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Physical exercise in Myasthenia Gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology. Ryhov Cty Hosp, Dept Neurol, Jonkoping, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
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2017 (English)In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 56, no 2, p. 207-214Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Due to the shortage of exercise-related research in Myasthenia Gravis (MG), there are no consensus guidelines on physical exercise for MG patients.

METHODS: In this prospective pilot study, 10 MG patients with mild disease performed supervised aerobic and resistance training twice weekly for 12 weeks. The Myasthenia Gravis Composite (MGC) score, compound motor action potential (CMAP), repetitive nerve stimulation, muscle force, physical performance-based measures, serum levels of interleukin-6, muscle enzymes as well as immuno-microRNAs miR-150-5p and miR-21-5p were assessed before and after the training period.

RESULTS: Physical exercise was well tolerated, and the MGC score was unchanged. Muscle resistance weights and CMAP amplitudes increased for biceps brachii and rectus femoris muscles, and physical performance-based measures improved. Muscle enzymes remained normal, whereas disease-specific microRNAs miR-150-5p and miR-21-5p were reduced after the training period.

CONCLUSIONS: We propose that general recommendations regarding physical exercise safely can be applied to well-regulated MG patients.

Place, publisher, year, edition, pages
2017. Vol. 56, no 2, p. 207-214
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-314678DOI: 10.1002/mus.25493ISI: 000406875000009PubMedID: 27935072OAI: oai:DiVA.org:uu-314678DiVA, id: diva2:1071416
Funder
Swedish Research Council, 2014-02048Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 520281, 520411Swedish Society of Medicine, SLS-499271Available from: 2017-02-04 Created: 2017-02-04 Last updated: 2018-03-08Bibliographically approved
In thesis
1. Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
Open this publication in new window or tab >>Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Myasthenia Gravis (MG) is an autoimmune disease caused by antibodies directed against proteins at the neuromuscular junction (NMJ). The disturbed neuromuscular transmission induces fatigable weakness in skeletal muscles. The severity of MG ranges from purely ocular symptoms to extensive weakness with, at worst, respiratory failure and need of intensive care. Due to different pathogenic antibodies, as well as varying phenotypes there is a classification into MG subgroups.

As lifestyle disorders are common conditions they occur also in MG patients. It is unknown whether there are any lifestyle factors associated with MG or MG subgroups. However, medication side effects and disability due to disease could contribute to higher risks for lifestyle related diseases. General treatment guidelines are not suitable to MG patients, since various medications are known to affect the disease negatively and as the tolerance and effects of physical activity in MG is unknown.

In this thesis the occurrence of lifestyle related environmental factors in MG patients were investigated. MG epidemiology, subgroup differences and the presence of lifestyle related risks in MG patients were evaluated in Jönköping county in Southern Sweden. The findings were compared to a similar evaluation in a region of Estonia. We found that MG patients in the late-onset disease subgroup had a more disadvantageous pattern of life-style related risk factors, with a higher rate of obesity, smoking and physical inactivity and a lower rate of fish consumption in comparison to matched population controls. Furthermore, we found that despite comparable clinical muscle fatigue status, Estonian MG patients subjectively scored fatigue and disease severity higher than Swedish MG patients. More Estonian patients were physically inactive. The tolerance and effects of physical exercise was further evaluated in two intervention studies, where MG patients with stable disease performed a 12-week-training-program according to general exercise recommendations to healthy adults. We found that physical exercise was well tolerated by the MG patients and that they had a beneficial skeletal muscle response to physical exercise.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1439
Keywords
Myasthenia Gravis, MG subgroups, Environmental factors, Lifestyle, Physical activity, Exercise
National Category
Neurology
Research subject
Clinical Neurophysiology
Identifiers
urn:nbn:se:uu:diva-344667 (URN)978-91-513-0262-1 (ISBN)
Public defence
2018-04-27, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, ingång 10, Uppsala, 09:00 (English)
Opponent
Supervisors
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenSwedish Research Council
Note

Ytterligare forskningsfinansiärer: Neuroförbundet, Palle Ferbs minnesfond samt Erik, Karin och Gösta Selanders stiftelse

Available from: 2018-04-05 Created: 2018-03-08 Last updated: 2018-04-24

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Westerberg, ElisabetMolin, Carl JohanEmtner, MargaretaRostedt Punga, Anna

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