Amber Shaikh
Journal article
The impact of physical exercise on neuromuscular function in Myasthenia gravis patients
Westerberg, Elisabet et al. “The impact of physical exercise on neuromuscular function in Myasthenia gravis patients: A single-subject design study.” Medicine vol. 97,31 (2018):
The impact of physical exercise on neuromuscular function in Myasthenia gravis patients (nih.gov)
I chose to do my journal article based on my second H&P with my patient with myasthenia gravis. I thought this was a very interesting case presentation, as we have not discussed this disease too much in class. In the patient case that I presented, my patient was being treated with plasmapheresis and eculizumab, which are often conventional approaches to treatment. However since this is a disease that effects muscle strength, I wanted to look more into how physical therapy and exercise would effect the progression.
This article highlights that even though it is safe to assume that myasthenia gravis patients will have similar benefits from physical activity as do healthy patients, however, exercise related research in MG patients is sparse. A lot of people often fear that increased exertion may lead to disease deterioration. However a recent large meta-analysis revealed that strengthening and aerobic exercise can be effective in patients with various primary muscle disorders. However, disease specific exercise needs for MG need to be evaluated considering the functional parameters as the pathology of MG involves the skeletal muscle synapse. Also due to increased weakness, fatigue and respiratory impairment, the capacity to perform these exercises can also be reduced.
In this research study they included 14 participants based on the inclusion criteria of being older then 18, having no other comorbidities, and living less then 100km from the research facility. They conducted a prospective study, where the patient each served as their own control as the level of improvement with exercise was compared to their own baseline. The participants were enrolled in a 12 week supervised physical therapy program that focused on aerobic and resistance training exercises. The outcomes that were looked at were symptom improvement in muscle status, changes in cardiovascular risk factors, and self well being.
Prior to starting the program, each participant measured their baseline physical activity and sedentary level using an accelerometer, they also completed questionnaires regarding their baseline physical activity habits. Each exercise session lasted an hour and a half and was supervised by a research assistant. Each session consisted of resistance training, aerobic, balance training, and physiotherapy 2 times a week for 12 weeks. The aerobic resistance consisted of stationary bikes and the muscle resistance training was done with wight adjustments on a person to person bases. Each session was then followed by 2 balance and 6 stretching exercises. Clinical and muscle function assessment was done prior to and after the session. The patients overall results were calculated via the MG Composite scale and the quantitative myasthenia gravis score and they looked at Isometric muscle force, motor nerve conduction studies, neuromuscular ultrasound, blood analysis, blood pressure, and quality of life and self assessment to see how the exercise effected their disease progression.
The results of this study showed an improvement in functional muscle outcomes, specially in the proximal leg muscles. They also saw an absence of side effects and deterioration in the MG symptoms in patients who followed regular aerobic and resistance training. “The advice regarding physical exercise to patients with MG has traditionally been to restrict, or even completely discourage, exercise mainly based on theoretical assumptions and lack of knowledge (Westerberg 2018)”. However, as per this study and the exercise tolerability in these participants, it is recommended that physical activity be encouraged in MG patients who are strong enough to complete it.
