title: Assisted bicycle training delays functional deterioration in boys with Duchenne muscular dystrophy: the randomized controlled trial "no use is disuse".
abstract: BACKGROUND
  Physical training might delay the functional deterioration caused by disuse in boys with Duchenne muscular dystrophy (DMD). The "No Use Is Disuse" study is the first explorative, randomized controlled trial in boys with DMD to examine whether assisted bicycle training is feasible, safe, and beneficial.
  
  
  METHODS
  Ambulatory and recently wheelchair-dependent boys with DMD were allocated to the intervention or control group. The intervention group received assisted bicycle training of the legs and arms during 24 weeks. The control group received the same training after a waiting period of 24 weeks. The primary study outcomes were the Motor Function Measure (MFM) and the Assisted 6-Minute Cycling Test (A6MCT). Group differences were examined by an analysis of covariance.
  
  
  RESULTS
  Thirty boys (mean age 10.5 ± 2.6 years, 18 ambulant and 12 wheelchair-dependent) were allocated to the intervention (n = 17) or the control (n = 13) group. All boys in the intervention group (except one) completed the training. After 24 weeks, the total MFM score remained stable in the intervention group, whereas it had significantly decreased in the control group (Δ = 4.9, 95% confidence interval = 2.2-7.6). No significant group differences were found for the A6MCT. No serious adverse events were observed.
  
  
  CONCLUSIONS
  Our results suggest that assisted bicycle training of the legs and arms is feasible and safe for both ambulant and wheelchair-dependent children and may decline the deterioration due to disuse. Progressive deterioration, however, may compromise the design of trials for DMD.
authors.affiliation: 1Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Merel
authors.initials: M
authors.lastname: Jansen
authors.forename: Nens
authors.initials: N
authors.lastname: van Alfen
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
authors.forename: Imelda J M
authors.initials: IJ
authors.lastname: de Groot
mesh_terms: D001642:Bicycling; D002648:Child; D005081:Exercise Therapy; D006801:Humans; D008124:Locomotion; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Duchenne muscular dystrophy; exercise training; neuromuscular disease; physical therapy; randomized clinical trial; rehabilitation; strength training