Prevention and Rehabilitation
Supervised home-based resistance training for managing idiopathic peripheral polyneuropathy – A case report

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Abstract

Purpose

This case report aimed to investigate the effects of supervised home-based resistance training (RT) on functional capacity and mental health on a man with idiopathic peripheral polyneuropathy (PP).

Method

A 50-year-old man diagnosed with PP with no previous experience in RT performed 24 session of home-based RT for 12 weeks. Resistance training consisted of 3 exercises performed with 3 sets and lasted approximately 30 min per session. Exercises were performed with minimal implements (e.g., elastic tubes and light dumbbells). The Patient was evaluated for muscle performance, functionality, anxiety levels, and depressive symptoms before and after intervention period. Muscle performance was evaluated though 30-s push up test (PU30), functional capacity was evaluated through functional tests [sit to stand test (SST), arm curl (AC), and 2-min step test (2-MST)] and anxiety levels and depressive symptoms were evaluated through the State-Trait Anxiety Inventory (STAI) and Beck's depression inventory (BDI), respectively.

Results

After 12 weeks, the performance on PU30 increased 40% (from 8 to 11 repetitions), while the performance on SST, AC and 2-MST increased 100% (from 4 to 8 repetitions), 44% (from 16 to 23 repetitions) and 157% (from 47 to 121 repetitions), respectively. Anxiety state and trait levels have been reduced 24% (from 42 to 32 scores) and 4% (from 47 to 45 scores), respectively. There was no change for BDI.

Conclusion

Supervised home-based RT using low cost and affordable equipment was a feasible strategy to provide functional capacity and mental health benefits in a patient with PP.

Introduction

Peripheral polyneuropathy (PP) is a common type of neurological disorder characterized by symmetrical sensorimotor impairment such as numbness, active tremors, weakness, paresthesia, and pain (Li, 2017; Sommer et al., 2018). The prevalence of PP in the general population ranges from 1 to 3% and increases to 7% in aging people (Hanewinckel et al., 2016). Many causes of PP have been identified e.g., metabolic, alcoholic, pharmacological, inflammatory, and hereditary; however, among 11–31% of the cases has not been determined and are usually diagnosed as chronic idiopathic axonal polyneuropathy (Zis et al., 2016). The functional decline due to PP symptoms is associated with poor mobility and increased risk of fall, which may lead to loss of autonomy, increased risk for morbidity and mortality and reduced quality of life (Hanewinckel et al., 2017; Panduranga et al., 2018). Furthermore, people diagnosed with PP might have increased risk for development of mental health problems as depressive symptoms (Rezania et al., 2011). Thus, strategies aiming to improve functional capacity and mental health issues should be adopted in clinical management and practice scenarios of the PP patients.

Resistance training (RT) that consists of the voluntary muscle contraction against a some kind of external resistance, is considered an effective strategy to provide health benefits such as increase on muscle strength and power and functionality and its practice has been widely recommended for health promotion in both health and clinical populations (Westcott, 2012; Winett et al., 2003). Additionally, the performance of RT is advised as a non-pharmacological strategy to mental problems management, such as high anxious levels and major depressive symptoms (Gordon et al., 2018). RT involves many training variables (i.e. load, volume, exercise selection, movement velocity) and can be performed in different forms (Gentil et al., 2017). Whereas RT is often performed using controlled muscle actions, the performance of RT using high-velocity have been suggested to optimize muscle power and functional performance (Cadore et al., 2018; Cadore and Izquierdo, 2018; Reid and Fielding, 2012).

A previous study showed significant increases on lower and upper limb muscle strength in PP patients after 12-week RT program using weight machines (Markvardsen et al., 2018). Considering that muscle strength is a component of physical fitness associated with functionality in PP (Erdmann et al., 2007), it is reasonable to assume that RT might be a promising approach to alleviate or even revert the persistent physical and functional decline due to PP.

Accessibility to specific facilities and specialized equipment could be perceived as a barrier to regular RT participation, particularly in individuals with impaired mobility that needs constant personal assistance to perform daily life activities. Thus, RT strategies that can be performed anywhere such as home-based RT using small and low-cost implements (i.e., elastic tubes/bands and light dumbbells) or exercises using bodyweight as resistance might be considered as a useful strategy to maintain the regular practice of RT.

Although large studies are important for bringing general information; they might lose important clinical details and be limited in diseases of low prevalence, like PP. Conversely, whilst case studies lose in generalization, they might provide important details for clinical practice, acting as instructive examples to professional who might encounter similar problems, bringing a better understanding of clinical treatments and outcomes (Carey, 2006; Solomon, 2006). Therefore, the present case study reported the use of such RT approach on muscle fitness, functionality and mental health issues in a Patient with PP.

Section snippets

Case report

A 50-year-old man with a moderate-intensity idiopathic peripheral polyneuropathy (1996 and 2018 testing's), nonsmoker and nonalcoholic. The peripheral polyneuropathy affected both upper and lower limbs with more intensity symptoms for lower limbs. The Patient gave his written informed consent after being informed about the study procedure, possible risks and benefits. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the relevant Ethics

Results

The Patient was classified with normal body mass and normotensive in accordance with BMI and resting blood pressure, respectively. During the intervention he used amisulpride 50 mg/day at 10:30 a.m. and primidone 100 mg/day, clobazam 20 mg/day, lamotrigine 100 mg/day, valproic acid 500 mg/day at 11:00 p.m. There were no changes in the medication used during the study.

After 12 weeks of intervention the Patient achieved improvements on performance in all physical and functional tests. The

Discussion

This case study investigated the effects of 12 weeks of supervised home-based RT on functionality and mental health issues in a man with PP. As our main findings, the Patient obtained improvements on functionality and muscle performance and reduction on anxiety levels. Whereas no change was observed for depressive symptoms. To the best of the author's acknowledgement, this is the first study to investigate the effects of a minimal dose RT protocol in functionality and mental health issues in a

Conclusions

According with this case report, 12 weeks of home-based RT using small implements may be considered a feasible, low cost, and safe strategy to restore functionality and prevent mental health problems in a PP Patient.

Consent

Written informed consent was obtained from the Patient for publication of this case report.

Disclosure and conflicts of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare they have no conflicts of interest.

CRediT authorship contribution statement

Daniel Souza: Conceptualization, Methodology, data collection, Formal analysis, Writing – original draft, preparation, Writing – review & editing. Alana Pessoni: Conceptualization, Methodology, data collection, Formal analysis, Writing – original draft, preparation, Writing – review & editing. Claudio Andre Barbosa de Lira: Writing – original draft, preparation, Writing – review & editing, Supervision. Rodrigo Luiz Vancini: Writing – original draft, preparation, Writing – review & editing.

Acknowledgements

The authors would like to thank the Patient for accept to participate in this case.

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