title: Strength training and aerobic exercise training for muscle disease.
abstract: BACKGROUND
  Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004.
  
  
  OBJECTIVE
  To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease.
  
  
  METHODS
  We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012).
  
  
  METHODS
  Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.We did not use the reporting of specific outcomes as a study selection criterion.
  
  
  METHODS
  Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies.
  
  
  RESULTS
  We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported.
  
  
  CONCLUSIONS
  Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.
authors.affiliation: Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, Netherlands. N.Voet@reval.umcn.nl.
authors.forename: Nicoline B M
authors.initials: NB
authors.lastname: Voet
authors.forename: Elly L
authors.initials: EL
authors.lastname: van der Kooi
authors.forename: Ingrid I
authors.initials: II
authors.lastname: Riphagen
authors.forename: Eline
authors.initials: E
authors.lastname: Lindeman
authors.forename: Baziel G M
authors.initials: BG
authors.lastname: van Engelen
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
mesh_terms: D003882:Dermatomyositis / Q000534:rehabilitation; D015444:Exercise; D006801:Humans; D017240:Mitochondrial Myopathies / Q000534:rehabilitation; D009135:Muscular Diseases / Q000534:rehabilitation*; D020391:Muscular Dystrophy, Facioscapulohumeral / Q000534:rehabilitation; D009223:Myotonic Dystrophy / Q000534:rehabilitation; D010809:Physical Fitness; D017285:Polymyositis / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic; D055070:Resistance Training / Q000379:methods*