Science News: Efficacy and Safety of Hydrokinesitherapy in Patients With Dystrophinopathy

Submitted by: Nakul Katyal, MD
Edited by: Joshua Wilson, MD

Citation: Suslov VM, Lieberman LN, Carlier PG, et al. Efficacy and safety of hydrokinesitherapy in patients with dystrophinopathy. Front Neurol. 2023;14:1230770. Published 2023 Jul 26. doi:10.3389/fneur.2023.1230770

Summary: This study aimed to assess the effectiveness and safety of regular pool dynamic aerobic exercises in ambulatory patients with Duchenne muscular dystrophy (DMD). Outcome measures, including the six-minute walk test, rising time from the floor, 10-meter running, stair climbing and descending, and muscle strength of the upper and lower extremities, were assessed at baseline and during dynamic observation at two and four months. In addition, a quantitative muscle MRI of the pelvic girdle and thigh was performed before and after training during the course. The aquatic rehabilitation course was divided into preparatory and training phases. Each patient's training intensity was individualized depending on their functional heart reserve. Each session lasted 60 min with a frequency of three times a week.

Twenty-eight patients with genetically confirmed DMD were included in the study. The average participant age was 6.9 ± 0.2 years. To be included all patients had to be independent in mobility. Further all patients were on daily steroid according to DMD Care consideration. 

There were statistically significant improvements in multiple outcomes four months post-training compared to baseline, including the six-min walk test (462.7 ± 6.2 m vs 492.0 ± 6.4 m), rising-from the-floor test (4.5 ± 0.3s vs. 3.8 ± 0.2 s), 10-meter-running test (4.9s ± 0.1 vs. 4.3 ± 0.1 s); four-stair climbing test (3.7 ± 0.2 vs. 3.2 ± 0.2 s) and four-stair descent test (3.9 ± 0.1 s vs. 3.2 ± 0.1 s). Quantitative MRI analyses showed that the Т2 water content of muscles remained constant during the study. Eighteen patients experienced mild side effects, including muscle pain (12 patients), muscle tension, and hardening in the lower extremities (13 patients). All patients were able to continue the course.

Comments: Currently, there is a lack of consensus guidelines regarding a safe and efficient exercise regimen for patients with DMD. This research emphasized the efficacy of dynamic aerobic exercises in a pool setting for ambulatory DMD patients. It demonstrated improvements in timed function tests with no significant alterations in muscle water content, suggesting aquatic kinesiotherapy’s safety for individuals with dystrophinopathy. This study contributes to the limited body of literature regarding the effectiveness of aquatic aerobics for those with neuromuscular disorders. Additional research is imperative to assess the long-term impacts of these exercises in dystrophinopathies and the rate of disease progression. This article is relevant to the AANEM audience because NM and PM&R physicians provide care for patients with dystrophinopathies. Developing a safe and efficient exercise regimen for these patients is crucial to mitigate disease advancement and related orthopedic issues.

Article of Similar Interest: Huguet-Rodríguez M, Arias-Buría JL, Huguet-Rodríguez B, Blanco-Barrero R, Braña-Sirgo D, Güeita-Rodríguez J. Impact of Aquatic Exercise on Respiratory Outcomes and Functional Activities in Children with Neuromuscular Disorders: Findings from an Open-Label and Prospective Preliminary Pilot Study. Brain Sci. 2020;10(7):458. Published 2020 Jul 17. doi:10.3390/brainsci10070458