Key takeaways:

• The exercise group had physical fitness rates 10% higher than the usual care group.
• Physical fitness rates did decrease in the 6- and 12-month intervals after completion of the exercise program.

Home-based aerobic exercises, combined with personal coaching, can create an uptake in physical fitness activity for patients with neuromuscular diseases, according to a study published in Neurology.

Although aerobic exercises can offer health benefits, groups with neuromuscular diseases often have low physical fitness rates stemming from discomfort, muscular pain and fatigue, according to the researchers. Recent studies are also considerably lacking in quality evidence, with small sample sizes and a focus on short-term outcomes, they wrote.

“It makes sense that exercise is good for most patients, but I think health care professionals are a bit afraid to prescribe exercise for these groups,” Eric Voorn, PhD, senior researcher at Amsterdam University Medical Center, told Healio.

“Patients may also have some fears, such as overexertion,” he continued. “It’s a pity that exercise is not being prescribed, but you need a solid body of evidence for it.”

To assess short- and long-term health outcomes for these groups, Voorn and colleagues conducted a randomized controlled trial evaluating physical activity rates of patients with neuromuscular diseases.

The intervention ran from September 2018 to March 2022 and included patients with different types of neuromuscular diseases, including muscular dystrophies, post-polio syndrome and Charcot-Marie-Tooth disease.

Additional markers were examined, including quality of life, physical functioning, metabolic syndrome markers and creatine kinase level.

The study included 91 patients (average age, 64 years; 60% female) separated into two groups: the usual care group, who did not change their lifestyle (n = 47); and the exercise group, who participated in a 6-month tailored fitness program (n = 44).

Workouts consisted of sessions on a stationary bike ranging from low to high intensity. Each week, patients would engage in two low-intensity sessions below their first ventilatory threshold (VT1) and one high-intensity session above their VT1.

Participants would receive regular contact from a physical therapist either in-person during six sessions or over the phone during three sessions for motivational interviewing, which the researchers said helps patients explore and resolve ambivalence toward behavior change without confrontation.

Physical fitness level was evaluated in a mixed model analysis, where patients took an exercise test at four intervals during the study: at the beginning and end of the program, then after 6 and 12 months.

Fitness levels were determined by peak oxygen uptake (VO_2peak) collected in airflow masks after testing, with higher oxygen rates representing higher fitness levels.

After program completion, the exercise group had mean VO_2peak levels that were 2.2 mL per minute per kg higher (95% CI, 0.2-4.1) than the usual care group, a 10% increase in physical activity.

At 1 year, average VO_2peak levels included 23.9 mL per minute per kg for the exercise group and 20.9 mL per minute per kg for the usual care group.

Over time, the patient group had a mean VO_2peak that was 1.7 mL per minute per kg (95% CI, 0.1-3.4) higher than the usual care group.

However, physical fitness rates did slightly decline in the 6-month and 12-month intervals after the program concluded.

“Despite the loss of follow-up numbers due to COVID-19, we still saw this improvement to VO_2peak,” Voorn observed.

Also, 16 patients in the exercise group had 22 adverse events, and 20 patients in the usual care group had 25 adverse events, both including falls (26%), pain (17%) and COVID-19 (15%). None of the five serious adverse events that occurred were related to the study.

The researchers indicated that tailored exercise programs with coaching are safe and can improve physical fitness rates for patients with neuromuscular diseases.

“Most patients with neuromuscular diseases can benefit from exercise,” Voorn said.

However, they noted there was no evidence to support the secondary outcomes.

Eric Voorn

“Outcome measures, like physical functioning and quality of life, can only partly cover the improvement in aerobic fitness rates we saw,” Voorn said. “There’s also measures such as step count, which have a much higher variability, even though we saw an increase in the number of steps in the intervention group.”

Overall, neurologists and health care professionals can play a valuable role in improving adherence to physical activity, Voorn said.

“I think neurologists should have the confidence to safely prescribe exercise interventions. Our evidence saw that there is going to be improvement in physical fitness and explaining that to a patient could motivate them to not only start the exercise program but to continue doing it.”

Furthermore, future interventions could adopt the telehealth measures that were originally used in response to the COVID-19 pandemic lockdowns.

“In the Netherlands, we’re forced to think of long-term sustainable solutions given the shortage of health care staff,” Voorn added. “Personalized home-based training might be a good and safe alternative to address these issues.”

Reference:

For more information:

Eric Voorn, PhD, can be reached on LinkedIn at https://nl.linkedin.com/in/eric-voorn-6a741048/.

Author: Health Watch Minute

Health Watch Minute Provides the latest health information, from around the globe.