Exercise training as a maintenance strategy for myopathies

What is the problem?

The characteristic aftermath of a myopathy is weakness. Because there is an increased risk of severe muscle damage in patients with an underlying myopathy, exercise training as a maintenance strategy is usually contraindicated. However, work by colleagues in Spain have shown that by understanding how the myopathy leads to muscle damage, exercise training can be achieved and improve overall quality of life. They specifically showed improvements in patients with glycogen storage disease V (also known as McArdle’s disease) when they were subjected to systematic exercise intervention, with an emphasis on the duration of each exercise bout. (Read more here)

What did we do?

In collaboration with the the Sport Science Institute of South Africa, we set out to test whether we could apply the same approach to a volunteer with inclusion body myositis (IBM). Specifically, we aimed to determine whether the exercise training:

  • was safe for the patient, and
  • improved muscle strength.

This was a pilot study with only one 71 year old male volunteer with advanced inclusion body myositis, an auto-immune disease with no known treatment or cure. The study was approved by the University of Cape Town Health Science Human Research Ethics Committee. The volunteer agreed to disclose his identity.

The overall design of the study was to test the volunteer’s strength, subject him to 8 weeks supervised exercise training (3x per week), test him again, continue with another 7 weeks of training, and finally, another round of strength tests. 

Dr Caroline D'Alton checking if Brian is ready to tackle the exercise challenge.

What was found?

Initially, we were concerned about the age of the volunteer and his advanced stage of IBM. However, the patient encountered no problems during the study. We also monitored his kidney function and also showed no elevated blood creatine kinase concentrations (being a marker of muscle damage) during the exercise training or after each strength test.

 

The training improved some, but not all muscle groups after the 8 and 15 weeks study (graph above). It also appears that there were asymmetrical changes that occurred. For some the strength also remained the same.

The data also shows the range in strength of healthy untrained individuals (grey horizontal box). IBM affects only specific muscles, and this is clearly shown by the muscle weakness in the biceps during elbow flexion, but normal output during elbow extension.

Conclusion

The exercise training was safe and improved some muscle function in the IBM volunteer.

Future directions?

We would like to continue this research and exercise intervention on a larger cohort of IBM volunteers. We will also publish the results of this case study.

If you are interested in pursuing an MSc or PhD in this field, please contact the MyoLab.

Research team

From left to right:

  • Avinesh Pursad (Head Biokineticist – SSISA)
  • Danielle Prins (Exercise Scientist – University of Cape Town)
  • Brian Berman (Participant)
  • Rachel Johnstone (Biokineticist – SSISA)
  • Caitlin du Plessis (Biokineticist – SSISA)
  • Tertius Kohn (Principle Investigator and project coordinator – Universities of Cape Town and the Western Cape)
  • Caroline D’Alton (Clinical advisor and assessor – University of Cape Town)