Exercise therapy and other types of physical therapy for patients with neuromusc

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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.

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.