title: Efficacy of muscle exercise in patients with muscular dystrophy: a systematic review showing a missed opportunity to improve outcomes.
abstract: BACKGROUND
  Although muscular dystrophy causes muscle weakness and muscle loss, the role of exercise in the management of this disease remains controversial.
  
  
  OBJECTIVE
  The purpose of this systematic review is to evaluate the role of exercise interventions on muscle strength in patients with muscular dystrophy.
  
  
  METHODS
  We performed systematic electronic searches in Medline, Embase, Web of Science, Scopus and Pedro as well as a list of reference literature. We included trials assessing muscle exercise in patients with muscular dystrophy. Two reviewers independently abstracted data and appraised risk of bias.
  
  
  RESULTS
  We identified five small (two controlled and three randomized clinical) trials comprising 242 patients and two ongoing randomized controlled trials. We were able to perform two meta-analyses. We found an absence of evidence for a difference in muscle strength (MD 4.18, 95% CIs - 2.03 to 10.39; p = 0.91) and in endurance (MD -0.53, 95% CIs -1.11 to 0.05; p = 0.26). In both, the direction of effects favored muscle exercise.
  
  
  CONCLUSIONS
  The first included trial about the efficacy of muscular exercise was published in 1978. Even though some benefits of muscle exercise were consistently reported across studies, the benefits might be due to the small size of studies and other biases. Detrimental effects are still possible. After several decades of research, doctors cannot give advice and patients are, thus, denied basic information. A multi-center randomized trial investigating the strength of muscles, fatigue, and functional limitations is needed.
authors.affiliation: Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy. silvia.gianola@gmail.com
authors.forename: Silvia
authors.initials: S
authors.lastname: Gianola
authors.forename: Valentina
authors.initials: V
authors.lastname: Pecoraro
authors.forename: Simone
authors.initials: S
authors.lastname: Lambiase
authors.forename: Roberto
authors.initials: R
authors.lastname: Gatti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Banfi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
mesh_terms: D015444:Exercise / Q000502:physiology*; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D009136:Muscular Dystrophies / Q000628:therapy*; D011788:Quality of Life
references.citation: Muscle Nerve. 1987 Jan;10(1):6-14
references.pmid: 3561438
references.citation: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003907
references.pmid: 20091552
references.citation: Arch Phys Med Rehabil. 1971 Jul;52(7):333-6
references.pmid: 5565885
references.citation: Brain. 2008 Nov;131(Pt 11):2824-31
references.pmid: 18776212
references.citation: BMJ. 2013 Jan 09;346:f105
references.pmid: 23303893
references.citation: FASEB J. 2003 Sep;17(12):1579-84
references.pmid: 12958164
references.citation: Med Sci Sports Exerc. 1997 Jan;29(1):107-12
references.pmid: 9000162
references.citation: BMC Neurol. 2010 Jun 30;10:56
references.pmid: 20591139
references.citation: Lancet. 2011 Nov 19;378(9805):1777-8
references.pmid: 22098852
references.citation: J Neurol. 2007 Jul;254(7):931-40
references.pmid: 17361345
references.citation: Mol Cell Biochem. 1998 Feb;179(1-2):111-23
references.pmid: 9543354
references.citation: Occup Ther Int. 2005;12(1):14-27
references.pmid: 15962697
references.citation: Muscle Nerve. 1983 Jun;6(5):323-38
references.pmid: 6888414
references.citation: Cochrane Database Syst Rev. 2004;(1):CD003316
references.pmid: 14974012
references.citation: Physiotherapy. 1981 Jun;67(6):174-6
references.pmid: 7029578
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: J Physiother. 2012;58(3):145-56
references.pmid: 22884181
references.citation: J Electromyogr Kinesiol. 1999 Dec;9(6):379-84
references.pmid: 10597050
references.citation: Phys Ther. 1986 Jul;66(7):1110-3
references.pmid: 3725897
references.citation: Acta Physiol Scand. 2001 Mar;171(3):359-66
references.pmid: 11412149
references.citation: Am J Phys Med. 1955 Feb;34(1):109-15
references.pmid: 14361678
references.citation: Muscle Nerve. 2001 Sep;24(9):1181-7
references.pmid: 11494271
references.citation: Ann Oncol. 2011 Nov;22 Suppl 7:vii44-vii49
references.pmid: 22039144
references.citation: Am J Phys Med. 1979 Feb;58(1):26-36
references.pmid: 434131
references.citation: BMC Pediatr. 2010 Aug 06;10:55
references.pmid: 20691042
references.citation: J Appl Physiol (1985). 2004 May;96(5):1861-6
references.pmid: 15075311
references.citation: Neurology. 2007 Jan 2;68(1):59-61
references.pmid: 17200494
references.citation: J Rehabil Med. 2011 Jul;43(8):695-702
references.pmid: 21670942
references.citation: Neurology. 2005 Mar 22;64(6):1064-6
references.pmid: 15781829
references.citation: Mol Diagn Ther. 2008;12(2):99-108
references.pmid: 18422374
references.citation: Top Stroke Rehabil. 2008 May-Jun;15(3):177-99
references.pmid: 18647724
references.citation: Muscle Nerve. 1984 Jul-Aug;7(6):496-9
references.pmid: 6543905
references.citation: J Strength Cond Res. 2001 Nov;15(4):439-45
references.pmid: 11726254
references.citation: Nat Genet. 2012 Feb 26;44(4):450-5, S1-2
references.pmid: 22366786
references.citation: J R Soc Med. 2003 Dec;96(12):575-6
references.pmid: 14645604
references.citation: Int J Pediatr Otorhinolaryngol. 2010 Oct;74(10):1126-34
references.pmid: 20638139
references.citation: Arch Phys Med Rehabil. 1995 Jul;76(7):612-20
references.pmid: 7605179
references.citation: Scand J Rehabil Med. 1999 Mar;31(1):9-16
references.pmid: 10229998
references.citation: J Rehabil Med. 2001 Sep;33(5):206-11
references.pmid: 11585151
references.citation: Phys Ther Rev (1948). 1958 Jan;38(1):26-32
references.pmid: 13494198
references.citation: BMJ. 2012 Sep 03;345:e5205
references.pmid: 22945950
references.citation: Phys Ther. 1984 Jan;64(1):41-5
references.pmid: 6361809
references.citation: Yonsei Med J. 1996 Aug;37(4):237-42
references.pmid: 8942293
references.citation: J Pain. 2012 Dec;13(12):1139-50
references.pmid: 23141188
references.citation: Int J Med Inform. 2001 Nov;64(1):1-14
references.pmid: 11673099
references.citation: Neurology. 2004 Aug 24;63(4):702-8
references.pmid: 15326246
references.citation: Neurorehabil Neural Repair. 2009 Feb;23(2):108-16
references.pmid: 18948413