Physical training and exercise in myasthenia gravis

Gilhus, Nils Erik

doi:10.1016/j.nmd.2020.12.004

Cited by 17 publications

(8 citation statements)

References 37 publications

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“…MG is exacerbated by anesthetic drugs, postoperative respiratory tract inflammation, emotional alterations, and increased autoantibody release, resulting in weak cough and expectoration, respiratory weakness, dyspnea, pneumonia, and atelectasis, and can even induce MG crisis [ 5 , 21 , 22 ]. Although there were ten intervention studies of the safety and usefulness of systematic training in MG patients, and three of them on respiratory muscles [ 23 ], it is unclear whether active training of respiratory muscle groups can improve their postoperative strength and reduce postoperative respiratory complications in patients with MG. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to chest physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG, and showed that RMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis

Chen

et al. 2023

J Cardiothorac Surg

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Objective The effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients surgically treated for myasthenia gravis (MG) remain unclear. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to respiratory physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG. Methods Eighty patients with MG scheduled for extended thymectomy were randomly divided into two groups. The 40 subjects in the study group (SG) received preoperative moderate-to-intense RMT and aerobic exercise in addition to respiratory physiotherapy, whereas the 40 subjects in the control group (CG) received only chest physiotherapy. Respiratory vital capacity (as determined by VC, FVC, FEV1, FEV1/FVC, and PEF) and exercise capacity (as determined by the 6-min walk test [6 MWT]) were measured pre- and postoperatively and before discharge. The duration of hospital stay and activity of daily living (ADL) were also determined. Results Demographic and surgical characteristics, along with preoperative vital capacity and exercise capacity, were similar in the two groups. In the CG, VC (p = 0.001), FVC (p = 0.001), FEV1 (p = 0.002), PEF (p = 0.004), and 6MWT (p = 0.041) were significantly lower postoperatively than preoperatively, whereas the FEV1/FVC ratio did not differ significantly. Postoperative VC (p = 0.012), FVC (p = 0.030), FEV1 (p = 0.014), and PEF (p = 0.035) were significantly higher in the SG than in the CG, although 6MWT results did not differ. ADL on postoperative day 5 was significantly higher in the SG than in the CG (p = 0.001). Conclusion RMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.

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Section: Discussionmentioning

confidence: 99%

Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis

Chen

et al. 2023

J Cardiothorac Surg

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“…However, in MG the muscle weakness increases with repeated muscle use, and because of this “overuse weakness” MG patients are sometimes recommended to abstain from exercise. Several controlled studies have demonstrated that physical training programs are safe in MG, and that muscle strength and daily function improve [ 34 ]. Four studies including a total of 60 MG patients with mild to moderate disease have examined the effect of systematic respiratory muscle training for 4–12 weeks [ 30 , 31 , 56 , 89 ].…”

Section: Methodsmentioning

confidence: 99%

Myasthenia gravis, respiratory function, and respiratory tract disease

Gilhus

2023

J Neurol

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Myasthenia gravis (MG) is characterized by muscle weakness caused by autoantibodies that bind to the postsynaptic membrane at the neuromuscular junction and impair acetylcholine receptor function. Weakness of respiratory muscles represents the most severe MG manifestation, and 10–15% of all patients experience an MG crisis with the need of mechanical ventilatory support at least once in their life. MG patients with respiratory muscle weakness need active immunosuppressive drug treatment long term, and they need regular specialist follow-up. Comorbidities affecting respiratory function need attention and optimal treatment. Respiratory tract infections can lead to MG exacerbations and precipitate an MG crisis. Intravenous immunoglobulin and plasma exchange are the core treatments for severe MG exacerbations. High-dose corticosteroids, complement inhibitors, and FcRn blockers represent fast-acting treatments that are effective in most MG patients. Neonatal myasthenia is a transient condition with muscle weakness in the newborn caused by mother’s muscle antibodies. In rare cases, treatment of respiratory muscle weakness in the baby is required.

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“…Considering the limitations of current therapies, attempts are being made to explore the potential of complement inhibition therapy [ 107 ], biomolecules targeting B-cell, T-cell, cytokine, and Fc receptor, novel antibody molecules, cell therapy including such as Chimeric Antigen Receptor-T (Car-T) Cell Therapy (CART), and nucleic acid technology like antisense technology to provide desired improved treatment for MG [ 12 , 108 ]. In addition, the prospects of traditional medicine and regular exercise are also under evaluation for their role in improving the quality of life (QoL) of MG patients [ 109 , 110 ]. These developments in current and novel treatments ( Table 1 ) have been discussed in the next sections.…”

Section: Traditional Current and Emerging Therapeutic Approaches For ...mentioning

confidence: 99%

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

Huang¹,

Wu²,

Wang³

et al. 2022

Aging and disease

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The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.

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Physical training and exercise in myasthenia gravis

Cited by 17 publications

References 37 publications

Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis

Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis

Myasthenia gravis, respiratory function, and respiratory tract disease

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

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