RESUMO
Duchenne muscular dystrophy (DMD) is one of the most common forms of hereditary muscular dystrophies in childhood and is characterized by steady progression and early disability. It is known that physical therapy can slow down the rate of progression of the disease. According to global recommendations, pool exercises, along with stretching, are preferable for children with DMD, as these types of activities have a balanced effect on skeletal muscles and allow simultaneous breathing exercises. The present study aimed to evaluate the effectiveness of regular pool exercises in patients with Duchenne muscular dystrophy who are capable of independent movement during 4 months of training. 28 patients with genetically confirmed Duchenne muscular dystrophy, who were aged 6.9 ± 0.2 years, were examined. A 6-min distance walking test and timed tests, namely, rising from the floor, 10-meter running, and stair climbing and descending, muscle strength of the upper and lower extremities were assessed on the baseline and during dynamic observation at 2 and 4 months. Hydrorehabilitation course lasted 4 months and was divided into two stages: preparatory and training (depend on individual functional heart reserve (IFHR)). Set of exercises included pool dynamic aerobic exercises. Quantitative muscle MRI of the pelvic girdle and thigh was performed six times: before training (further BT) and after training (further AT) during all course. According to the results of the study, a statistically significant improvement was identified in a 6-min walking test, with 462.7 ± 6.2 m on the baseline and 492.0 ± 6.4 m after 4 months (p < 0.001). The results from the timed functional tests were as follows: rising from the floor test, 4.5 ± 0.3 s on the baseline and 3.8 ± 0.2 s after 4 months (p < 0.001); 10 meter distance running test, 4.9 ± 0.1 s on the baseline and 4.3 ± 0.1 s after 4 months (p < 0.001); 4-stair climbing test, 3.7 ± 0.2 s on the baseline and 3.2 ± 0.2 s after 4 months (p < 0.001); and 4-stair descent test, 3.9 ± 0.1 s on the baseline and 3.2 ± 0.1 s after 4 months (p < 0.001). Skeletal muscle quantitative MRI was performed in the pelvis and the thighs in order to assess the impact of the procedures on the muscle structure. Muscle water T2, a biomarker of disease activity, did not show any change during the training period, suggesting the absence of deleterious effects and negative impact on disease activity. Thus, a set of dynamic aerobic exercises in water can be regarded as effective and safe for patients with DMD.
RESUMO
Becker muscular dystrophy (BMD) is inherited X-linked neuromuscular disease characterized by progressive fatigue, atrophy, hypotonia and muscle weakness, that is predominantly located in muscles of pelvic girdle, femurs and lower leg. There are only singular studies at present showing the efficacy of different training programs for patients with muscular dystrophy, and there are no recommendations allowing to detect the optimal motor regimen, that is effective and safe for such patients. OBJECTIVE: To evaluate the efficacy of regular dynamic aerobic exercises in children with BMD, who are able to self-sustained movement. MATERIAL AND METHODS: The number of patients equal 13 with genetically confirmed BMD at the age from 8.9 to 15.9 years were examined. All patients took the course of exercise therapy for 4 months. The course was divided into 2 stages: the preparative (51-60% of the individual functional reserve of the heart (IFRH) with 6-8 repetitions of every exercise) and the training (61-70% of the IFRH with 10-12 repetitions of every exercise). The training duration was 60 min. The motor capabilities of patients were assessed by the 6-minute walk test, timed up & go test, MFM scale (sections D1, D2, D3) at the initial stage and during dynamic observation after 2 and 4 months. RESULTS: Statistically significant positive dynamics of indicators was revealed. The average distance in the 6-minute walk test at the initial stage was 526.9±12.7 m, after 4 months was 545.2±13.0 m (p<0.05). The average uplift time at the initial stage was 3.9±0.2 s, after 2 months was 3.5±0.2 s (p<0.05). The average running time for the distance of 10 m initially was 4.3±0.1 s, after 2 months was 3.8±0.1 s (p<0.05), after 4 months was 3.8±0.1 s (p<0.05). There was some positive dynamics in the evaluation of uplift and movement capabilities (D1) by the MFM scale: initially the indicator was 87.7±1.5%, after 2 months - 93.4±1.4% (p<0.001), after 4 months - 94.5±1.3% (p<0.001). Clinically significant adverse effects were not registered during the training courses. CONCLUSION: Aerobic trainings without weight combined with exercises on a cycle machine for 4 months allow to improve movement capabilities and are not characterized by clinically significant adverse effects in children with BMD.
