Supervised Physical Therapy and Polymyositis/Dermatomyositis—A Systematic Review of the Literature

Abstract

Objective: to find the most up-to-date evidence of the effectiveness and safety of supervised physical therapy in polymyositis/dermatomyositis patients. Methods: a systematic review of the literature in the main scientific databases was carried out. We searched for randomized controlled trials concerning supervised physical therapy and polymyositis/dermatomyositis. The PICOS method was used for the formulation of the clinical query. Methodological quality and the level of evidence of the included studies were assessed using the modified Jadad scale and the Oxford Centre for Evidence-Based Medicine Levels of Evidence guide, respectively. Results: a total of 2591 articles were found. By applying the inclusion/exclusion criteria, six randomized controlled clinical trials were admitted to the final phase of the review. The compared approaches concerned supervised exercise programs based on strategies of muscle strengthening or aerobic work. Following these exercises, an increase in the maximum rate of oxygen consumption, a decrease in creatine phosphokinase levels, an enhancement in the patient’s aerobic performance and an improvement in the quality of life indexes were registered. The methodological quality of the included studies ranged from 3 to 4.5. All the studies were classified as presenting an evidence level of 2b. Conclusions: supervised physical therapy in polymyositis/dermatomyositis is an effective, safe and free-of-contraindications tool to be used both in the acute and in the established phases of the pathology. However, further and higher-quality studies are necessary to confirm those findings, to clarify the timing of exercise delivery and to guide the choice towards different types of muscle contraction exercises.

Rehabilitation and Exercise in Dermatomyositis: A Case Report and Narrative Review of the Literature

“…The institution of an early rehabilitation program appears to have beneficial effects, with a positive impact on functionality and independence. This fact contradicts the classic belief that performing exercise may enhance muscle inflammation and increase CK levels, aggravating muscle weakness and fatigue [1,4]. The increase in CK blood levels with consequent normalization after 24 hours is a normal acute response to exercise, but there are no studies that support this idea [4].…”

“…According to some studies, exercise increases the performance of patients with DM by improving aerobic muscle metabolism [1,4,[10][11][12][13][14] increasing maximum VO 2 values, and improving mitochondrial enzymatic activity and oxygen supply from the skeletal muscle. In one of these studies, Munter et al [11] found that there was an activation of the aerobic phenotype and a decreased inflammatory response, through the positive regulation of molecular pathways involved in aerobic capacity, muscle remodeling, and increased capillary density, improved mitochondrial function, and ATP production.…”

“…Idiopathic inflammatory myopathies are a heterogeneous group of rare multisystemic immune-mediated diseases with infiltration of skeletal muscle tissue by autoantibodies [ 1 ], with consequent fatigue and decreased muscle strength. This group includes dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM), overlapping myositis, and autoimmune necrotizing myositis [ 2 ], which are often associated with other immune-mediated diseases and neoplasms.…”

“…The clinical course is characterized by an insidious onset of muscle fatigue, atrophy, and symmetrical muscle weakness (proximal muscles of the upper and lower limbs, cervical flexors, pharyngeal and respiratory muscles) [ 2 ], with specific dermatological manifestations [ 5 ] (Gottron’s sign and papules, heliotrope erythema, poikiloderma with “shawl” sign), as well as symmetric joint involvement (usually small joints). In more severe cases, it may also be accompanied by dysphagia with an increased risk of aspiration pneumonia, cardiovascular dysfunction (arrhythmias, myocarditis, endocarditis in the chronic setting) [ 1 ], and respiratory dysfunction (restrictive syndrome).…”

“…Pharmacological treatment includes high-dose corticosteroid therapy (with progressive weaning depending on clinical evolution) and immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, or biological agents such as rituximab [ 6 ]. Integration into a rehabilitation program can enhance the functional prognosis by improving muscle strength and performance [ 1 , 2 ], preventing disuse atrophy [ 1 ], improving aerobic and functional capacity, and decreasing disease activity [ 2 ]. The molecular mechanisms of these effects are not completely known but can be partially explained by the inhibition of genes associated with inflammation and fibrosis and the upregulation of genes associated with aerobic metabolism in muscle tissue [ 2 ].…”