriction, nor was patient age or type of publication. The search strategy was not published within the pain article but could well have been in the supplementary materials however I had difficulty accessing the file. Midline, embassy, Web of Science, Scopus and Pedro databases were all accessed and reference lists of relevant trials was also screened.
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Two researchers were available to screen the studies for eligibility with a third to resolve disagreement by consensus. A TIDieR checklist was used to record key descriptions of the articles. All of the main information taken from the articles were readily available in the main table in the article.
Risk of Bias was assessed using Cochran’s risk of bias tool and the certainty of the evidence was evaluated using the GRADE framework. In total 584 patients from 13 RCTs were included within the review. The median exercise period was 16 weeks (8 up to 52).
Results and Clinical Importance
In summary exercise does not seem to be counter productive for patients living with muscular dystrophy’s and the most benefit seems to come from endurance training with particular carry over to walking. This is where clinicians should focus the aims of the exercise plans for patients with muscular dystrophy.
Due to the limitation of the reporting of strength training it is more difficult to draw even weak conclusions about the benefits of this type of training. This is definitely an area for future research, specifically dose, intensity and duration of exercise. If clinicians are to use strength training as a treatment option it is recommended that it is low paces and performed gradually to reduce the risk of adverse effects.
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