Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial

Jørgensen, Anders Nørkær; Aagaard, Per; Boyle, Eleanor; Diederichsen, Louise Pyndt

doi:10.1080/03009742.2017.1423109

Cited by 46 publications

(154 citation statements)

References 44 publications

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“…However, numerous facets of LL‐BFR exercise training have yet to be thoroughly investigated. Clinical studies involving this exercise modality in various patient groups remain somewhat sparse . Parameters such as self‐exercise feasibility and user's perception of the exercise modality, as listed by ACSM to optimize exercise compliance, have yet to be investigated in relation to BFR training protocols.…”

Section: Discussionmentioning

confidence: 96%

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Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Grønfeldt

Nielsen

Mieritz

et al. 2020

Scandinavian Med Sci Sports

113

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Introduction Heavy‐load strength training (HLT) is generally considered the Gold Standard exercise modality for inducing gains in skeletal muscle strength. However, use of heavy external exercise loads may be contraindicative in frail individuals. Low‐load resistance exercise combined with partial blood‐flow restriction (LL‐BFR exercise) may offer an effective alternative for increasing mechanical muscle strength and size. The aim of this study was to compare the effect of LL‐BFR training to HLT on maximal muscle strength gains. Prospero registration‐id (CRD42014013382). Materials and methods A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post‐intervention changes in maximal muscle strength. A random‐effects meta‐analysis with standardized mean differences (SMD) was used. Results Of 1413 papers identified through systematic search routines, sixteen papers fulfilled the inclusion criteria, totalling 153 participants completing HLT and 157 completing LL‐BFR training. The magnitude of training‐induced gains in maximal muscle strength did not differ between LL‐BFR training and HLT (SMD of −0.17 (95% CI: −0.40; 0.05)). Low between‐study heterogeneity was noted (I2 = 0.0%, Chi2 P = 9.65). Conclusion Low‐load blood‐flow‐restricted training appears equally effective of producing gains in maximal voluntary muscle strength compared to HLT in 20‐ to 80‐year‐old healthy and habitually active adults.

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Section: Discussionmentioning

confidence: 96%

“…Clinical studies involving this exercise modality in various patient groups remain somewhat sparse. 24,[54][55][56][57] Parameters such as T A B L E 2 Percentage changes in muscle cross-sectional area (CSA) or muscle thickness (MT) measured with either circumference measurement, magnetic resonance imaging (MRI), or ultrasonography (US)…”

Section: Discussionmentioning

confidence: 99%

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Grønfeldt

Nielsen

Mieritz

et al. 2020

Scandinavian Med Sci Sports

113

View full text Add to dashboard Cite

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“…Over the last two decades, many studies have been conducted to investigate safety and effects of exercise in adults with myositis, with the majority focusing on polymyositis and dermatomyositis [ 5 , 7 – 33 , 34 ••, 35 •, 36 ••]. The emerging evidence supports exercise as a safe and effective treatment to optimize health and reduce disability in adult patients with myositis.…”

Section: Introductionmentioning

confidence: 99%

“… CON (altered expr. In 227 genes) Upregulation: IFN signaling, apoptosis Jörgensen A et al 2017/case report [ 35 •] IBM, n = 1 Blood-flow restricted quadriceps resistance training, cuff pressure 100 mmHG/12 weeks 25 VRM/4–5 45 s bouts CK: unchanged Quadriceps IMVC: + 60% Quadriceps CPM: unchanged knee AROM: + 68% 10-m max gate speed: + 19% TUG: Unchanged – Jörgensen A et al 2018/RCT [ 36 ••] IBM, n = 22 BFR, n = 11 CON, n = 11 Blood-flow restricted resistance quadriceps training, cuff pressure 110 mmHG/12 weeks 25 VRM/4–5 45 s bouts MDAAT: Pat. Global BFR/CON: unchanged Phys.…”

Section: Introductionmentioning

confidence: 99%

“…Two case reports exploring feasibility of blood-restricted resistance training (BRF) in sporadic inclusion body myositis indicated positive effects on muscle strength [ 22 , 35 •]. A randomized controlled trial from group in Denmark was not able to show improvement in self-reported or objectively assessed function in the exercise group compared to the control group [ 36 ••]. However, there was a striking significant time effect difference regarding knee extensor muscle strength in favor for the exercise group which was unchanged (+ 5.8%) while the control group worsened (− 9.2%).…”

Section: Introductionmentioning

confidence: 99%

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Exercise in Myositis

Alexanderson

2018

Curr Treat Options in Rheum

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Purpose of the reviewA growing body of evidence supports exercise as a very important part of the treatment for adult patients with idiopathic inflammatory myopathies (IIM). This review mainly focuses on exercise studies published during the last 2 years in adult myositis.Recent findingsDuring the last couple of years, new publications present further evidence for intensive endurance exercise as an anti-inflammatory treatment inducing muscle growth and improving mitochondrial function compared a non-exercising control group. Further, blood-flow restricted resistance training was effective to maintain muscle strength compared to a non-exercising control group which lost a mean of 9.2% in quadriceps strength over 3 months in inclusion body myositis. Another study evaluates the effects of intra-muscular injections of an isoform of follistatin (FS344) by AAV1 in combination with exercise in a small group of patients with inclusion body myositis. An improvement in physical capacity was associated to higher exercise levels. Less is known about exercise effects in patients with recent onset, active polymyositis, and dermatomyositis.SummaryAll studies report safety of exercise in all types and stages of myositis and exercise could now be considered as medicine. It is recommended to initiate exercise on a low intensity under supervision of a physical therapist with regular follow-up and progression of intensity over time.

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Expert Perspective: Management of Refractory Inflammatory Myopathy

undberg

2021

Arthritis & Rheumatology

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The idiopathic inflammatory myopathies (IIMs) are chronic disorders characterized by inflammation in skeletal muscle but also in other organs such as the skin, lungs, joints, gastrointestinal tract, and heart. The effect of immunosuppressive treatment varies between individual patients and between organ manifestations within the same individual. Many patients respond poorly to first-line treatment with glucocorticoids and other immunosuppressive agents such as methotrexate or azathioprine, with symptoms persisting in the muscles, skin, and lungs, leading to refractory disease. Management of refractory IIM is a clinical challenge, and a systematic approach is proposed to better understand the lack of treatment response, in order to guide disease management. The first step in the management of refractory IIM is to recognize whether remaining symptoms are caused by persistent inflammation in the affected tissue or whether the symptoms may be attributable to damage preceding inflammation. Thus, a second diagnostic examination is recommended. Second, in particular for patients with remaining muscle weakness, it is important to ascertain whether the diagnosis of myositis is correct or whether another underlying muscle disorder could explain the symptoms. Third, with confirmation of remaining inflammation in the tissues, a strategy to change treatment needs to be undertaken. Few controlled trials are available to guide our treatment strategies. Furthermore, different subgroups of patients may benefit from different therapies, and different organ manifestations may respond to different therapies. In this context, subgrouping of patients with IIM based on autoantibody profile may be helpful, as there are emerging data from open studies and case series to support the notion of a varying treatment response in different autoantibody-defined subgroups of IIM patients. Clinical challengeThe index patient, a 38-year-old woman, presented with weakness of the proximal leg muscles, elevated creatine kinase (CK) levels (5 times the upper limit of normal), signs of myopathy on electromyogram, and atrophy of the gluteus muscles on magnetic resonance imaging (MRI). A biopsy sample from the thigh muscle showed some fiber size variation and internal nuclei, but otherwise normal histopathology. She was diagnosed as having polymyositis (PM). Despite having received treatment with high-dose glucocorticoids in combination with azathioprine followed by cyclosporine (methotrexate treatment was excluded due to pregnancy planning) and despite a routine of regular physical exercise, the patient's muscle weakness progressed and she developed atrophy of her hamstring muscles-a refractory myopathy.

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Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial

Cited by 46 publications

References 44 publications

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Exercise in Myositis

Expert Perspective: Management of Refractory Inflammatory Myopathy

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