Physical exercise among patients with systemic autoimmune myopathies

Oliveira, Diego Sales de; Misse, Rafael Giovani; Lima, Fernanda Rodrigues; Shinjo, Samuel Katsuyuki

doi:10.1186/s42358-018-0004-1

Diego Sales de Oliveira

Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3150 - Cerqueira César, Sao Paulo 01246-903, Brazil

Rafael Giovani Misse

Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3150 - Cerqueira César, Sao Paulo 01246-903, Brazil

Fernanda Rodrigues Lima

Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil

Samuel Katsuyuki Shinjo ^** Correspondence: samuel.shinjo@gmail.com

Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3150 - Cerqueira César, Sao Paulo 01246-903, Brazil

* Correspondence: samuel.shinjo@gmail.com

Authors' contributions

All authors contributed equally to write and review the manuscript. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Term	Concept
Aerobic capacity	Maximum capacity of the individual to capture oxygen from the environment, transport it through the bloodstream, and use it in cellular respiration. It can be estimated using peak oxygen consumption (peak VO₂) via ergospirometry
Aerobic training	Training characterized by low and moderate intensity efforts with a prolonged duration (over 150 s). This training predominantly uses oxygen (O₂)-dependent bioenergetic pathways to meet the energy demand required by the activity
1RM	Test used to determine the maximum muscle strength of the individual, determined as the maximum amount of weight lifted in only one repetition during a standardized exercise
MVC	Test used to determine the maximum number of repetitions/contractions that the participant can perform with a preset load
Strength training	Training that uses exercises requiring a level of strength above that used in everyday tasks to increase muscle function. When prescribing this training, the 1RM and/or MVC test is necessary, and the training is based on the percentage of each participant's 1RM (usually between 50 and 80% of 1RM/MVC)
Isometric exercise	During this exercise, the production of muscle tension equals the external load imposed on the muscle. Moreover, this exercise is characterized by the absence of joint movement during its execution
Dynamic exercise	This exercise involves the displacement of the body in time and space, and it is characterized by alternations between eccentric and concentric contractions

Author	Patients (n)	Protocol (Exercises)	Time (week)	Evaluated Components	Inflammatory markers	Results
Hicks et al. [⁸8. Hicks JE, Miller F, Plotz P, Chen TH, Gerber L. Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patients with polymyositis. J Rheumatol. 1993;20:1399-401.]	1	Isometric strength	4	Isometric strength 3 MVC	↔ CPK	↑ Isometric strength
Wiesinger et al. [¹⁰10. Wiesinger GF, Quittan M, Aringer M, Seeber A, Volc-platzer B, Smolen J, et al. Improvement of physical fitness and muscle strength in polymyositis/dermatomyositis patients by a training programme. Br J Rheumatol. 1998;37:196-200.]	14	Aerobic	6	VO₂ peak Isometric strength Activities of daily living	↔ CPK	T VO₂ peak ↑ Isometric strength ↑ Activities of daily living
Wiesinger et al. [¹⁹19. Wiesinger GF, Quittan M, Graninger M, Seeber A, Ebenbichler G, Sturm B, Kerschan K, Smolen J, Graninger W. Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients. Br J Rheumatol. 1998;37:1338-42.]	13	Aerobic	24	VO₂ peak Isometric strength Activities of daily living	↔ CPK	↑ VO₂ peak ↑ Isometric strength ↑ Activities of daily living
Alexanderson et al. [²³23. Alexanderson H, Dastmalchi M, Esbjornsson-Liljedahl M, Opava CH, Lundberg IE. Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum. 2007;57:768-77.]	10	Strength Dynamic	12	Muscle function Walking distance Quality of life	↔ CPK ↔ Immune /inflammatory markers	↑ Muscle function ↑ Walking distance ↑ Quality of life
^a a included patients with inclusion body myositis Heikkilä et al. [⁴⁴44. Heikkila S, Viitanen JV, Kautiainen H, et al. Rehabilitation in myositis. Physiother. 2001;87:301-9.]	22	Strength Dynamic	3	Functional capacity Pain	↔ CPK	↑ Muscle function ↔ Pain
^b b included patients with active disease Varvu et al. [⁴⁵45. Varjú C, Pethö E, Kutas R, Czirják L. The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil. 2003;17:83-7.]	19	Strength Dynamic	3	Respiratory function (Spirometry) Muscle strength	↔ CPK	↑ Respiratory function ↑ Muscle function
Harris-Love et al. [⁴⁶46. Harris-Love MO. Safety and efficacy of submaximal eccentric strength training for a subject with polymyositis. Arthritis Rheum. 2005;53:471-4.]	1	Strength Eccentric	12	Isometric strength	↔ Muscle enzymes	↑ Isometric strength ↑ Concentric strength
Alexanderson et al. [²³23. Alexanderson H, Dastmalchi M, Esbjornsson-Liljedahl M, Opava CH, Lundberg IE. Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum. 2007;57:768-77.]	8	Strength Dynamic	7	10-15 MVC Functional capacity	↔ CPK	↑ 10-15 MVC ↑ Disease activity ↑ Functional capacity
Dastmalchi et al. [¹⁴14. Dastmalchi M, Alexanderson H, Loell I, Stahlberg M, Borg K, Lundberg IE, et al. Effect of physical training on the proportion of slow-twitch type I muscle fibers, a novel nonimmune-mediated mechanism for muscle impairment in polymyositis or dermatomyositis. Arthritis Rheum. 2007;57:1303-10.]	9	Aerobic Strength	12	Type of muscle fiber Quality of life Functional capacity	Not reported	↑ Type I Fiber ↑ Functional Capacity ↑ Quality of Life
Chung et al. [⁴⁷47. Chung YL, Alexanderson H, Pipitone N, Morrison C, Dastmalchi M, Ståhl-Hallengren C, et al. Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment: six-month, double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;57:694-702.]	37	Strength Dynamic Creatine supplementation	20	Functional capacity Muscle strength Quality of life Pain and fatigue Anxiety and depression	↔ CPK	↑ Functional capacity ↑ Muscle strength ↔ Quality of life ↔ Anxiety and depression ↔ Pain and fatigue
Nader et al. [²¹21. Nader GA, Dastmalchi M, Alexanderson H, Grundtman C, Gernapudi R, Esbjornsson M, et al. A longitudinal, integrated, clinical, histological and mRNA profiling study of resistance exercise in myositis. Mol Med. 2010;16:455-64.]	8	Strength Dynamic	7	Genes related to inflammation and fibrosis	↓ CPK	↓ Genes related to inflammation and fibrosis ↓ Tissue fibrosis
Munters et al. [¹²12. Alemo Munters L, Dastmalchi M, Katz A, Esbjörnsson M, Loell I, Hanna B, et al. Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis. Arthritis Res Ther. 2013;15:83-96.]	9	Aerobic	12	Aerobic capacity Activity of mitochondrial enzymes	↔ CPK	↑ Aerobic capacity ↑ Activity of mitochondrial enzymes
Munters et al. [²⁰20. Alemo Munters L, Dastmalchi M, Andgren V, Emilson C, Bergegård J, Regardt M, et al. Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res (Hoboken). 2013;65:1959-68.]	11	Aerobic	12	Aerobic capacity Disability Disease activity Quality of life 5 MVC	↔ CPK	↓ Disease activity ↑ Muscle strength ↑ Quality of life ↑ Aerobic capacity ↑ Quality of life
Mattar et al. [²⁵25. Mattar MA, Gualano B, Perandini LA, Shinjo SK, Lima FR, Sá-Pinto LA, et al. Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis. Arthritis Res Ther. 2014;16:473.]	13	Strength Dynamic Vascular occlusion	12	Muscle strength Functional capacity Quality of life	↔ CPK ↔ Aldolase	↑ Muscle strength ↑ Functional capacity ↑ Quality of life
Munters et al. [²²22. Munters LA, Loell I, Ossipova E, Raouf J, Dastmalchi M, Lindroos E, et al. Endurance exercise improves molecular pathways of aerobic metabolism in patients with myositis. Arthritis Rheumatol. 2016;68:1738-50.]	15	Aerobic	12	Aerobic capacity Proteomic analysis Molecular profile	↔ CPK	↑ Aerobic capacity ↑ Genes related to capillary growth, mitochondrial biogenesis, protein synthesis, cytoskeletal remodeling and muscular hypertrophy ↑ Genes related to the immune and inflammatory response and sarcoplasmic reticulum stress

Author	Patients (n)	Disease activity	Protocol (Exercises)	Time (week)	Evaluated components	Inflammatory markers	Results
Escalante et al. [⁹9. Escalante A, Miller L, Beardmore TD. Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. J Rheumatol. 1993;41:1124-32.]	5	Active	Strength Dynamic	8	Isometric strength	↔ CPK	↑ Isometric strength
Alexanderson et al. [²⁴24. Alexanderson H, Stenstrom CH, Jenner G, Lundberg I. The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol. 2000;29:295-301.]	11	Active	Strength Dynamic	12	Muscle function Quality of life	↔ CPK	↑ Muscle function ↑ Quality of life
^a a Active disease but with chronic evolution Varvu et al. [⁴⁵45. Varjú C, Pethö E, Kutas R, Czirják L. The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil. 2003;17:83-7.]	19	Chronic/Active	Strength Dynamic	3	Respiratory function (Spirometry) Muscle strength	↔ CPK	↑ Respiratory function ↑ Muscle function
Mattar et al. [²⁹29. Mattar MA, Gualano B, Roschel H, Perandini LA, Dassouki T, Lima FR, Shinjo SK, de Sá Pinto AL. Exercise as an adjuvant treatment in persistent active polymyositis. J Clin Rheumatol. 2014;20:11-5.]	3	Active	Strength Aerobic	12	Muscle strength Functional capacity Quality of life	↔ CPK↔ Aldolase	↑ Muscle strength ↑ Functional capacity ↑ Quality of life

Author	Patients (n)	Protocol (Exercises)	Time (week)	Evaluated Components	Inflammatory markers	Results
Spector et al. [³⁵35. Spector SA, Lemmer JT, Koffman BM, Fleisher TA, Feuerstein IM, Hurley BF, et al. Safety and efficacy of strength training in patients with sporadic inclusion body myositis. Muscle Nerve. 1997;20:1242-8.]	5	Strength Dynamic	12	Isometric strength 3 MVC	↔ CPK ↔ Immune / inflammatory markers	↑ Isometric strength ↑ 3 MVC ↔ Increased cross-sectional area
Arnardottir et al. [³⁹39. Arnardottir S, Alexanderson H, Lundberg IE, Borg K. Sporadic inclusion body myositis: pilot study on the effects of a home exercise program on muscle function, histopathology and inflammatory reaction. J Rehabil Med. 2003;35:31-5.]	7	Strength Dynamic	12	Isometric strength	↔ CPK ↔ Cytokines ↔ Adhesion molecules	↑ Isometric strength
Johnson et al. [³²32. Johnson LG, Collier KE, Edwards DJ, Philippe DL, Eastwood PR, Walters SE, et al. Improvement in aerobic capacity after an exercise program in sporadic inclusion body myositis. J Clin Neuromuscul Dis. 2009;10:178-84.]	7	Aerobic	12	VO₂ peak Functional Capacity	↔ CPK	↑ VO₂ peak ↔ Functional capacity
	7	Strength Dynamic	16	Muscle strength Functional capacity	↔ CPK	↑ Muscle strength ↑ Functional capacity
Gualano et al. [³⁶36. Gualano B, Neves M Jr, Lima FR, Pinto AL, Laurentino G, Borges C, et al. Resistance training with vascular occlusion in inclusion body myositis: a case study. Med Sci Sports Exerc. 2010;42:250-4.]	1	Strength Dynamic With vascular occlusion	12	Muscle strength Balance Quality of life Cross-sectional area	↔ CPK	↑ Muscle strength ↑ Balance ↑ Quality of life ↑ Cross-sectional area
Santos et al. [³⁷37. Santos AR, Neves MT Jr, Gualano B, Laurentino GC, Lancha AH Jr, Ugrinowitsch C, et al. Blood flow restricted resistance training attenuates myostatin gene expression in a patient with inclusion body myositis. Biol Sport. 2014;31:121-4.]	1	Strength Dynamic With vascular occlusion	12	Myostatin gene Myostatin inhibitor genes	↔ CPK	↓ Myostatin gene ↑ Myostatin inhibitor genes
Jorgensen et al. [³⁸38. Jørgensen AN, Aagaard P, Nielsen JL, Frandsen U, Diederichsen LP. Effects of blood-flow-restricted resistance training on muscle function in a 74-year-old male with sporadic inclusion body myositis: a case report. Clin Physiol Funct Imaging. 2016;36:504-9.]	1	Strength Dynamic With vascular occlusion	12	Isometric strength Functional capacity Gait speed	↔ CPK	↑ Isometric strength ↑ Functional capacity ↑ Gait speed

[1] * Correspondence: samuel.shinjo@gmail.com

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Physical exercise among patients with systemic autoimmune myopathies

Abstract