Resistive home exercise in patients with recent-onset polymyositis and dermatomyositis -- a randomized controlled single-blinded study with a 2-year followup.
OBJECTIVE
To evaluate the outcome of resistive home exercise and its possible longterm influence on health, disability, and disease activity in patients with active polymyositis (PM) or dermatomyositis (DM).


METHODS
Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone. They were assessed by independent assessors as to perceived health, muscle performance, aerobic capacity, and serum creatine phosphokinase (CPK) at baseline and after 24 weeks, including repeated muscle biopsies at 24 weeks (single-blinded randomized controlled study), and in an open-label followup at 52, 78, and 104 weeks. Patients were randomized to 12 weeks, 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise (EG, n = 10) or to 24 weeks, 5 days/week range of motion exercise (CG, n = 9). Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises.


RESULTS
At baseline, the EG had poorer perceived health, but otherwise the groups were comparable. At 24 weeks, both groups improved in muscle performance and aerobic capacity (p < 0.001 to < 0.05) with no signs of increased inflammation assessed by CPK levels or muscle biopsies. Both groups improved in muscle performance and aerobic capacity up to 52 weeks (p < 0.05) lasting to 104 weeks in the EG (p < 0.05) and presented minor improvements in perceived health.


CONCLUSIONS
Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects. An individually adapted physical therapist-supervised home exercise program might be recommended in early active PM/DM, with regular evaluation of muscle performance and health.
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm. helene.alexanderson@karolinska.se.
Helene
H
Alexanderson
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Li Alemo
LA
Munters
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Maryam
M
Dastmalchi
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Ingela
I
Loell
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Mikael
M
Heimbürger
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Christina H
CH
Opava
From the Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge; Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet; Rheumatology Clinic, Karolinska University Hospital, Huddinge, Stockholm, Sweden.H. Alexanderson, PhD, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; L. Alemo Munters, PhD, RPT, Rheumatology Unit, Department of Medicine, and Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Solna; M. Dastmalchi, MD, PhD; I. Loell, PhD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm; M. Heimbürger, PhD, MD, Rheumatology Clinic, Karolinska University Hospital, Huddinge; C.H. Opava, Professor, RPT, Department of NVS, Division of Physical Therapy, Karolinska Institutet, Huddinge, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, and Karolinska Institutet, Stockholm; I.E. Lundberg, Professor, MD, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm.
Ingrid E
IE
Lundberg
D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000628:therapy*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055070:Resistance Training / Q000379:methods*; D012648:Self Care; D016037:Single-Blind Method; D016896:Treatment Outcome
AEROBIC CAPACITY; DERMATOMYOSITIS; EXERCISE; MUSCLE PERFORMANCE; POLYMYOSITIS