Get access

Strength training and aerobic exercise training for muscle disease

  • Review
  • Intervention

Authors

  • Nicoline BM Voet,

    Corresponding author
    1. Radboud University Nijmegen Medical Center, Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Nijmegen, Netherlands
    • Nicoline BM Voet, Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, 6500 HB, Netherlands. N.Voet@reval.umcn.nl.

    Search for more papers by this author
  • Elly L van der Kooi,

    1. Medical Centre Leeuwarden, Department of Neurology, Leeuwarden, Netherlands
    Search for more papers by this author
  • Ingrid I Riphagen,

    1. Norwegian University of Science and Technology, Unit for Applied Clinical Research, Faculty of Medicine, Trondheim, Norway
    Search for more papers by this author
  • Eline Lindeman,

    1. Rehabilitation Centre Utrecht & University Medical Centre Utrecht, Utrecht, Netherlands
    Search for more papers by this author
  • Baziel GM van Engelen,

    1. Radboud University Nijmegen Medical Center, Neuromuscular Center Nijmegen, Nijmegen, Netherlands
    Search for more papers by this author
  • Alexander CH Geurts

    1. Radboud University Nijmegen Medical Center, Department of Rehabilitation, Nijmegen Center for Evidence Based Practice, Nijmegen, Netherlands
    Search for more papers by this author

Abstract

Background

Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease.

Objectives

To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease.

Search methods

We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (July 2009), the Cochrane Rehabilitation and Related Therapies Field Register (October 2002, August 2008 and July 2009), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009) MEDLINE (January 1966 to July 2009), EMBASE (January 1974 to July 2009), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2009).

Selection criteria

Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least 10 weeks.

For strength training
Primary outcome: static or dynamic muscle strength. Secondary: muscle endurance or muscle fatigue, functional assessments, quality of life, muscle membrane permeability, pain and experienced fatigue.

For aerobic exercise training
Primary outcome: aerobic capacity expressed as work capacity. Secondary: aerobic capacity (oxygen consumption, parameters of cardiac or respiratory function), functional assessments, quality of life, muscle membrane permeability, pain and experienced fatigue.

Data collection and analysis

Two authors independently assessed trial quality and extracted the data.

Main results

We included three trials (121 participants). The first compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared strength training versus no training, both combined with albuterol or placebo, in 65 people with facioscapulohumeral muscular dystrophy. The third trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. In the myotonic dystrophy trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. In the facioscapulohumeral muscular dystrophy trial only a +1.17 kg difference (95% confidence interval 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group.

Authors' conclusions

In myotonic dystrophy and facioscapulohumeral muscular dystrophy, moderate-intensity strength training appears not to do harm but there is insufficient evidence to conclude that it offers benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.

摘要

背景

肌肉疾病的力量訓練和有氧運動訓練

在肌肉疾病的患者,力量訓練或有氧運動可能可以提高肌肉和心肺功能,防止更多的廢用性萎縮。然而,過度施加可能會導致疾病進展更加迅速

目標

檢驗力量訓練和有氧運動訓練對肌肉疾病患者的效果及安全性

搜尋策略

我們搜尋Cochrane Neuromuscular Disease Group Trials Specialized Register (2009年7月); Cochrane Rehabilitation and Related Therapies Field Register (2002年10月、2008年10月及2009年7月); Cochrane Central Register of Controlled Trials (考科藍圖書館2009年第3期); MEDLINE (1966年1月至2009年7月); EMBASE (1974年1月至2009年7月); EMBASE Classic (1947−1973年); CINAHL (1982年1月至2009年7月)。

選擇標準

隨機或準隨機對照試驗,維持十周以上的力量訓練和/或有氧運動的療程。 成效評估的種類:對於力量訓練的評估:初級評估:靜態或動態肌肉力量。次級評估: 肌肉力量(肌耐力或疲勞度),功能評測,生活品質,肌膜通透性,疼痛和疲勞度。對於有氧運動訓練的評估: 初級評估:有氧容納力(以做功最大能力表示)。次級評估:有氧容納力(氧氣消耗,心臟或呼吸功能),功能評估,生活品質,肌膜通透性,疼痛和疲勞度。

資料收集與分析

兩位專家獨立回顧分析獨立臨床試驗的品質並提取數據

主要結論

我們確定了兩個隨機試驗符合納入標準。第一項試驗比較36例強直性肌肉失養症患者力量訓練與沒有接受訓練的差異。另一試驗比較了65例顏肩肱型肌肉失養症患者接受力量訓練,與不接受訓練但合併沙丁胺醇或安慰劑治療的差別。其試驗方法和訓練計劃均良好及適宜。 在強直性肌肉失養症的試驗,有無接受訓練在初級評估的結果並沒有顯著差異。在顏肩肱型肌肉失養症的試驗,有無接受訓練在靜態肌力沒有表現出顯著差異。在動態曲肘肌力方面,接受訓練的患者肌力增加了一點二公斤(95 %信賴區間0.2 ~ 2.1),達到統計學意義。對大部分次級成效的評估,包括副作用等,在兩個試驗都沒有顯著差異。

作者結論

在強直性肌肉失養症和顏肩肱型肌肉失養症患者,中等強度的力量訓練似乎沒有害處,但也沒有足夠的證據來證明它提供好處。這些試驗設計的局限性使得目前的結論無法應用在其他肌肉疾病上。

翻譯人

本摘要由新光醫院鍾禎智翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中等強度的力量訓練在強直性肌肉失養症和顏肩肱型肌肉失養症患者似乎不會傷害肌肉,但在其他肌肉疾病方面還需要更多的研究。 在肌肉疾病的患者,力量訓練或全面的有氧運動可能可以最大限度地提高肌肉和心肺功能,防止肌肉耗損。然而,過量運動可能會導致疾病進展更迅速。 本篇回顧發現只有兩個符合條件的臨床試驗。結果顯示中等強度的力量訓練在強直性肌肉失養症和顏肩肱型肌肉失養症患者似乎不會傷害肌肉。目前仍無足夠的證據顯示應全面性的在這些疾病患者身上使用運動處方。在其他肌肉疾病也需要更多的研究。

Plain language summary

Strength training or comprehensive aerobic exercise training for muscle disease

Strength training, which is performed to improve muscle strength and muscle endurance, or aerobic exercise programmes, which involve training at moderate levels of intensity for extended periods of time (for example, distance cycling) might optimise physical fitness and prevent additional muscle wasting in people with muscle disease. However, people with muscle disease and clinicians are still afraid of overuse and have a cautious approach to training. This updated review included two eligible trials on strength training and one new trial on strength training combined with aerobic exercise. These showed that moderate-intensity strength training appears not to harm muscles in people with myotonic dystrophy or with facioscapulohumeral muscular dystrophy, and has a very limited positive effect on muscle strength in facioscapulohumeral muscular dystrophy. Strength training combined with aerobic exercise appears to be safe and may be effective in increasing endurance in people with mitochondrial myopathy. However, there is insufficient evidence for general prescription of exercise programmes in these disorders. More research is needed in all muscle diseases.

Ancillary