Key result
Exercise training significantly increased peak aerobic capacity (SMD 0.56) and peak power (SMD 0.70) compared to usual care in patients with neuromuscular disorders, without causing significant harm.
Why the study?
The benefit and safety of exercise training for patients with neuromuscular disorders has long been contentious, partly due to challenges associated with rare diseases including small, heterogeneous populations.
Does exercise training improve functional capacity and physiological outcomes in patients with neuromuscular disorders?
Meta-Analysis (n=1,805)
Does exercise training improve functional capacity and physiological outcomes in patients with neuromuscular disorders?
Standardized Mean Difference: 0.56 (95% CI 0.02–1.1)
p-value: p=0.04
Exercise training in patients with neuromuscular disorders is safe and significantly improves peak aerobic capacity and peak power.
Supports exercise training in neuromuscular disorder care; reinforces Level 1 evidence for aerobic capacity and power gains.
Background: The benefit and safety of exercise training for patients with neuromuscular disorders (NMDs) has long been a contentious topic. This is, in part, due to recognised challenges associated with rare diseases including small and heterogenous patient populations. We performed a systematic review and meta-analyses to evaluate the effectiveness and safety of interventional exercise and establish minimal clinically important differences (MCID) in outcomes to facilitate clinical interpretation. Methods: We searched six databases from inception to Mar 2018. Aerobic, strength, and combined (aerobic and strength) intervention were eligible. Meta-analyses compared outcomes at baseline with those after at least six weeks (before-after exercise within individuals). A further meta-analysis compared outcomes before-after exercise between groups (exercise training versus usual care). Disease heterogeneity was explored using a random effect model. This study was registered (PROSPERO, CRD42018102183). An interactive database was developed to facilitate full interrogations of data. Results: We identified 130 articles describing 1,805 participants with 35 different forms of NMD. Of these studies, 76 were suitable for meta-analyses. Within group and between group meta-analyses detected an increase in peak aerobic capacity (p=0·04), and peak power (p=0·01). Six-minute walk test (p=0·04), sit-to-stand (STS) (repetitions) (p=0·03), STS (seconds) (p=0·04), rise from supine (p=0·008), SF-36 (p=0·0003), fatigue severity (p=<0·0001), citrate synthase (p=0·0002), central nuclei (p=0·04), type 1 (p=0·002) and type II muscle fibre area (p=0·003), were only able to detect change within group meta-analyses. Substantial I 2 statistic heterogeneity was revealed for STS (seconds) ( I ²=58·5%; p=0·04) and citrate synthase ( I ²=70·90%; p=0·002), otherwise heterogeneity for all outcomes was low. No study-related serious adverse events were reported nor significant increases in creatine kinase. Conclusions: Exercise training in patients with NMDs appears to cause no harm across a range of outcomes. With the emergence of new therapeutic strategies, defining MCID is vital in informing future clinical trial design.
No takes yet. Share an insight, caveat, or question.
Stefanetti et al. (2020) conducted a meta-analysis in Neuromuscular disorders (n=1,805). Exercise training (aerobic, strength, or combined) vs. Usual care was evaluated on Peak aerobic capacity (VO2peak) (SMD 0.56, 95% CI 0.02, 1.10, p=0.04). Exercise training significantly increased peak aerobic capacity (SMD 0.56) and peak power (SMD 0.70) compared to usual care in patients with neuromuscular disorders, without causing significant harm.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: