Strength training and aerobic exercise training for muscle disease
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.
PICOs
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.
