Review article
Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular Diseases: A Systematic Review

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Abstract

Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review.

Objective

To summarize and critically appraise the available evidence on exercise therapy and other types of physical therapies for patients with neuromuscular diseases (NMD).

Data Sources

Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Medline, CINAHL, EMBASE (Rehabilitation and Physical Medicine), and reference lists of reviews and articles.

Study Selection

Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and other designs were included. Study participants had to have any of the following types of NMD: motoneuron diseases, disorders of the motor nerve roots or peripheral nerves, neuromuscular transmission disorders, or muscle diseases. All types of exercise therapy and other physical therapy modalities were included. Outcome measures had to be at the level of body functions, activities, or participation according to the definitions of the International Classification of Functioning, Disability and Health (ICF).

Data Extraction

Two reviewers independently decided on inclusion or exclusion of articles and rated the methodologic quality of the studies included. All RCTs, CCTs, and other designs only if of sufficient methodologic quality were included in a best evidence synthesis. A level of evidence was attributed for each subgroup of NMD and each type of intervention.

Data Synthesis

Initially 58 studies were included: 12 RCTs, 5 CCTs, and 41 other designs. After methodologic assessment, 19 other designs were excluded from further analysis. There is level II evidence (“likely to be effective”) for strengthening exercises in combination with aerobic exercises for patients with muscle disorders. Level III evidence (“indications of effectiveness”) was found for aerobic exercises in patients with muscle disorders and for the combination of muscle strengthening and aerobic exercises in a heterogeneous group of muscle disorders. Finally, there is level III evidence for breathing exercises for patients with myasthenia gravis and for patients with myotonic muscular dystrophy. Adverse effects of exercise therapy were negligible.

Conclusions

The available evidence is limited, but relevant for clinicians. Future studies should be preferably multicentered, and use an international classification of the variables of exercise therapy and an ICF core set for NMD in order to improve comparability of results.

Section snippets

Search Strategy

We searched in the Cochrane Central Register of Controlled Trials (Cochrane Library 2005, Issue 3), Ovid Medline In-Process & Other Non-Indexed Citations and Ovid Medline (1966 through September 2005), CINAHL WebSPIRS 5.1 (1982 through September 2005), and EMBASE WebSPIRS 5.03 (Rehabilitation and Physical Medicine) (1995 through September 2005). We also searched in the Cochrane Database of Systematic Reviews to find articles indirectly by screening reference lists. Further, potentially relevant

Selection of Studies

The search resulted in 5712 citations (see fig 1). Of these, 5634 articles were excluded because the type of study, the participants, the intervention, or outcome measures did not meet the predefined criteria.

The preliminary selection resulted in 62 articles and 16 reviews that were retrieved for more detailed evaluation. Citation tracking resulted in 19 additional reviews and 27 additional articles to be retrieved. The final selection resulted in a total of 60 articles, comprising 58 different

Methodology

The extensive search used in this review with MeSH terms exploded without restrictions and free-text words such as activities of daily living or physical activity, which resulted in a large database of citations. However, 90% of the citations did not fulfill our predefined inclusion criteria regarding the study design, the participants, the intervention, or the outcome measures. Surprisingly, hand searching of the reference lists of the articles and reviews revealed a substantial number of

Conclusions

Our best evidence synthesis resulted in level II evidence (likely to be effective) for strengthening exercises in combination with aerobic exercises for patients with muscle disorders. Level III evidence (indications of effectiveness) was found for aerobic exercises in patients with muscle disorders and for the combination of muscle strengthening and aerobic exercises in a heterogeneous group of patients with muscle disorders. Finally, there is level III evidence for breathing exercises for

Acknowledgment

We thank Sylvia van den Heuvel (Dutch Institute of Allied Health Care, Amersfoort, The Netherlands) for her assistance with the EMBASE search.

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