The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS

Anna Caroline Marques Braga, Anabela Pinto, Susana Pinto, Mamede de Carvalho, Anna Caroline Marques Braga, Anabela Pinto, Susana Pinto, Mamede de Carvalho

Abstract

Introduction: The efficacy of cardiopulmonary exercise testing (CPET) to determining exercise intensity has not been established in Amyotrophic Lateral Sclerosis (ALS). We studied this intervention.

Methods: We included 48 ALS patients randomized in 2 groups: G1 (n = 24), exercise intensity leveled by CPET; G2 (n = 24), standard care limited by fatigue, during 6 months. ALS functional scale (ALSFRS-R) and forced vital capacity (FVC) were performed every 3 months; CPET was done at admission (T1) and 6 months later (T2). We registered oxygen uptake, carbon dioxide output, and ventilation at anaerobic threshold and at peak effort. Primary outcome was functional change. We used parametric statistics for comparisons and multiple regression analyses to identify independent predictors of functional decline.

Results: At T1 both groups were identical, except for higher FVC in G1 (p = 0.02). At T2, ALSFRS-R was higher (p = 0.035) in G1. Gas exchange variables at T2 did not change in G1 but had significant differences in G2 (p < 0.05). Multiregression analyses showed the Spinal ALSFRS-R slope and Intervention group (p < 0.001) as significant predictors of ALSFRS-R at T2.

Conclusion: Aerobic exercise defined by CPET is feasible and can improve functional outcome in ALS. This trial is registered with Clinical trials.gov ID: NCT03326622.

Figures

Figure 1
Figure 1
At the end of study we can identify the main findings between groups. The arrows indicate the direction of the significant differences in G1 when compared with standard care group G2. The VO2 peak in G2 reduced 46% since T1. AECI: aerobic exercise with controlled intensity and NIV: non-invasive ventilation.
Figure 2
Figure 2
Slope of ALSFRS-R total score between T0, T1, and T2 for both groups.
Figure 3
Figure 3
Influence of use of NIV on ALSFRS-R at end of study, Confidence Interval 95% (−3.08–6.04).
Figure 4
Figure 4
VO2 Peak at T1 (p = 0.13, [CI: −0,78–0,11]) and at T2 (p = 0.002, [CI: −0,96–−0,25]).
Figure 5
Figure 5
VO2 at the Anaerobic Threshold, T1 (p = 0.8, [CI 95%: −0,23–0,29]) and T2 (p = 0.02, [CI 95%: −0,70–−0,06]).

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