Abstract
Objectives The present study aimed to explore the effect of resistance training in patients with amyotrophic lateral sclerosis (ALS), a disease characterized by progressive motor neuron loss and muscle weakness. Materials and Methods Following a 12-week “lead-in” control period, a population of ALS patients from Funen, Denmark, completed a 12-week resistance training program consisting of 2-3 sessions/week. Neuromuscular function (strength and power) and voluntary muscle activation (superimposed twitch technique) were evaluated before and after both control and training periods. Physical capacity tests (chair rise and timed up and go), the revised ALS functional rating scale (ALSFRS-R) scores, and muscle cross sectional area (histology) were also assessed. Results Of twelve ALS patients assessed for eligibility, six were included and five completed the study. Training did not significantly affect the ALSFRS-R score, and loss of neuromuscular function (strength and power) increased following the training period. However, an improved functionality (chair rise) and an increase in greatly hypertrophied type II fibres combined with an increase in atrophied fibres following the training period compared to the control period were observed. Conclusion In this small study, the present form of resistance training was unable to attenuate progressive loss of neuromuscular function in ALS, despite some changes in physical capacity and morphology.
Highlights
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting motor neurons in the spinal cord, brain stem, and motor cortex, resulting in muscle weakness and atrophy and eventually death [1].In young as well as old healthy individuals resistance training appears highly effective for reducing muscle weakness and improving neuromuscular function [2,3,4]
One patient left the study by the end of the control period due to percutaneous endoscopic gastrostomy (PEG) surgery and is excluded from all data calculations
Three of the participants completed 85–95% of all planned training sessions, while the remaining two participants completed 50–60% of training sessions due to medical problems not related to the exercise program
Summary
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting motor neurons in the spinal cord, brain stem, and motor cortex, resulting in muscle weakness and atrophy and eventually death [1].In young as well as old healthy individuals resistance training appears highly effective for reducing muscle weakness and improving neuromuscular function (i.e., inducing gains in skeletal muscle strength and power) [2,3,4]. In addition to an early case report showing positive effects of resistance training in ALS patients [6], it was first reported that exercise could improve the clinical course (Spinal Norris scores) and the performance in respiratory functional tests following exercise [7, 8]. Very recently it was reported in a randomized controlled trial that 6 months combined resistance and aerobic training led to improvements in the revised ALSFRS (ALS functional rating scale) [9]. Other observations in small cohorts include improved ALSFRS scores, quality of life, and maximal muscle strength measured by the Quantitative Muscle Assessment system following three months combined resistance type and flexibility training [10] and improved ALSFRS and decreased muscle spasticity following three months resistance type training [11]
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