Submitted by: Shailesh Reddy, MD
Edited by: Niranjan Singh, MD
Birnbaum S, Porcher R, Portero P, et al. Home-based exercise in autoimmune myasthenia gravis: A randomized controlled trial. Neuromuscul Disord.
This study aimed to examine exercise tolerance and impact on quality of life in patients with stabilized, generalized autoimmune myasthenia gravis (MG). Patients were enrolled for a total 36 weeks. Randomization into exercise versus control group occurred at 3 months and intervention lasted for a total of 3 months. The primary endpoint was adjusted mean between-group different in MG-specific health-related quality of life which was assessed using the French version of the MG quality of life questionnaire.
This study found that a 3-month unsupervised home exercise program did not statistically improve MG-specific health related quality of life. Home exercise program was, however, well tolerated and improved impact on daily life as assessed by MG-ADL score. There was also improvement on 6-minute walking distance in those who had home exercise program. Exercise intensity for this study was chosen to be moderate and did not lead to any myasthenia deterioration, increased pain, or cardiopulmonary symptoms when compared to control group. However more research is needed to determine optimal intensity, duration, and frequency of exercise.
Study limitations included increased prevalence of young female demographic and inability to blind participants to intervention. This study shows that exercise can be well tolerated in the MG population for which there exist no specific recommendations.
This was a nice introductory study to an area of neuromuscular medicine that there is not much research or guidelines about. There were some shortcomings in terms of standardization. Currently, no evidence-based guideline exists on the amount and type of exercise in the patient with generalized MG and effects on the quality of life. In this study, the authors tried to analyze home-based exercise over a home rowing program over 3 months. Although the exercise was well tolerated, the intention to treat analysis revealed no evidence of improved health-related quality of life.
Knowledge about the type and intensity of exercise is important for the AANEM audience who frequently manages patients with MG. It remained to be determined up to what extent and types of exercise to be recommended to the patient with myasthenia gravis.
Article of similar interest:
Krivickas LS. Exercise in neuromuscular disease. J Clin Neuromuscular Dis.
(2003) 5:29–39. doi:10.1097/00131402-200309000-00004