Exercise therapy for idiopathic inflammatory myopathies

Last updated

Although they vary in particulars, polymyositis, dermatomyositis and inclusion body myositis are idiopathic inflammatory myopathies (IIM) [1] primarily characterized by chronic inflammation of human skeletal muscle tissue [2] that ultimately causes the necrosis of muscle cells. This degeneration leads to muscle tissue wasting, weakness and fatigue among other serious effects. Until recently, exercise has been avoided as a type of therapy, and even forbidden due to the risk of triggering or amplifying inflammation. However, several studies have been conducted to test this assumption and have shown that aerobic exercise as well as resistance training can maintain and even improve quality of life for IIM-affected individuals without increased inflammatory response. [3]

Contents

Modes of exercise therapy: trials

With the main goals of treatment being improved functionality and quality of life, exercise programs should focus on "functional" exercises (e.g. walking, walking up/down stairs, sit-to-stand), when applicable. Performing functional exercises increases (a) the efficiency of the exercise program and (b) the likelihood the improvements will be transferred to activities of daily living. [4]

Isometric activity

In 1993, isometric exercise training was applied for four weeks resulting in isometric peak power at 60% of maximal voluntary contraction. [5] The increase in isometric power was later shown to have no significant effect on serum creatine kinase (CK) after two weeks of strength training. [6]

Aerobic activity

A six-week training program in 1998 that included 30 minutes of aerobic activity three times per week set at 60% maximum heart rate (predicted by age) resulted in increased VO2 max (i.e. maximal oxygen consumption or aerobic capacity), diminished pain, reduced muscle impairment, and improved quality of life. [7] [8]

Weight bearing activity

The results produced by aerobic activity were repeated in 1999 [9] where for 12 weeks, weight-bearing exercise was added for patients not exhibiting marked physical incapacity as measured by the Functional Index in Myositis [10] (see Functional Assessment section). Confirmed by MRI and muscle biopsy, both the 1998 and 1999 studies showed that there were no significant changes in levels of creatine kinase and aldolase, and no increase in muscle inflammation. In 2001, 22 patients were placed on a three-week physical therapy and exercise program, and found that creatine kinase levels actually dropped in 20 of the patients. [11]

The longest study to date was a six-month exercise program demonstrating a significant improvement in exercise capacity, VO2, isokinetic strength, and the ability to perform daily tasks compared to controls. [7]

Stretching and range of motion activity

Chest expansion and thoracic extension exercises may offer preventive support to those at risk of restrictive lung disease through the effects of IIM, and patients with inclusion body myositis may also be able to prevent contracture and extend functional daily activities through stretching and range of motion exercises. [12]

Monitoring

It is important to recognize that all described exercise programs were conducted by physicians or physiotherapists during the stable phase of the disease (except Painelli [3] ). Patients were monitored closely for indicators of deleterious effects, such as increases in serum creatine kinase, inflammation or weakness. Monitoring of this kind can only be done in conjunction with a medical team who is aware of the risks posed by increased inflammatory response in patients with IIM.[ citation needed ]

Future research

The pathophysiology of IIMs is not well understood. Muscle weakness can be caused by a single or combined effect on muscle tissue by inflammation, inflammatory infiltrates, muscle atrophy, metabolic abnormalities that indicate disordered energy metabolism, [2] and possibly neuropathy, [13] among others. Therefore, physical exercise has the potential to cause harm.

However, the results of these exercise studies, at minimum, show that exercise can attenuate muscle damage due to disease, inactivity and steroid use. [3] They reflect the benefit of exercise through the strengthening of complement (non-diseased) muscles, and should encourage further studies to confirm whether diseased muscle may experience regeneration. The definition of improvement must be established, [2] and reproducible longitudinal studies must be conducted to determine the efficacy of exercise as therapy for IIM.[ citation needed ]

Related Research Articles

Inclusion body myositis (IBM) is the most common inflammatory muscle disease in older adults. The disease is characterized by slowly progressive weakness and wasting of both proximal muscles and distal muscles, most apparent in the finger flexors and knee extensors. IBM is often confused with an entirely different class of diseases, called hereditary inclusion body myopathies (hIBM). The "M" in hIBM is an abbreviation for "myopathy" while the "M" in IBM is for "myositis". In IBM, two processes appear to occur in the muscles in parallel, one autoimmune and the other degenerative. Inflammation is evident from the invasion of muscle fibers by immune cells. Degeneration is characterized by the appearance of holes, deposits of abnormal proteins, and filamentous inclusions in the muscle fibers. sIBM is a rare disease, with a prevalence ranging from 1 to 71 individuals per million.

<span class="mw-page-title-main">Myalgia</span> Painful sensations in muscle tissue

Myalgia or muscle pain is a painful sensation evolving from muscle tissue. It is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likely cause is viral infection, especially when there has been no injury.

<span class="mw-page-title-main">Glycogen storage disease type V</span> Human disease caused by deficiency of a muscle enzyme

Glycogen storage disease type V, also known as McArdle's disease, is a metabolic disorder, one of the metabolic myopathies, more specifically a muscle glycogen storage disease, caused by a deficiency of myophosphorylase. Its incidence is reported as one in 100,000, roughly the same as glycogen storage disease type I.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Juvenile idiopathic arthritis</span> Childhood rheumatic disease

Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common chronic rheumatic disease of childhood, affecting approximately 3.8 to 400 out of 100,000 children. Juvenile, in this context, refers to disease onset before 16 years of age, while idiopathic refers to a condition with no defined cause, and arthritis is inflammation within the joint.

<span class="mw-page-title-main">Juvenile dermatomyositis</span> Medical condition

Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy (IMM) of presumed autoimmune dysfunction resulting in muscle weakness among other complications. It manifests itself in children; it is the pediatric counterpart of dermatomyositis. In JDM, the body's immune system attacks blood vessels throughout the body, causing inflammation called vasculitis. In the United States, the incidence rate of JDMS is approximately 2-3 cases per million children per year. The UK incidence is believed to be between 2-3 per million children per year, with some difference between ethnic groups. The sex ratio is approximately 2:1. Other Idiopathic inflammatory myopathies include; juvenile polymyositis (PM), which is rare and not as common in children as in adults.

<span class="mw-page-title-main">Dermatomyositis</span> Long-term inflammatory disorder of the skin and muscles

Dermatomyositis (DM) is a long-term inflammatory disorder which affects the skin and the muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin.

In medicine, myopathy is a disease of the muscle in which the muscle fibers do not function properly. Myopathy means muscle disease. This meaning implies that the primary defect is within the muscle, as opposed to the nerves or elsewhere.

<span class="mw-page-title-main">Polymyositis</span> Chronic muscular inflammation, primarily of the endomysium

Polymyositis (PM) is a type of chronic inflammation of the muscles related to dermatomyositis and inclusion body myositis. Its name is derived from poly- 'many' myos- 'muscle' and -itis 'disease'. The inflammation of polymyositis is mainly found in the endomysial layer of skeletal muscle, whereas dermatomyositis is characterized primarily by inflammation of the perimysial layer of skeletal muscles.

Aerobic conditioning is the use of continuous, rhythmic movement of large muscle groups to strengthen the heart and lungs, as well as changes to the skeletal muscles. Improvement in aerobic conditioning occurs when athletes expose themselves to an increase in oxygen uptake and metabolism, but to keep this level of aerobic conditioning, the athletes must keep or progressively increase their training to increase their aerobic conditioning.

<span class="mw-page-title-main">Myositis</span> Inflammation of skeletal muscle

Myositis is a rarely-encountered medical condition characterized by inflammation affecting the muscles. The manifestations of this condition may include skin issues, muscle weakness, and the potential involvement of other organs. Additionally, systemic symptoms like weight loss, fatigue, and low-grade fever can manifest in individuals with myositis.

<span class="mw-page-title-main">Bioenergetic systems</span> Metabolic processes for energy production

Bioenergetic systems are metabolic processes that relate to the flow of energy in living organisms. Those processes convert energy into adenosine triphosphate (ATP), which is the form suitable for muscular activity. There are two main forms of synthesis of ATP: aerobic, which uses oxygen from the bloodstream, and anaerobic, which does not. Bioenergetics is the field of biology that studies bioenergetic systems.

Scleromyositis, is an autoimmune disease. People with scleromyositis have symptoms of both systemic scleroderma and either polymyositis or dermatomyositis, and is therefore considered an overlap syndrome. Although it is a rare disease, it is one of the more common overlap syndromes seen in scleroderma patients, together with MCTD and Antisynthetase syndrome. Autoantibodies often found in these patients are the anti-PM/Scl (anti-exosome) antibodies.

<span class="mw-page-title-main">Interferon alpha-1</span> Protein-coding gene in the species Homo sapiens

Interferon alpha-1 is a protein that in humans is encoded by the IFNA1 gene.

<span class="mw-page-title-main">Inflammatory myopathy</span> Muscular inflammatory disease of unknown origin

Inflammatory myopathy, also known as idiopathic inflammatory myopathy (IIM), is disease featuring muscle weakness, inflammation of muscles (myositis), and in some types, muscle pain (myalgia). The cause of much inflammatory myopathy is unknown (idiopathic), and such cases are classified according to their symptoms and signs, electromyography, MRI, and laboratory findings. It can also be associated with underlying cancer. The main classes of idiopathic inflammatory myopathy are polymyositis (PM), dermatomyositis (DM), inclusion-body myositis (IBM), immune-mediated necrotising myopathy (IMNM), and focal autoimmune myositis.

<span class="mw-page-title-main">Camptocormia</span> Symptom of a multitude of diseases, most commonly seen in the elderly

Camptocormia, also known as bent spine syndrome (BSS), is a symptom of a multitude of diseases that is most commonly seen in the elderly. It is identified by an abnormal thoracolumbar spinal flexion, which is a forward bending of the lower joints of the spine, occurring in a standing position. In order to be classified as BSS, the anterior flexion must be of 45 degrees anteriorly. This classification differentiates it from a similar syndrome known as kyphosis. Although camptocormia is a symptom of many diseases, there are two common origins: neurological and muscular. Camptocormia is treated by alleviating the underlying condition causing it through therapeutic measures or lifestyle changes.

<span class="mw-page-title-main">Acquired non-inflammatory myopathy</span> Medical condition

Acquired non-inflammatory myopathy (ANIM) is a neuromuscular disorder primarily affecting skeletal muscle, most commonly in the limbs of humans, resulting in a weakness or dysfunction in the muscle. A myopathy refers to a problem or abnormality with the myofibrils, which compose muscle tissue. In general, non-inflammatory myopathies are a grouping of muscular diseases not induced by an autoimmune-mediated inflammatory pathway. These muscular diseases usually arise from a pathology within the muscle tissue itself rather than the nerves innervating that tissue. ANIM has a wide spectrum of causes which include drugs and toxins, nutritional imbalances, acquired metabolic dysfunctions such as an acquired defect in protein structure, and infections.

<span class="mw-page-title-main">Antisynthetase syndrome</span> Medical condition

Antisynthetase syndrome (ASS) is a multisystematic autoimmune disease associated with inflammatory myositis, interstitial lung disease, and antibodies directed against various synthetases of aminoacyl-transfer RNA. Other common symptoms include mechanic's hands, Raynaud's phenomenon, arthritis, and fever.

Statin-associated autoimmune myopathy (SAAM), also known as anti-HMGCR myopathy, is a very rare form of muscle damage caused by the immune system in people who take statin medications. However, there are cases of SAAM in patients who have not taken statin medication, and this can be explained by the exposure to natural sources of statin such as red yeast rice, which is statin rich. This theory is supported by the higher prevalence of statin-naive SAAM patients in Asian cohorts, who have statin-rich diets.

Benign acute childhood myositis (BACM) is a syndrome characterized by muscle weakness and pain in the lower limbs that develop in children after a recent viral illness. It is transient with a spontaneous clinical resolution within 1 week.

References

  1. ↑ "Inflammatory Myopathies, Detail".
  2. 1 2 3 Lundberg I. and Y-L Chung, 2000. Treatment and Investigations of idiopathic inflammatory myopathies. "Rheumatology". 39:7-17.
  3. 1 2 3 Painelli VdS, B Gualano, GG Artioli, AL de Sa Pinto, E Bonfa, AH Lancha Jr., FR Lima, 2009. The possible role of physical exercise on the treatment of idiopathic inflammatory myopathies. Autoimmunity Reviews. 8:355-359.
  4. ↑ Johnson, L.G., Collier, K.E., Edwards, D.J., Phillippe, D.L., Eastwood, P.R., Walters, S.E., Thickbroom, G.W., Mastaglia, F.L. (2009). Improvement in aerobic capacity after an exercise program in sporadic inclusion body myositis. Journal of Clinical Neuromuscular Disease, 10(4), 178-184
  5. ↑ Hicks JE, F Miller, P Plotz, TH Chen and I Gerber, 1993. Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patient with polymyositis. Journal of Rheumatology. 20:1399-140l.
  6. ↑ Escalante A, L Miller and TD Beardmore, 1993. Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. Journal of Rheumatology. 20:1340-1344.
  7. 1 2 Wiesinger GF, M Quittan, M Aringer, A Seeber, B Volc-Platzer, J Smolen, et al, 1998. Improvement of physical fitness and muscle strength in polymyositis/dermatomyositis patients by a training programme. British Journal of Rheumatoloty. 37:196-200.
  8. ↑ Alemo Munters, Li; Dastmalchi, Maryam; Katz, Abram; Esbjörnsson, Mona; Loell, Ingela; Hanna, Balsam; Lidén, Maria; Westerblad, Håkan; Lundberg, Ingrid E.; Alexanderson, Helene (2013-08-13). "Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis". Arthritis Research & Therapy. 15 (4): R83. doi: 10.1186/ar4263 . ISSN   1478-6362. PMC   3978470 . PMID   23941324.
  9. ↑ Alexanderson H, CH Stenstrom and I Lundberg, 1999. Safety of a home exercise programme in patients with polymyositis and dermatomyositis: A pilot study. Rheumatology. 38, 608-611.
  10. ↑ "Treatment and investigation of idiopathic inflammatory myopathies -- Lundberg and Chung 39 (1): 7 -- Rheumatology". rheumatology.oxfordjournals.org. Archived from the original on 22 November 2005. Retrieved 14 March 2022.
  11. ↑ Heikkila S, JV Viitanen, H Kautiainen, T Rajamaki, P Mantyvuo, and T Harju, 2001. Rehabilitation in Myositis: Preliminary Study. Physiotherapy. 87:301-309.
  12. ↑ Boon AJ and KA Stolp-Smith, 2000. Inclusion Body Myositis Masquerading as Polymyositis: A Case Study. Archives of Physical Medicine and Rehabilitation. 81:1123-1126.
  13. ↑ Hermanns B, M Molnar and JM Schroder, 2000. Peripheral neuropathy associated with hereditary and sporadic inclusion body myositis: confirmation by electron microscopy and morphometry. Journal of the Neurological Sciences. 179:92-102.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.