Muscular dystrophy is an umbrella term for a group of diseases that are progressive hereditary diseases caused by mutations in genes that are involved in muscle function. Examples are Duchenne muscular dystrophy and Becker muscular dystrophy.
Muscular dystrophy can vary widely in ethology and presentation, but most forms cause muscle weakness and muscle atrophy, which leads to fatigue and restrictions in daily life.
There is currently no known cure for any of the muscular dystrophies that focus on symptom management and delaying the onset or progression of symptoms. Often exercise and rehabilitation are the mainstays of personal treatment, but there is some debate as to how useful this is.
The role of exercise and strength training is controversial as there are two plausible but contradicting answers. Muscular dystrophy leads to a progressive loss of muscle mass and strength. Exercise can then be viewed as harmful as it can cause damage, inflammation, and failure of muscles to repair themselves. However, the lack of physical activity can lead to loss of function, weight gain, fatigue, and exacerbation and acceleration of the effects of muscular dystrophy.
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Randomized control studies examining the effects of exercise programs on people with muscular dystrophies have for the most part inconclusive results and are limited in size and scope due to the rarity of the conditions as well as the variation in the conditions themselves which limit applicability.
A new systematic review was published in Frontiers of Neurology to see if there are further developments in our understanding of the beneficial or negative effects of exercise as a treatment option for living people who are muscular dystrophies.
Methods
PROSPERO registered and PRISMA guidelines followed. Only RCTs were searched for in which Duchennes muscular dystrophy, Becker's muscular dystrophy, limb girdle dystrophy, facio-scapular digit dystrophy and myotonic dystrophy were involved.
Exercise can be any form of strength training or exercise expressed as maximum torque, endurance or fatigue. Studies were only included when control was common diligence or no caste at all. If the control was suspected of affecting the exercise arm, the study was excluded. This included the phenomenon of cross-education.
It is great to see that the language was neither an eligibility restriction nor the patient's age or manner of publication. The search strategy was not published in the pain article, but it could have been included in the supplementary materials, but I had difficulty accessing the file. The Midline, Embassy, Web of Science, Scopus and Pedro databases were accessed and reference lists of relevant studies were also screened.
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Two researchers were available to check the studies for their suitability, a third to resolve differences of opinion by consensus. A TIDieR checklist was used to record important descriptions of the items. All of the main information from the articles was readily available in the main table of the article.
Risk of bias was assessed using the Cochran Risk of Bias tool, and the certainty of evidence was assessed using the GRADE framework. A total of 584 patients from 13 RCTs were included in the review. The mean exercise time was 16 weeks (8 to 52).
Results and clinical significance
In summary, exercise does not seem to be counterproductive for patients with muscular dystrophy, and the greatest benefit seems to come from endurance training with a particular transfer to walking. This is where clinicians should focus the goals of exercise plans for patients with muscular dystrophy.
Because of the limited coverage 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, especially dose, intensity, and duration of the workout. If clinicians are to use strength training as a treatment option, it is recommended that the pace be slow and gradual to reduce the risk of side effects.
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