Exercise therapy and other types of PT for patients with neuromuscular diseases:

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Arch Phys Med Rehabil. 2007 Nov;88(11):1452-64.

Exercise therapy and other types of physical therapy for patients

with neuromuscular diseases: a systematic review.

Cup EH, Pieterse AJ, Ten Broek-Pastoor JM, Munneke M, van Engelen

BG, Hendricks HT, van der Wilt GJ, Oostendorp RA.

Department of Occupational Therapy, Research Centre of Allied Health

Care, Nijmegen, The Netherlands.

Exercise therapy and other types of physical therapy for patients

with neuromuscular diseases: a systematic review.

OBJECTIVE: To summarize and critically appraise the available

evidence on exercise therapy and other types of physical therapies

for patients with neuromuscular diseases (NMD).

DATA SOURCES: Cochrane Central Register of Controlled Trials and

Cochrane Database of Systematic Reviews, Medline, CINAHL, EMBASE

(Rehabilitation and Physical Medicine), and reference lists of

reviews and articles.

STUDY SELECTION: Randomized clinical trials (RCTs), controlled

clinical trials (CCTs), and other designs were included. Study

participants had to have any of the following types of NMD:

motoneuron diseases, disorders of the motor nerve roots or

peripheral nerves, neuromuscular transmission disorders, or muscle

diseases. All types of exercise therapy and other physical therapy

modalities were included. Outcome measures had to be at the level of

body functions, activities, or participation according to the

definitions of the International Classification of Functioning,

Disability and Health (ICF).

DATA EXTRACTION: Two reviewers independently decided on inclusion or

exclusion of articles and rated the methodologic quality of the

studies included. All RCTs, CCTs, and other designs only if of

sufficient methodologic quality were included in a best evidence

synthesis. A level of evidence was attributed for each subgroup of

NMD and each type of intervention.

DATA SYNTHESIS: Initially 58 studies were included: 12 RCTs, 5 CCTs,

and 41 other designs. After methodologic assessment, 19 other

designs were excluded from further analysis. There is level II

evidence ( " likely to be effective " ) for strengthening exercises in

combination with aerobic exercises for patients with muscle

disorders. Level III evidence ( " indications of effectiveness " ) was

found for aerobic exercises in patients with muscle disorders and

for the combination of muscle strengthening and aerobic exercises in

a heterogeneous group of muscle disorders. Finally, there is level

III evidence for breathing exercises for patients with myasthenia

gravis and for patients with myotonic muscular dystrophy. Adverse

effects of exercise therapy were negligible.

CONCLUSIONS: The available evidence is limited, but relevant for

clinicians. Future studies should be preferably multicentered, and

use an international classification of the variables of exercise

therapy and an ICF core set for NMD in order to improve

comparability of results.