Resistance training with vascular occlusion in inclusion body myositis: a case study.
Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy that produces remarkable muscle weakness. Resistance training with vascular occlusion has been shown to improve muscle strength and cross-sectional area in other muscle wasting conditions.


OBJECTIVE
We evaluated the efficacy of a moderate-intensity resistance training program combined with vascular occlusion by examining functional capacity, muscle morphology, and changes in the expression of genes related to muscle protein synthesis and proteolysis in a patient with IBM.


METHODS
A 65-yr-old man with IBM resistant to all proposed treatments underwent resistance training with vascular occlusion for 12 wk. Leg press one-repetition maximum; thigh cross-sectional area; balance, mobility, and muscle function; quality of life; and blood markers of inflammation and muscle damage were assessed at baseline and after the 12-wk program. The messenger RNA (mRNA) expression levels of mechanogrowth factor, mammalian target of rapamycin, atrogin-1, and muscle RING finger-1 were also quantified.


RESULTS
After the 12-wk training program, the patient's leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. All Short Form-36 Health Survey Questionnaire subscales demonstrated improvements as well, varying from 18% to 600%. mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold. Muscle RING finger-1 and mammalian target of rapamycin mRNA levels were only slightly altered, 1.18- and 1.28-fold, respectively. Importantly, the exercise did not induce disease flare.


CONCLUSIONS
We describe a novel, and likely the first, nonpharmacological therapeutic tool that might be able to counteract the muscle atrophy and the declining strength that usually occur in IBM.
Gualano
Bruno
B
School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil. gualano@usp.br
Neves
Manoel
M
Lima
Fernanda Rodrigues
FR
Pinto
Ana Lúcia De Sá
AL
Laurentino
Gilberto
G
Borges
Claudia
C
Baptista
Luciana
L
Artioli
Guilherme Giannini
GG
Aoki
Marcelo Saldanha
MS
Moriscot
Anselmo
A
Lancha
Antonio Herbert
AH
Bonfá
Eloísa
E
Ugrinowitsch
Carlos
C
D000368:Aged; D019412:Anatomy, Cross-Sectional; D001157:Arterial Occlusive Diseases; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D018979:Myositis, Inclusion Body / Q000503:physiopathology / Q000628:therapy*; D052097:Quadriceps Muscle / Q000503:physiopathology; D012333:RNA, Messenger / Q000032:analysis; D055070:Resistance Training; D011795:Surveys and Questionnaires
D012333:RNA, Messenger