According to the World Health Organization’s (WHO) framework, the International Classification of Functioning, Disability and Health (ICF), the term “functioning” is defined as measures of body functions and structures, in addition to activity and participation level (including interaction in the context of environmental and personal factors) ( 16). Both boys, parents and physiotherapists require exercise training that is safe and beneficial. There are no clear guidelines for exercise training in DMD. Lack of dystrophin may lead to contraction-induced injuries, with ongoing cycles of degeneration and inflammation, impaired muscle tissue repair and the replacement of muscle fibres by fat and connective tissue ( 11).įour systematic reviews and one meta-analysis have considered exercise interventions in mixed NMD populations ( 12– 15), only one has focused on DMD, including solely inspiratory muscle training ( 15). Intensive eccentric muscle exercise, where the muscle is both activated and lengthened, in addition to high-resistance exercise, may exacerbate muscle damage and should be avoided ( 10). Regular submaximal exercise may maintain muscular strength and prevent secondary disuse atrophy ( 1, 8, 9). For persons with DMD, there is uncertainty considering what type, level and intensity of exercise training are most beneficial. Exercise training is defined as a structured physical activity prescribed by the type, intensity, duration and frequency in order to improve functions of the cardiorespiratory, muscular and nervous system ( 7). Regular physical activity is essential to maintain health, functioning, quality of life and social participation ( 6). Corticosteroids delay the loss of ambulation, preserve upper limb function and respiration ( 4), and combined with ventilation, the median survival of patients with DMD has increased to more than into their 30s ( 5). Despite new and promising drugs, there are no curative treatments ( 3). Thereafter, a gradual loss of arm function develops, with an increasing need for personal assistance to perform daily functions ( 1). Most boys become wheelchair-dependent by the age of 12 years. DMD presents with early-life onset of progressive muscle weakness, associated motor delay, and loss of ambulation, due to absence of the structural protein dystrophin ( 1). The results should therefore be interpreted with caution.ĭuchenne muscular dystrophy (DMD) is one of the most common inherited neuromuscular disorders (NMDs) in children, with an incidence of 1 in 3,500–5,000 newborn boys. The validity of the results was reduced by the low number of studies included, the low quality of the studies, and diversity in both the interventions and outcome measures used. The study was not able to identify the best type of exercise training and prescriptions to use in Duchenne muscular dystrophy. The results suggest that exercise training preserves functioning, and benefits muscular strength and endurance. The results have been systematically gathered and analysed, to give a broader view of what effect exercise training may have for people with Duchenne muscular dystrophy.
This review investigates existing research on this topic. A further aim was to evaluate safety and, if possible, to find the most effective exercise training intervention. Secondary outcomes were muscular strength and endurance. The primary outcomes were functioning and health-related quality of life.
The aim of this study was to examine the effects of all types of exercise training compared with no training, placebo or alternative exercise training programmes in people with Duchenne muscular dystrophy.
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