Strength training and aerobic exercise training for muscle disease

  • Conclusions changed
  • Review
  • Intervention

Authors

  • Nicoline BM Voet,

    Corresponding author
    1. Radboud University Medical Centre, 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 Medical Centre, PO Box 9101, Nijmegen, 6500 HB, Netherlands. N.Voet@reval.umcn.nl.

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  • Elly L van der Kooi,

    1. Medical Centre Leeuwarden, Department of Neurology, Leeuwarden, Netherlands
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  • Ingrid I Riphagen,

    1. Norwegian University of Science and Technology, Unit for Applied Clinical Research, Faculty of Medicine, Trondheim, Norway
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  • Eline Lindeman,

    1. University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands
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    • Deceased

  • Baziel GM van Engelen,

    1. Radboud University Medical Centre, Department of Neurology, Nijmegen, Netherlands
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  • Alexander CH Geurts

    1. Radboud University Medical Centre, Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Nijmegen, Netherlands
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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. This is an update of a review first published in 2004.

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 Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012).

Selection criteria

Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.

We did not use the reporting of specific outcomes as a study selection criterion.

Data collection and analysis

Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies.

Main results

We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.

In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 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. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported.

Authors' conclusions

Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer 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。

Resumo

Treinamentos de força e aeróbico para doença muscular

Introdução

Programas de treinamento de força e de treinamento aeróbico podem otimizar a função muscular e cardiorrespiratória e prevenir a atrofia adicional por desuso e o descondicionamento em pessoas com doença muscular. Esta é uma atualização de uma revisão publicada inicialmente em 2004.

Objetivos

Avaliar a segurança e a eficácia do treinamento de força e do treinamento aeróbico em pessoas com doença muscular.

Métodos de busca

Pesquisamos as seguintes bases de dados: Cochrane Neuromuscular Disease Group Specialized Register (julho de 2012), CENTRAL (2012 Issue3 of 4), MEDLINE (janeiro de 1946 a julho de 2012), EMBASE (janeiro de 1974 a julho de 2012), EMBASE Classic (1947 a 1973) e CINAHL (janeiro de 1982 a julho de 2012).

Critério de seleção

Selecionamos ensaios clínicos randomizados ou quasi-randomizados que compararam programas de treinamento de força ou de treinamento aeróbico, ou os dois, com nenhum treinamento. O treinamento deveria durar no mínimo seis semanas e os participantes deveriam ser pessoas com diagnóstico bem descrito de uma doença muscular.

Nós não utilizamos desfechos específicos como critério de seleção dos estudos.

Coleta dos dados e análises

Dois autores avaliaram a qualidade dos estudos e extraíram os dados independentemente, a partir de estudos completos, e em contatos com os pesquisadores dos estudos originais. Extraímos também os dados de eventos adversos dos estudos incluídos.

Principais resultados

Nós incluímos cinco estudos (170 participantes). O primeiro estudo comparou o efeito do treinamento de força versus nenhum treinamento em 36 pessoas com distrofia miotônca. O segundo estudo comparou o exercício aeróbico versus nenhum treinamento com 14 pessoas portadoras de polimiosite e dermatomiosite. O terceiro estudo comparou o treinamento de força versus nenhum treinamento em um estudo fatorial que também comparou albuterol com placebo, com 65 pessoas com distrofia muscular fáscio-escápulo-umeral (FSHD). O quarto estudo comparou o treinamento de força combinado com o treinamento aeróbico versus nenhum treinamento em 18 pessoas com miopatia mitocondrial. O quinto estudo comparou a combinação de treinamento de força e treinamento aeróbico versus nenhum treinamento em 35 pessoas com distrofia miotônica tipo 1.

Nos dois estudos de distrofia miotônica e nos estudos de dermatomiosite e polimiosite, não houve diferença significante entre os grupos treinamento e não treinamento para as medidas de desfecho primárias e secundárias. Os riscos de viés do estudo de treinamento de força para distrofia miotônica e do estudo de exercício aeróbico para polimiosite e dermatomiosite foram julgados como incertos, e, para o estudo com o treinamento combinado, o risco de viés foi julgado como adequado. No estudo sobre FSHD, que foi classificado como tendo um risco de viés adequado, houve uma diferença estatisticamente significante na força dinâmica dos flexores do cotovelo no grupo de treinamento (+1,17 kg (intervalo de confiança 95%, 95% CI, 0,18 a 2,16). No estudo de miopatia mitocondrial, não houve diferenças significantes para as medidas de força dinâmica entre os grupos treinamento e não treinamento. A duração do exercício e a distância percorrida na bicicleta em um teste submáximo de resistência cardiorrespiratória aumentou significantemente no grupo treinamento em comparação com o grupo controle. As diferenças no tempo médio e na distância média percorrida na bicicleta até a exaustão entre os dois grupos foram de 23,70 min (95% CI 2,63 a 44,77) e 9,70 km (95% CI 1,51 a 17,89), respectivamente. O risco de viés foi julgado como incerto. Em todos os estudos, nenhum evento adverso foi relatado.

Conclusão dos autores

O treinamento de força com intensidade moderada para distrofia miotônica e FSHD e o treinamento aeróbico para dermatomiosite, polimiosite e distrofia miotônica tipo 1 parece não causar danos, mas não há evidência suficiente para concluir que o treinamento oferece benefício. Para miopatia mitocondrial, o exercício aeróbico combinado com o treinamento de força parece ser seguro e pode ser efetivo para aumentar a resistência cardiorrespiratória submáxima. As limitações nos desenhos dos estudos em outras doenças musculares impedem que se chegue a conclusões mais gerais para essas condições.

Notas de tradução

Tradução do Centro Cochrane do Brasil (Maíra T. Parra).

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 are designed to improve cardiorespiratory endurance, might optimise physical fitness and prevent additional muscle wasting in people with muscle disease. However, people with muscle disease and some clinicians are still afraid of overuse and have a cautious approach to training. This updated review (most recent date of search 2 July 2012) included two eligible trials of strength training in people with facioscapulohumeral muscular dystrophy (FSHD) and myotonic dystrophy (101 participants), two trials of strength training combined with aerobic exercise in people with mitochondrial myopathy (18 participants) and myotonic dystrophy type I (35 participants) and one trial of aerobic exercise in people with polymyositis and dermatomyositis (14 participants). These trials showed that moderate-intensity strength training in people with myotonic dystrophy or with FSHD, and aerobic exercise training in people with dermatomyositis or polymyositis appear not to harm muscles. Strength training combined with aerobic exercise appears to be safe in myotonic dystrophy type I and may be effective in increasing endurance in people with mitochondrial myopathy. Evidence suggests that strength training is not harmful in people in FSHD, myotonic dystrophy, mitochondrial disorders and dermatomyositis and polymyositis, but further research is needed to determine potential benefit.

எளியமொழிச் சுருக்கம்

தசை நோய்க்கான வலிமை பயிற்சி அல்லது வரிவான ஏரோபிக் உடற்பயிற்சி

தசையின் வலிமை மற்றும் ,உழைப்பாற்றலை மேம்படுத்த செய்யப்படும் வலிமை பயிற்சி, அல்லது இதயம் மற்றும் நுரையீரலின் உழைப்பாற்றலை மேம்படுத்த வடிவமைக்க பட்ட ஏரோபிக் உடற்பயிற்சிகள் தசை நோயால் பாதிக்கபட்ட மக்களுக்கு மேலும் தசை பாதிப்பு வராமல் தடுக்கவும், மேலும் உடற்தகுதி முன்னேற்றதிற்கும் வழி வகுக்கலாம். எனினும், தசை நோயால் பாதிக்கபட்ட நோயாளிகள் மற்றும் மருத்துவர்களும் தசையை அதிகம் பயன்படுத்தல் குறித்து அஞ்சி உடற்பயிற்சி செய்யவதை எச்சரிக்கையாக அணுகுகிறார்கள். இந்த புதுப்பிக்கப்பட்ட திறனாய்வு (2 ஜூலை 2012 அன்று கடைசியாக தேடல் செய்யப்பட்டது) முகம் ,தோள் ,சிறகெலும்பின் தசை திசு சிதைவு(FSDH) மற்றும் மயோடோனிக் திசு இறப்பு (dystrophy) (101 பங்கேற்பாளர்கள்)உள்ள நபர்களுக்கு வலிமை கூட்டும் பயிற்சி அளிக்கும் இரண்டு தகுதியுள்ள ஆராய்ச்சிகளையும் இழைத்தணுக்கு தசை திசு சிதைவு (18 பங்கேற்பாளர்கள்) மற்றும் மயோடோனிக் திசு இறப்பு (dystophy) வகை 1 (35 பங்கேற்பாளர்கள்) நோயாளிகளுக்கு தசை வலிமை கூட்டும் உடற்பயிற்சியுடன் ஏரோபிக் உடற்பயிற்சியை இணைத்து செய்தஇரண்டு ஆராய்ச்சிகளையும் பல-தசைத்திசு அழிவு மற்றும் சரும தசையழல் பல-தசைத்திசு அழிவு (14 பங்கேற்பாளர்கள்) நோயாளிகளுக்கு ஏரோபிக் உடற்பயிற்சி அளிக்கப்பட்ட ஒரு ஆராய்ச்சியினையும் உள்ளடக்கியது. மிதமான தீவிரத்துடன் செய்யப்படும் வலிமை கூட்டும் பயிற்சிகள் மயோடோனிக் திசு இறப்பு (dystrophy) அல்லது FSDHஉடன் இருக்கும் நோயாளிகளின் தசைக்கும், ஏரோபிக் பயிற்சிகள் சரும தசையழல் அல்லது பல-தசைத்திசு அழிவு நோயாளிகளிகளின் தசைக்கும் எவ்வித தீங்கும் விளைவிப்பதுபோல் தோன்றவில்லை என இவ்வாராய்ச்சிகள் காண்பிக்கின்றன. தசை வலிமை கூட்டும் உடற்பயிற்சியை ஏரோபிக் உடற்பயிற்சியுடன் இணைத்து செய்வது வகை 1 மயோடோனிக் திசு இறப்பு (dystophy) நோய்க்கு பாதுகாப்பானதாக தோன்றுகிறது,மேலும் இது இழைத்தணுக்கு தசை அழிவு நோய்க்கு உழைப்பாற்றலை அதிகரிக்கலாம். FSHD, மயோடோனிக் திசு இறப்பு (dystophy), இழைத்தணுக்கு கோளாறுகள் மற்றும் சரும தசையழல் மற்றும் பல-தசைத்திசு அழிவு (polymyositis) போன்ற நோய்களுக்கு தசை வலிமை கூட்டும் உடற்பயிற்சினால் தசைக்கு தீங்கு ஏதும் இல்லை என்று ஆதாரங்கள் தெரிவிக்கிறது ஆனாலும் இதனின் முழுமையான பயனை தீர்மானிக்க மேலும் ஆராய்ச்சிகள் தேவை.

மொழிபெயர்ப்பு குறிப்புகள்

மொழிபெயர்ப்பு: பிறைசுடன் ஜெயகாந்தன் க. ஹரிஓம் மற்றும் சி.இ.பி.என்.அர் குழு

Resumo para leigos

Treinamento de força ou treinamento aeróbico para doenças musculares

O treinamento de força, que é realizado para melhorar o fortalecimento e a resistência muscular, ou os programas de exercício aeróbico, que visam melhorar a resistência cardiorrespiratória, podem otimizar a aptidão física e prevenir a perda muscular adicional em pessoas com doenças musculares. Entretanto, pessoas com doença muscular e alguns médicos ainda têm medo da sobrecarga causada por esses treinamentos e podem ser mais cautelosos em relação a essas intervenções. Esta atualização de revisão (a data mais recente da busca foi 2 de julho de 2012) incluiu dois estudos de treinamento de força combinados com o treinamento aeróbico em pessoas com miopatia mitocondrial (18 participantes) e distrofia miotônica tipo 1 (35 participantes) e um estudo de exercício aeróbico em pessoas com polimiosite e dermatomiosite (14 participantes). Esses estudos mostraram que o treinamento de força de intensidade moderada em pessoas com distrofia miotônica ou com FSHD e o treinamento aeróbico em pessoas com dermatomiosite ou polimiosite parece não causar danos aos músculos. O treinamento de força combinado com o treinamento aeróbico parece ser seguro para distrofia miotônica tipo 1 e pode ser efetivo para aumentar a resistência cardiorrespiratória em pessoas com miopatia mitocondrial. As evidências sugerem que o treinamento de força não causa danos para pessoas com FSHD, distrofia miotônica, doenças mitocondriais, dermatomiosite e polimiosite, mas mais pesquisas são necessárias para determinar seus possíveis benefícios.

Notas de tradução

Tradução do Centro Cochrane do Brasil (Maíra T. Parra).

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