The effectiveness of a home-based, patient-specific, functional exercise program on patients with inclusion body myositis (IBM)

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Johnson, Liam
Inclusion body myositis -- Exercise therapy.; Exercise Science
thesis / dissertation description
Previous research has shown exercise to be beneficial in the treatment of myositis-affected patients. However, the potential of functional exercises to improve muscle strength and function in the absence of disease progression markers in patient's with Inclusion Body Myositis (IBM) is not well understood. It is believed that the initial exercise dose and patient specificity is of paramount importance in the successful use of this modality in the routine management and long term treatment of such patients. The objective of this study was to investigate the effects of a home-based, patient-specific functional exercise programme, including aerobic exercise and resistance training, on muscle strength, endurance and function, and the aerobic capacity of the patient.Pre muscle strength and functional assessments, and a maximal aerobic exercise test were conducted on seven IBM patients' prior to a 12-week training period. As part of the patient's routine management, the patients maintained their scheduled visits to the neuromuscular clinic whereby their serum creatine kinase (CK) levels were assessed pre- and post-training intervention. The patients' were gently and selectively overloaded in the early stages of their 12-week exercise program to encourage compliance and gradual adaptation, and to prevent 'overtraining' early in the program. The exercise program combined upper and lower body resistance training exercises with an aerobic component. It was anticipated that the patients would exercise frequently at low intensities and at volumes that would optimally induce muscular strength and endurance improvements. Integral to the prescription of exercise for this patient group was the patient-specificity of the exercise dose being prescribed and the method of exercise overload. The patient's progress was monitored by fortnightly phone calls; maintenance of the patients scheduled visits to their specialist at the neuromuscular clinic, and a 'training diary' was given to the patient to fill out daily. At the conclusion of the training intervention period, all parameters of muscle strength and function were reassessed, and the patients undertook follow-up testing of their maximal aerobic capacity. The results show that, a diseased muscle, having undergone exercise training, maintained its strength (knee extension [100.9±10%]) (mean±standard error [SE]), whilst significant improvements (p < 0.05) were observed in otherwise healthy, trained muscles, with hip abduction strength improving by 59.1±31 %, shoulder abduction strength increasing by 66.1±12% and hip flexion strength increasing by 83.7±35%. Functional assessments showed that there was not a statistically significant improvement in the time taken to perform a stair climb and walk 30 metres, and also the amount of paces used during the walk. However, the patient group improved in all functional tasks. Research suggests that muscle strength and function can be improved by resistance training and an aerobic exercise program. However, further research is required to evaluate the effects of a mild, daily, exercise program performed in the patient's home. Exercise guidelines for this clinical population are substantially lacking. However, this study has added to the current depth of knowledge regarding exercise and Inclusion Body Myositis patients'. Program adherence, exercise prescription and progression and program monitoring are areas which require further examination in long-term, multi-centre exercise intervention trials. It would appear that an exercise program tailored to the individual is important for the clinical management of the disease.