Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis

Abstract

Exercise for patients with amyotrophic lateral sclerosis (ALS) can be expected to improve function at the early stage of disease, but improvement cannot be expected at the late stage. However, no report has investigated the correlation between the effect of exercise and time since onset. This study examined the relevance between the effect of muscle strengthening exercise and time since onset in patients with ALS.This study is a retrospective nonconsecutive case series study at a single university hospital. We included 2 patients with ALS who were admitted twice. Case 1 was a 60-year-old man with the bulbar type. He was hospitalized 10 months (ALS functional rating scale-revised, 42 points) and 1 year and 8 months (33 points) after onset. Case 2 was a 52-year-old man with the lower limb type. He was hospitalized 1 year and 3 months (44 points) and 1 year and 8 months (33 points) after onset. Physical therapy was implemented daily on weekdays for approximately 30 minutes. The intervention period was 2 weeks. Lower limb muscle strengthening exercises were mainly performed and exercise intensity was adjusted to a modified Borg Scale score of 5 (lower limbs). The study investigated knee extension muscle strength (KEMS) by using a hand-held dynamometer and Functional Ambulation Categories (FAC) at the start and end of physical therapy during each hospitalization.KEMS improved during the initial hospitalization in both patients, and FAC improved in Case 2; neither KEMS nor FAC improved during rehospitalization in either patient. In Case 1, KEMS was maintained for 10 months.The current results suggest that the positive effect of muscle strengthening exercise is greater at the early stage and may be maintained in patients with bulbar type ALS. In addition, improvement can be achieved approximately 1 year after onset and in patients with an ALSFRS-R score of 40 points or more. Therefore, it is necessary to initiate and continue exercise earlier after onset.

The Role of Exercise as a Non-pharmacological Therapeutic Approach for Amyotrophic Lateral Sclerosis: Beneficial or Detrimental?

“…Specifically, Merico et al found that 5 week moderate, submaximal resistance and endurance training improved the functional independence, oxygen consumption, fatigue and muscle strength in ALS patients (105). The positive effects of combined endurance and resistance training in ALS patients were also confirmed in a retrospective, non-consecutive case series study (106). In this study, 2 week endurance training on a cycle ergometer combined with lower-body resistance training appeared feasible and beneficial for ALS patients improving their muscle strength at the early stage of disease but not at the late stage of disease (106).…”

“…The positive effects of combined endurance and resistance training in ALS patients were also confirmed in a retrospective, non-consecutive case series study (106). In this study, 2 week endurance training on a cycle ergometer combined with lower-body resistance training appeared feasible and beneficial for ALS patients improving their muscle strength at the early stage of disease but not at the late stage of disease (106). Given that initial improvements in muscle strength, especially among untrained people, are explained mainly by the increased voluntary neural activation of the trained muscles and not by muscle hypertrophy which has a gradually increasing role in strength development as the training proceeds (after the first 3 to 5 weeks) (107, 108), a longer exercise intervention (>5 weeks) could induce further and greater skeletal muscle adaptations in ALS patients at either early or late stage of disease.…”

“…Given that initial improvements in muscle strength, especially among untrained people, are explained mainly by the increased voluntary neural activation of the trained muscles and not by muscle hypertrophy which has a gradually increasing role in strength development as the training proceeds (after the first 3 to 5 weeks) (107, 108), a longer exercise intervention (>5 weeks) could induce further and greater skeletal muscle adaptations in ALS patients at either early or late stage of disease. In addition, while encouraging, these findings should be interpreted carefully considering the lack of statistical analysis due to the very small sample size ( n = 2) used in this study (106). An overview of the effects of concurrent endurance and resistance training in ALS patients is summarized in Table 5.…”

“…Despite mild-to-moderate exercise training improving the survival of ALS mice, currently, there is no clinical evidence supporting this notion in ALS patients (48). Regardless, most clinical studies suggest that every type of exercise training including stretching, resistance, endurance or concurrent training, has an advantageous impact on the quality of life of ALS patients increasing mainly their functionality (47, 48, 91–93, 103, 105) and sometimes their muscle strength (105, 106) and/or their cardiorespiratory function (91, 93, 105). The discrepancy between preclinical and clinical findings could be partly explained by the limitations observed in most of clinical studies in ALS, such as a small sample size, non-representative control populations, inadequate control of confounders and heterogeneous disease stage of patients.…”

Rehabilitation bei Amyotropher Lateralsklerose

“…Die Übungsbehandlung bei der ALS wurde in der Vergangenheit kontrovers diskutiert, da es sich um eine fortschreitende Erkran kung handelt [16]. Die Übungsbehandlung kann bei ALS nur in der frühen Phase der Erkrankung zu einem Zugewinn an Kraft führen [17]. Mittlerweile ist ein größeres Spektrum an Methoden unter sucht worden, beispielsweise aerobes Steppen mit zurückgelehn tem Oberkörper ("recumbent stepping") [18], aerobes Ergometer training [19], Gangtrainer mit Gewichtsentlastung [20]…”