Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study

Helene Alexanderson, Jenny Bergegård, Lena Björnådal, Annica Nordin, Helene Alexanderson, Jenny Bergegård, Lena Björnådal, Annica Nordin

Abstract

Background: No previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment. The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50-100% of forced vital capacity.

Methods: A single-subject experimental design with repeated systematic measures during a six week A-phase (non-interventional baseline period) and an eight week B-phase (exercise intervention period) was used. Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale (strenuous) and muscular endurance training three times/week. Physical capacity (six-minute walk test), aerobic capacity (submaximal treadmill test) and muscle endurance in shoulder and hip flexion (Functional Index 2) were assessed every other week throughout the 14-week study. Activity limitation (Health Assessment Questionnaire), quality of life (Short Form 36), Raynaud, Fatigue and Global Health during the recent week (Visual Analogue Scales) were assessed at weeks 0, 6, 14.

Results: Three participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevant in aerobic capacity. All other variables remained unchanged, except for a trend towards reduced fatigue.

Conclusions: This eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance.

Trial registration: Clinicaltrials.gov Identifier: NCT01813578.

Figures

Figure 1
Figure 1
Individual results of muscle endurance assessed by the FI-2 in participants 2 and 3 (1a-1e), and aerobic capacity in participant 3 (1f).
Figure 2
Figure 2
Individual results of patient-reported fatigue assessed by the VAS, 0–100.

References

    1. Hinchcliff M, Varga J. Systemic sclerosis/Scleroderma: a treatable multisystem disease. Am Fam Physician. 2010;78:961–968.
    1. Proudman SM, Stevens WM, Sahhar J, Celermajer D. Pulmonary arterial hypertension in systemic sclerosis: the need for early detection and treatment. Intern Med J. 2007;37:485.494.
    1. Mouthon L, Berezné A, Brauner M, Kambouchner M, Guillevin L, Valeyre D. Interstitial lung disease in systemic sclerosis. Rev Mal Respir. 2007;24:1–11.
    1. Hunzelmann N, Brinckmann J. What are the new milestones in the pathogenesis of systemic sclerosis. Ann Rheum Dis. 2010;69(Suppl 1):i52–i56. doi: 10.1136/ard.2009.117119.
    1. Avouac J, Walker U, Tyndall A, Kahan A, Matucci-Cerinic M, Allanore Y. et al.Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR scleroderma trial and research group (EUSTAR) database. J Rheumatol. 2010;37:1488–1501. doi: 10.3899/jrheum.091165.
    1. Sandusky SB, McGuire L, Smith MT, Wigley FM, Haythornthwaite JA. Fatigue: an overlooked determinant of physical function in scleroderma. Rheumatology (Oxford) 2009;48:165–169.
    1. Khanna D, Clements PJ, Furst DE, Chon Y, Elashoff R, Roth MD. et al.Correlation of the degree of dyspnea with health-related quality of life, functional abilities, and diffusing capacity for carbon monoxide in patients with systemic sclerosis and active alveolitis: results from the scleroderma lung study. Arthritis Rheum. 2005;52:592–600. doi: 10.1002/art.20787.
    1. Steen VD. Clinical manifestations of systemic sclerosis. Semin Cutan Med Surg. 1998;17:48–54. doi: 10.1016/S1085-5629(98)80062-X.
    1. Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M. et al.Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum. 2009;61:1112–1160. doi: 10.1002/art.24676.
    1. Oliveira NC, Dos Santos Sabbaq LM, De Sá Pinto AL, Borges CL, Lima FR. Aerobic exercise is safe and effective in systemic sclerosis. Int J Sports Med. 2009;30:728–732. doi: 10.1055/s-0029-1224180.
    1. Pinto AL, Oliveira NC, Gaualano B, Christmann RB, Painelli VS, Artoli CG. et al.Efficacy and safety of concurrent training in systemic sclerosis. J Strength Cond Res. 2011;25:1423–1428. doi: 10.1519/JSC.0b013e3181d6858b.
    1. Maddali Bongi S, Del Rosso A, Galluccio F, Tai G, Sigismondi F, Passalacqua M. et al.Efficacy of a tailored rehabilitation program for systemic sclerosis. Clin Exp Rheumatol. 2009;27(suppl 54):44–50.
    1. Anonioli CM, Bua G, Frigè A, Prandini K, Radici S, Scarsi M. et individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility. Clin Rheumatol. 2009;28:159–165. doi: 10.1007/s10067-008-1006-x.
    1. Hurkmans E, Van Der Giesen FJ, Vliet Vlieland TPM, Schoones J, Van Den Ende EHCM. Dynamic exercise programs (aerobic capacity and and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009;7 doi:10.1002/14651858.CD006853.
    1. Alexanderson H, Lundberg IE. Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheum. 2012;2012(24):201–207.
    1. Markovitz GH, Cooper CB. Rehabilitation in non-COPD: mechanisms of exercise limitation and pulmonary rehabilitation for patients with pulmonary fibrosis/restrictive lung disease. Chron Resp Dis. 2010;7:47–60. doi: 10.1177/1479972309348654.
    1. Minor MA, Johnson CJ. Reliability and validity of a submaximal treadmill test to estimate aerobic capacity in women with rheumatic disease. J Rheumatol. 1996;23:1517–1523.
    1. American Thoracic Society Committee on Proficiency Standard for Clinical Pulmonary Function Laboratories. Guidelines for the six-minute walk test. Am Resp J Crit Care Med. 2002;166:111–117.
    1. Buch MH, Denton CP, Furst DE, Guillevin L, Rubin LJ, Wells AU. et al.Submaximal exercise testing in the assessment of interstitial lung disease secondary to systemic sclerosis: reproducibility and correlations of the 6-min walk test. Ann Rheum Dis. 2007;66:169–173.
    1. Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2:92–98.
    1. Alexanderson H, Broman L, Tollbäck A, Lundberg IE, Stenström CH. Functional Index-2: Validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis. Arthritis Rheum. 2006;55:114–122. doi: 10.1002/art.21715.
    1. Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B. et al.The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum. 1993;36:729–740. doi: 10.1002/art.1780360601.
    1. Ekdahl C, Eberhardt K, Andersson SI, Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17:263–271. doi: 10.3109/03009748809098795.
    1. Sullivan M, Karlsson J, Ware Je Jr. The Swedish SF-36 Health Survey. I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41:1349–1358. doi: 10.1016/0277-9536(95)00125-Q.
    1. Zhan S, Ottenbacher KJ. Single subject research designs for disability research. Disabil Rehabil. 2001;23:1–8. doi: 10.1080/09638280150211202.
    1. Backman CL, Harris SR, Chisholm JA, Monette AD. Single-Subject Research in Rehabilitation: a Review of Studies Using AB, Withdrawal, Multiple Baseline, and Alternating Treatments Designs. Arch Phys Med Rehabil. 1997;78:1145–1153. doi: 10.1016/S0003-9993(97)90142-8.
    1. Paulus HE, Egger MJ, Ward JR, Williams HJ. Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo. The Cooperative Systematic Studies of Rheumatic Disease Ggroup. Arthritis Rheum. 1990;33:477–484. doi: 10.1002/art.1780330403.
    1. Schoindre Y, Meune C, Dinh-Xuan A, Avouac J, Kahan A, Allanore Y. Lack of specificity of the 6. Minute Walk Test as an Outcome Measure for Patients with Systemic Sclerosis. J Rheumatol. 2009;36:1481–1485. doi: 10.3899/jrheum.081221.
    1. Garin MC, Highland KB, Silver RM, Strange C. Limitations to the 6-minute walk test in Interstitial Lung Disease and Pulmonary Hypertension in Scleroderma. J Rheumatol. 2009;36:330–336. doi: 10.3899/jrheum.080447.
    1. Clarke-Jenssen AC, Fredriksen PM, Lilleby V, Mengshoel AM. Effects of supervised aerobic exercise in patients with systemic lupus erythematosus: a pilot study. Arthritis Rheum. 2005;53:308–312. doi: 10.1002/art.21082.
    1. Watson HR, Robb R, Belcher G, Belch JJ. Seasonal variation of Raynaud's phenomenon secondary to systemic sclerosis. J Rheumatol. 1999;26:1734–1737.
    1. Sandström S, Röstlund S, Alexanderson H. Improved muscle function following whole-body vibration exercise for patients with polymyositis and dermatomyositis. a pilot study. Ann Rheum Dis. 2011;70(Suppl. 3):776.
    1. Saketkoo LA, Escorpizo R, Keen KJ, Fligelstone K, Distler O. EUSTAR. International Classification of Functioning, Disability and Health Core Set construction in systemic sclerosis and other rheumatic diseases: a EUSTAR initiative. Rheumatology (Oxford) 2012;51:2170–2176. doi: 10.1093/rheumatology/kes185.

Source: PubMed

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