The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS

Abstract

Introduction The efficacy of cardiopulmonary exercise testing (CPET) to determining exercise intensity has not been established in Amyotrophic Lateral Sclerosis (ALS). We studied this intervention. Methods We included 48 ALS patients randomized in 2 groups: G1 (n = 24), exercise intensity leveled by CPET; G2 (n = 24), standard care limited by fatigue, during 6 months. ALS functional scale (ALSFRS-R) and forced vital capacity (FVC) were performed every 3 months; CPET was done at admission (T1) and 6 months later (T2). We registered oxygen uptake, carbon dioxide output, and ventilation at anaerobic threshold and at peak effort. Primary outcome was functional change. We used parametric statistics for comparisons and multiple regression analyses to identify independent predictors of functional decline. Results At T1 both groups were identical, except for higher FVC in G1 (p = 0.02). At T2, ALSFRS-R was higher (p = 0.035) in G1. Gas exchange variables at T2 did not change in G1 but had significant differences in G2 (p < 0.05). Multiregression analyses showed the Spinal ALSFRS-R slope and Intervention group (p < 0.001) as significant predictors of ALSFRS-R at T2. Conclusion Aerobic exercise defined by CPET is feasible and can improve functional outcome in ALS. This trial is registered with Clinical trials.gov ID: NCT03326622.

Intentions of Canadian health professionals towards recommending exercise to people living with ALS

“…A barrier for physicians at the time of data collection was lack of evidence of benefit of exercise. In addition to the results of [16], where no statistical benefit was shown, two other recent exercise trials have reported reduced rates of functional decline associated with aerobic or combined aerobic and strengthening exercise [15,39]. Ideally a metaanalysis and update of the Cochrane review [14] will provide clarity on the issue of benefit of exercise for pALS.…”

Can Therapeutic Exercise Slow Down Progressive Functional Decline in Patients With Amyotrophic Lateral Sclerosis? A Meta-Analysis

“…Regarding these different results in the respiratory and limb motor function scores, we can suggest a possible explanation. Most of ALS patients who were included in meta-analysis study were limb-onset ALS (74.3%, 162/218) (20,24,25). For this reason, we think the patients participated in these studies would have weakness mainly in limb muscles, but less in respiratory muscles.…”

Intentions of Canadian health professionals towards recommending exercise for people living with ALS

“…A barrier for physicians at the time of data collection was lack of evidence of benefit of exercise. In addition to the results of [16], where no statistical benefit was shown, two other recent exercise trials have reported reduced rates of functional decline associated with aerobic or combined aerobic and strengthening exercise [15,39]. Ideally a meta-analysis and update of the Cochrane review [14] will provide clarity on the issue of benefit of exercise for pALS.…”