Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach

Abstract

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression 1 . Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients 2,3 . Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life 4 . Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population. Protocol Determination of full vascular occlusion pressure Resistance training with vascular occlusion DiscussionWe presented a novel, and likely the first, non pharmacological therapeutic tool able to counteract the muscle atrophy and decline of strength that usually occurs in patients with IBM under conventional treatment. Resistance training with vascular occlusion is a relatively novel training method, but results are very encouraging. We have found that after a 12-wk training program, an IBM patient's leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. Health Survey Questionnaire subscales demonstrated improvements ranging from 18% to 600% and mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold 4,5 . This video describes in details the protocol of a resistance training program with vascular occlusion for this population. The appropriate determination of full vascular occlusion pressure is essential for the correct implementation of this training modality and it may be applied to any patient undergoing regular resistance exercise program. Equipments required consist of a vascular Doppler, two customized tourniquets cuffs with pressure manometers and a regular training facility. Moreover, we recommend that each training session is supervised by at least one physical trainer in order to ensure the safety and efficacy of the proposed method. 1. In order to determine the blood pressure of vascular occlusion, in mmHg, a vascular Doppler is used 2. The patient lies in a supine position while a customized blood pressure cuff (180mm length x 80mm width) is fixed on his thigh. 3. After detection of the tibial artery location, the Doppler's probe is then placed over the determined spot in the patient's leg. 4. A sound signal is generated by the Doppler machine as it captures the artery pulse. 5. The customized blood...

Resistance Exercise Performed at Different Degrees of Arterial Occlusion Pressure does not Induce Prolonged Oxidative Stress or Muscle Damage

“…Using elastic bands, Wilson, et al [27] observed a significant elevation in the determinants of hypertrophy without identifying significant elevations in the indicators of muscle damage (muscle soreness, muscle swelling and power) up to 24 h post-exercise. This supports the idea of using BFR resistance exercise as an effective alternative for promoting significant enhancements in the levels of strength and hypertrophy for those who are unable to train at high loads [28,29]. It also supports the relative safety of this method of training [30].…”

Blood Flow Restricted Resistance Training Attenuates Myostatin Gene Expression in a Patient With Inclusion Body Myositis

“…In order to assess the expression of genes related to MSTN signalling, muscle samples previously obtained from an IBM patient who underwent a 12-week BFRRT programme were utilized [9, 10]. BFRRT was chosen because this training mode is effective in increasing muscle mass while using low exercise loads [14].…”

Effects of leucine supplementation and resistance exercise on dexamethasone-induced muscle atrophy and insulin resistance in rats

“…In animal models, despite the limitations of the RE models and protocols, some studies have also observed attenuation of muscle atrophy under catabolic conditions such as muscle disuse [12][13][14][15][16]. Furthermore, we recently demonstrated in a case report that chronic RE with vascular occlusion attenuated the loss of skeletal muscle functionality (strength) in a subject with body inclusion myositis [17]. RE also promotes the therapeutic role of glucose homeostasis, because mechanical stimuli are widely known to improve glucose uptake to skeletal muscle through glucose transporter-4 (GLUT4) translocation to the sarcolemma [18].…”