3. Aerobic exercise compared to control for Duchenne muscular dystrophy (DMD): GRADE assessments for other functional outcome measures (supplementary to 'Summary of findings' table 4).
| Aerobic exercise compared to control for Duchenne muscular dystrophy (DMD) | |||||
| Patient or population: boys with DMD Setting: at home or at school, depending on the preferences of the participants Intervention: aerobic exercise Comparison: control without aerobic exercise training | |||||
| Time‐scored functional assessments of muscle performance | Mean (SD) without aerobic exercise | Mean (SD) with aerobic exercise | Difference (95% CI) | Certainty of the evidence (GRADE) | What happens |
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Functional ability in standing positions and transfers Assessed with Motor Function Measure D1 Scale from 0% to 100% Follow‐up: mean 14 weeks 29 participants (1 RCT) |
The mean difference in motor Function Measure D1 without aerobic exercise was a decrease of 9.1% (22.1) | The mean difference in motor Function Measure D1 with aerobic exercise was an increase of 0.8% (29.2) | MD 9.9% higher (8.8 lower to 28.6 higher) | ⊕⊝⊝⊝ Very lowa,b | The effect on functional ability in standing positions and transfers is uncertain |
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Functional ability in axial and proximal motor functions Assessed with Motor Function Measure D2 Scale from: 0% to 100% Follow‐up: mean 14 weeks 29 participants (1 RCT) |
The mean difference in Motor Function Measure D2 without aerobic exercise was a decrease of 4.1% (13.8) | The mean difference in Motor Function Measure D2 with aerobic exercise was an increase of 0.3% (15.3) | MD 4.4% higher (6.2 lower to 15.0 higher) | ⊕⊝⊝⊝ Very lowa,b | The effect on functional ability in axial and proximal motor functions is uncertain |
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Functional ability in distal motor function Assessed with Motor Function Measure D3 Scale from: 0% to 100% Follow‐up: mean 14 weeks 29 participants (1 RCT) |
The mean difference in Motor Function Measure D3 without aerobic exercise was a decrease of 5.2% (8.0) | The mean difference in Motor Function Measure D3 with aerobic exercise was an increase of 1.5% (7.6) | MD 6.7% higher (1.0 higher to 12.4 higher) | ⊕⊝⊝⊝ Very lowa,b | The effect on functional ability in distal motor function is uncertain |
| CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; SD: standard deviation | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded two levels for imprecision as it is not known if the sample size is sufficient. Quote: "No historical data were available at the start of this study in 2008. The sample size was therefore not based on statistical analysis. We arbitrarily chose to include 20 to 30 participants". CI consistent with both effects in favour of training and little or no effect. bDowngraded one level for study limitations: participants and outcome assessor had no information about previous test results at each assessment but were not blinded to treatment allocation. Moreover, boys were originally allocated to the intervention group, but replaced to the control group within two weeks after trying the intervention. One boy discontinued the training and assessment after 12 weeks and was excluded from the analysis, so the analysis was not intention‐to‐treat. Blinding of participants and personnel was not possible.