A pilot randomised controlled trial of a home-based exercise programme aimed at improving endurance and function in adults with neuromuscular disorders

Abstract

Aim: To investigate the feasibility and effect of a home-based exercise programme on walking endurance, muscle strength, fatigue and function in people with neuromuscular disorders (NMDs). Methods: 20 adults with NMDs recruited to a control (n = 11) or exercise (n = 9) group were assessed by blinded assessors at baseline and at week 8. Walking and strengthening exercises were given to the exercise group in an 8-week home exercise programme. A 2-min walk distance was the main outcome measurement; isometric muscle strength, fatigue and function were secondary measurements. 1 Regular exercise leads to health and social benefits even in people with disease.2 The limited clinical research on adults with NMD suggests that they benefit from targeted aerobic and muscle training exercise programmes. These interventions may be effectively provided in the community setting 5 6 and are more effective if supported by a therapist. 7Patients with NMD in the UK receive specialist support from regional centres, which may be located some distance from their home. We developed a training programme that could be delivered with a single demonstration of exercises in the clinic, with follow-up support delivered through a leaflet and by telephone. We carried out a pilot investigation on the effect of an exercise programme on walking distance, specifically developed for the treatment of a range of NMDs in adults. We also investigated the effect on fatigue, isometric muscle strength and performance, and perceived ability in targeted functional activities. METHODParticipants were adults >16 years old, diagnosed with primary muscle disease and with an abnormal gait pattern attending a regional neuromuscular clinic, or those with a 10 m time exceeding the normal age-related time by >2 s, but able to walk 10 m without physical help (aids were permitted). People who had physical, cognitive, sensory or psychological impairments, or other conditions precluding full engagement with the experimental paradigm, were excluded. Informed consent was obtained before participation.On first assessment, the following measurements were obtained:

The Effectiveness of an Individualized, Home-Based Functional Exercise Program for Patients With Sporadic Inclusion Body Myositis

“…The patient-specific aspect of this study, and the prescription of exercise on a low-intensity, high-frequency basis, allowed the investigator to gently overload each patient while targeting the muscles primarily affected by the disease. 19 The protocol was well tolerated by all the patients and did not cause adverse muscle symptoms or elevation of serum CK levels. From interviews with the patients, it was generally felt by those who had previously had exercise therapy that this had been too strenuous and had resulted in muscle pain and increased levels of weakness and fatigue.…”

“…22 Home-based programs are easy to implement, are accessible to the patient, and encourage compliance. 19 The impaired mobility that typifies a patient with IBM gives a home-based exercise program obvious advantages over a class-based program-in particular, the safety and familiarity of exercising in their own home, the assistance and encouragement of partners, the flexibility to perform the exercises according to their own schedule, and the avoidance of arranging transport.…”

It’s more than just physical therapy: reported utilization of physiotherapy services for adults with neuromuscular disorders attending a specialist centre

“…Therefore, rather than being reliant on continuous physiotherapy input, clients are motivated to share the commitment to their physical wellbeing [23]. More time educating on home exercise programmes, collaborative goal setting between specialist physiotherapists and their clients and guidance on such issues as fatigue management could, when appropriate, endow clients with strategies to assist them to achieve this [8,24,25]. Nevertheless, the extent and progression of the condition, leading to differing client needs, will necessitate variability in intervention and hence frequency of attendance [26].…”

Physiotherapy, based on the Bobath concept, may influence the gait pattern in persons with limb‐girdle muscle dystrophy: a multiple case series study

“…Physiotherapy may be important in order to maintain as much muscle function as possible, and help the patients to function at their highest level within the constraints imposed by the disorders. Previous studies have shown that exercise can improve muscle strength and endurance in persons with LGMD and FSHD (van der Kooi et al, 2004; Olsen et al, 2005; Dawes et al, 2006; Sveen et al, 2007). However, to the best of our knowledge, no study has examined whether specific physiotherapy approaches (such as the Bobath concept) may influence the gait pattern in these patients.…”