Table 2.
Effects of physical exercise on Duchenne Muscular Dystrophy patients
| 2.A Acute exercise | ||||
| Age (years) | Period | Protocola | Effects | Reference |
| Exercise of upper and lower limbs | ||||
| 8.4 | 1 time | Bicycle ergometer and isokinetic limb strength measurements | Clin. Exercise in DMD is limited by reduced cardiorespiratory capacities, leg strength and peripheral oxygen utilization | Sockolov et al., 1977 [87] |
| 6 – 10 or 11 – 16 | 1 time | 15 minutes of exercise in water | Clin. ↑ Myoglobunuria; ↑ Serum creatine kinase | Pöche et al., 1987 [88] |
| Early stage (<12) | 1 time | 50–80 lengthening contractions of calf muscle | Clin. ↓ Muscle injury at the end of exer. | Barbiroli et al., 1993 [89] |
| Mol. ↓ Inorganic phosphate recovery; | ||||
| ↓ intracellular pH resting value recovery | ||||
| Early stage (<12) | 1 time | Aerobic exercise on forearm flexor digitorum superficialis | Mol. ↑ Intracellular pH at the end of exercise | Kemp et al., 1993 [90] |
| 5 – 10 | 1 time | Maximum voluntary contraction of tibialis anterior for 4 min | Clin. Less central fatigue of TA | Sharma et al., 1995 [91] |
| 10.8±0.5 | 1 time | 20 handgrips/min for 5 min | Mol. No vasoconstrictor response to exercise | Sander et al., 2000 [92] |
| 6 to 8 | 1 time | Playing football or running | Clin. ↑ Myoglobinuria | Garrood et al., 2008 [93] |
| 8,2±2.6 | 1 time | 20 steps on a 20 cm high-bench | Mol. ↑ Contrast enhancement in TA | Garrood et al., 2009 [94] |
| 2.B Chronic exercise | ||||
| Exercise of upper and lower limbs | ||||
| Early stage (<12) | 8 weeks | Training with arm ergometer | Clin. ↑ Ambulation scores; ↑ Endurance and arm functions; ↑ Proximal muscle strength | Alemdaroğlu et al., 2014 [95] |
| Late stage (>12) | 28 weeks | ? | Clin. ↑ Muscle strength; ↓ Contractures; ↑ Performance of daily activities | Abramson, Rogoff, 1952 [96] |
| Early stage (<12) | 48 weeks | Full extension of knee using Cybex isokinetic exerciser 5 days/week | Clin. ↑ Isokinetic strength | de Lateur, Giaconi, 1979 [97] |
| 10±3 | 96 weeks | Bicycle training of arm and legs | Clin. Stabilisation of motor function for the duration of the training | Jansen et al., 2013 [98] |
| Exercise of masticatory muscles | ||||
| 16 – 24 | 24 weeks | 5 minutes jaw clench. Open jaw 5 times. Move tongue 5 times. | Clin. ↑ Biting force; ↑ Latency of jaw-jerk reflex; ↑ Masticatory performance of masseter | Kawazoe et al., 1982 [99] |
| 20 | 24 weeks | Massage of masseter 10 min and jaw training 5 min per day | Clin. ↑ Greatest occlusal force; ↑ Satisfaction to eat | Nozaki et al., 2010 [100] |
| Age | Period | Protocola | Effects | Reference |
| Exercise of respiratory muscles | ||||
| ≈ 11.4 | 2.5 weeks | Triflow II inspirometer, 20 inspirations/day | Clin. No benefit of exercise | Rodillo et al., 1989 [101] |
| Late stage (>12) | 5 weeks | Video game ajusted to respiratory efforts, 10 min/day | Clin.↑ Maximum voluntary respiration; | Vilozni et al., 1994 [102] |
| ↑ Maximal achieved respiration | ||||
| ↑ Duration of progressive isocapnic hyperventilation manœuvre | ||||
| 14.4±5 | 6 weeks | Inspiratory resistance 15 min, twice/day | Clin. ↑ Maximum resistance and maximum duration of ventilation | DiMarco et al., 1985 [103] |
| 18 | 6.5 weeks | Inspiratory muscle training 5 to 30 min/day | Clin. ↑ Vital capacity; ↑ Maximal inspiratory airway pressure | Aldrich, Uhrlass, 1987 [104] |
| 14.7±4.5 | 6 weeks | Breathing through a valve 10 min, twice/day | Clin. ↑ Endurance of respiratory muscles | Topin et al., 2002 [105] |
| 14.5±3.8 | 24 weeks | Breathing through a valve 10 min, twice/day | Clin. ↑ Maximal sniff assessed esophageal and transdiaphragmatic pressure; ↑ Inspiratory muscle endurance | Wanke et al., 1994 [106] |
| 12 | 24 weeks | Resistive inspiration and expiratory loads | Clin. ↑ Maximal static inspiratory and expiratory pressures; ↓ Decreased respiratory load perception | Gozal, Thiriet, 1999 [107] |
| 8 – 29 | 36 weeks | Force training then endurance training 10 times, twice/day | Clin. ↑ Maximal inspiratory mouth pressure; ↑ 12 s-maximum voluntary ventilation | Winkler et al., 2000 [108] |
| 9.5±2.3 | 40 weeks | Yoga training: [fast pelvic contractions], [forced apnea after expiration] and [maximal contraction followed by apnea] | Clin. ↑ Increased of force vital capacity; ↑ Forced expiratory volume in 1 second | Rodrigues et al., 2014 [109] |
| 12.5±2.3 16.5±4 19.9±5 | 96 weeks (2 years) | Breathing through a valve 10 min, twice/day | Clin. ↑ Maximal inspiratory mouth pressure; ↑ 12 s-maximum voluntary ventilation | Koessler et al., 2001 [110] |
Normal words signal a positive effect of exercise. Underscored words signal a neutral effect of exercise. Italic words signal a negative effect of exercise. Clin. signals an observation at the physiological/clinical level. Mol. signals an observation at the molecular level. aDescription of experimental protocol with duration of exercise, speed and other parameters. Abbreviations: TA Tibialis Anterior.