Exercise in Myositis

Abstract

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.

The effect of a 24-week training focused on activities of daily living, muscle strengthening, and stability in idiopathic inflammatory myopathies: a monocentric controlled study with follow-up

“…Data in A and C are presented as the mean ± standard error of the mean (whiskers). Data in the tree diagrams (B and D) present the percentage distribution of patients by outcome, which is stratified into five levels of improvement/deterioration over weeks 0-24. w, week; p*, unadjusted inter-group comparison by two-way ANOVA; p, unadjusted intra-group comparison by one-way ANOVA in black (IG) and gray (CG); p †, difference in the overall distribution in five levels of the patient outcome by chi-square test; p ‡, difference in the category of clinically meaningful improvement by chi-square test To date, studies on non-pharmacological interventions in IIM have provided evidence of efficacy for various interventions and employed a broad spectrum of outcome measures [9][10][11][12][13][14][15]. For indirect comparison, we focus on the top 12 published studies ranked by quality in the recent systematic review by Van Thillo et al [13], which comprised five randomized controlled trials (RCTs) [37][38][39][40][41] and seven non-randomized non-controlled trials (nRnCTs) [42][43][44][45][46][47][48].…”

“…However, regular physical therapy is often unavailable to the patients, due to the lack of experienced physiotherapists with experience and specific skills required for treating IIM patients. Although it has long been feared that physical exercise exacerbates muscle inflammation and consequently aggravates the clinical manifestations of IIM, over the past years, rehabilitative treatment of IIM has gained increasing attention and demonstrated to be safe and effective to a varying extent [ 9 , 10 ]. However, only a limited number of studies on the subject are published.…”

“…However, only a limited number of studies on the subject are published. These studies assess the effect of a broad range of treatment modalities and their combinations with various outcomes and are often limited by a small number of patients, short period of intervention, and lack of a control group, follow-up, or a blinded assessor [9,10]. To our knowledge, five systematic reviews provide a comprehensive overview of the already existing evidence on the effect and safety of non-pharmacological interventions in IIM and analyze the quality and limitations of the published studies [11][12][13][14][15].…”

Entwicklung eines Trainingsleitfadens für Patienten mit entzündlicher Muskelerkrankung

“…Zur Erstellung konkreter Trainingsrichtlinien für ein Kraft-und Ausdauertraining bei Patienten mit IM, erfolgte ein Rückgriff auf die langjährige klinische Erfahrung der Physiotherapeuten des Myositisteams im Universitätsspital Zürich, auf Trainingsrichtlinien des American College of Sports Medicine (ACSM) [18] sowie auf eine aktuelle narrative Übersichtsarbeit zum Thema [22]. Die Erstellung der Trainingsrichtlinien orientierte sich an der Checkliste zur Qualitätsbeurteilung von Leitlinien, AGREE Instrument (Appraisal of Guidelines, Research & Evaluation), die sechs Bereiche mit insgesamt 23 Elementen enthält [23].…”

Sexual function in patients with idiopathic inflammatory myopathies: a cross-sectional study

“…Serious clinical manifestations of myositis are often associated with significant impairment of health-related quality of life (HRQoL) [ 3 ]. Despite clinical improvement following pharmacotherapy, most patients develop persistent disability that affects all aspects of HRQoL, including sexual function [ 4 , 5 ].…”