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      Can Therapeutic Exercise Slow Down Progressive Functional Decline in Patients With Amyotrophic Lateral Sclerosis? A Meta-Analysis

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          Abstract

          Background: Despite the high incidence of muscle weakness in patients with amyotrophic lateral sclerosis (ALS), the effects of therapeutic exercise on these individuals have not been clearly determined.

          Methods: A comprehensive database search was conducted on PubMed, Embase, Cochrane Library, and SCOPUS. We included studies published up to December 31, 2019 that fulfilled our inclusion and exclusion criteria. Functional status was determined as the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) score (previous and revised versions) before and after a therapeutic exercise program for the meta-analysis. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials was used for the methodological quality assessments of included studies. The meta-analysis was performed using the RevMan v.5.3.

          Results: A total of 94 patients in the experimental group (who received therapeutic exercise) and 159 patients in the control group (who received conventional exercise or therapy) were included from five randomized controlled trials. The decrement of ALSFRS (previous version), ALSFRS-R (revised version), and ALSFRS-R-Respiratory scores at the 6-month evaluation were less for the therapeutic exercise group as compared to the control group. However, at the 6-month evaluation, the ALSFRS-R-Limb scores did not significantly differ between the two groups.

          Conclusions: Therapeutic exercise appears beneficial for patients with ALS. Further, it appears to exert more of a cardiopulmonary benefit, as opposed to preventing the progression of limb weakness. However, as the therapeutic exercises applied in each included study were not uniform, the result of our meta-analysis should be considered cautiously.

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          Global Epidemiology of Amyotrophic Lateral Sclerosis: A Systematic Review of the Published Literature

          A Chiò, G. Logroscino, B.J Traynor … (2013)
          Background: Amyotrophic lateral sclerosis (ALS) is relatively rare, yet the economic and social burden is substantial. Having accurate incidence and prevalence estimates would facilitate efficient allocation of healthcare resources. Objective: To provide a comprehensive and critical review of the epidemiological literature on ALS. Methods: MEDLINE and EMBASE (1995-2011) databases of population-based studies on ALS incidence and prevalence reporting quantitative data were analyzed. Data extracted included study location and time, design and data sources, case ascertainment methods and incidence and/or prevalence rates. Medians and interquartile ranges (IQRs) were calculated, and ALS case estimates were derived using 2010 population estimates. Results: In all, 37 articles met the inclusion criteria. In Europe, the median incidence rate (/100,000 population) was 2.08 (IQR 1.47-2.43), corresponding to an estimated 15,355 (10,852-17,938) cases. Median prevalence (/100,000 population) was 5.40 (IQR 4.06-7.89), or 39,863 (29,971-58,244) prevalent cases. Conclusions: Disparity in rates among ALS incidence and prevalence studies may be due to differences in study design or true variations in population demographics such as age and geography, including environmental factors and genetic predisposition. Additional large-scale studies that use standardized case ascertainment methods are needed to more accurately assess the true global burden of ALS.
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            The value of muscle exercise in patients with amyotrophic lateral sclerosis.

            Vivian E. Drory, Evgeny Goltsman, Jacqueline Goldman Reznik … (2001)
            The role of physical activity for patients with amyotrophic lateral sclerosis (ALS) is controversial. Twenty-five ALS patients were randomized to receive a moderate daily exercise program (n=14) or not to perform any physical activity beyond their usual daily requirements (n=11). At baseline and after 3, 6, 9 and 12 months, patients were assessed by manual muscle strength testing, the Ashworth spasticity scale, ALS functional rating scale (FRS), fatigue severity scale, a visual analogue scale for musculoskeletal pain and the quality-of-life scale (SF-36). At 3 months, patients who performed regular exercise showed less deterioration on FRS and Ashworth scales, but not on other parameters. At 6 months, there was no significant difference between groups, although a trend towards less deterioration in the treated group on most scales was observed. At 9 and 12 months, there were too few patients in each group for statistical evaluation. Our results show that a regular moderate physical exercise program has a short-lived positive effect on disability in ALS patients and should be recommended.
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              A randomized controlled trial of resistance exercise in individuals with ALS.

              V Bello, J Scheirbecker, Janet Kloos … (2007)
              To determine the effects of resistance exercise on function, fatigue, and quality of life in individuals with ALS. Subjects with a diagnosis of clinically definite, probable, or laboratory-supported ALS, forced vital capacity (FVC) of 90% predicted or greater, and an ALS Functional Rating Scale (ALSFRS) score of 30 or greater were randomly assigned to a resistance exercise group that received a home exercise program consisting of daily stretching and resistance exercises three times weekly or to a usual care group, who performed only the daily stretching exercises. ALSFRS, the Fatigue Severity Scale (FSS), and Short Form-36 (SF-36) were completed at baseline and monthly for 6 months. FVC and maximum voluntary isometric contraction (MVIC) were monitored monthly throughout the study. Of 33 subjects screened, 27 were randomly assigned (resistance = 13; usual care = 14). Eight resistance exercise subjects and 10 usual care subjects completed the trial. At 6 months, the resistance exercise group had significantly higher ALSFRS and SF-36 physical function subscale scores. No adverse events related to the intervention occurred, MVIC and FVC indicated no negative effects, and less decline in leg strength measured by MVIC was found in the resistance exercise group. Our study, although small, showed that the resistance exercise group had significantly better function, as measured by total ALS Functional Rating Scale and upper and lower extremity subscale scores, and quality of life without adverse effects as compared with subjects receiving usual care.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Neurol
                Journal ID (iso-abbrev): Front Neurol
                Journal ID (publisher-id): Front. Neurol.
                Title: Frontiers in Neurology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-2295
                Publication date (Electronic): 13 August 2020
                Publication date Collection: 2020
                Volume: 11
                Electronic Location Identifier: 853
                Affiliations
                [1] 1Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan, South Korea
                [2] 2Department of Medical Statistics, College of Medicine, Catholic University of Daegu , Daegu, South Korea
                [3] 3Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital , Daegu, South Korea
                [4] 4Department of Rehabilitation Medicine, College of Medicine, Yeoungnam University , Daegu, South Korea
                Author notes

                Edited by: Angelo Schenone, University of Genoa, Italy

                Reviewed by: Adriano Chio, University of Turin, Italy; Gabriele Siciliano, University of Pisa, Italy

                *Correspondence: Min Cheol Chang wheel633@ 123456gmail.com

                This article was submitted to Neuromuscular Diseases, a section of the journal Frontiers in Neurology

                Article
                DOI: 10.3389/fneur.2020.00853
                PMC ID: 7438585
                SO-VID: b6c9e6bd-daca-46df-ac28-2fc0d03d454d
                Copyright © Copyright © 2020 Park, Kwak, Park, Choo and Chang.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 05 February 2020
                Date accepted : 07 July 2020
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 27, Pages: 7, Words: 3944
                Categories
                Subject: Neurology
                Subject: Review

                ScienceOpen disciplines: Neurology
                Keywords: amyotrophic lateral sclerosis,therapeutic exercise,conventional exercise,motor function,respiratory function,meta-analysis
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: amyotrophic lateral sclerosis, therapeutic exercise, conventional exercise, motor function, respiratory function, meta-analysis

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