Effectiveness of physical training on physical performance in patients with dermatomyositis and polymyositis: systematic review and meta-analysis

Teixeira, Vanessa Pereira; Costa, Thamires Silveira; Moreira, Vanessa Cristina dos Santos; Campos, Helton Oliveira

doi:10.1590/1809-2950/21001328032021

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ORIGINAL RESEARCH • Fisioter. Pesqui. 28 (3) • Jul-Sep 2021 • https://doi.org/10.1590/1809-2950/21001328032021 linkcopy

Effectiveness of physical training on physical performance in patients with dermatomyositis and polymyositis: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to evaluate the impact of physical training on physical performance in patients with dermatomyositis and polymyositis. For this purpose, we conducted a systematic review and meta-analysis according to the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The literature search was conducted in the following databases: PubMed/MEDLINE and Web of Science, using combinations of the following keywords in English: dermatomyositis OR polymyositis OR myositis AND exercise OR physical exercise OR physical therapy OR aerobic exercise OR endurance exercise OR resistance exercise. Studies that met the following criteria were included: (1) participants diagnosed with dermatomyositis or polymyositis; (2) patients that undergone a physical training protocol; (3) physical performance measured before and after the physical training protocol. A total of 14 articles were selected for inclusion in the systematic review and 10 articles were selected for inclusion in the meta-analysis. The outcomes demonstrate that physical training is effective in increasing overall physical performance in patients with dermatomyositis and polymyositis (effect size: 0.72; 95% CI 0.55; 0.89). Also, our study demonstrated that both the aerobic performance (effect size: 0.88; 95% CI 0.54; 1.21) and resistance performance variables (effect size: 0.64; CI 95% 0.43; 0.85) benefit from physical training in these patients. We concluded that physical training had a significant beneficial effect on the overall, aerobic and resistance physical performance in patients with dermatomyositis and polymyositis.

Keywords:
Dermatomyositis; Exercise; Rehabilitation

Reference	n	Age	Physical training				Test	Characteristic	Outcome
Reference	n	Age	Type of exercise	Duration (weeks)	Weekly frequency (×/week)	Session time (min)	Test	Characteristic	Outcome
Alemo-Munters et al., 2013¹⁹	9	60 (48-72)	5-min warm-up (cycling at 50% of VO_2max)	12	3	60	Cycling test until exhaustion	Exercise duration (min)	Pre: 15.4+5.1
			30-min cycling (70% of VO_2max)				Cycling test until exhaustion	Exercise duration (min)	Post: 33.7+13.3
			20-min resistance exercise (30-40% 1 RM)				Submaximal cycling until exhaustion - 65% of VO_2max	VO_2max (1.min^-1)	Pre: 1.63±0.30
			Relaxation and stretching				Submaximal cycling until exhaustion - 65% of VO_2max	VO_2max (1.min^-1)	Post: 1.91±0.30*
Alemo-Munters et al., 2013²⁰	11	62	30-min cycling (70% of VO_2max)	12	3	60	Cycling test until exhaustion	VO_2max (l.min^-1)	Pre: 1.41±0.47
			20-min resistance exercise (30-40% 1 RM)				Cycling test until exhaustion	VO_2max (l.min^-1)	Post: 1.59±0.55
							5 max repetitions	Knee extensors - load (kg)	Pre: 9.5±7.6
							5 max repetitions	Knee extensors - load (kg)	Post: 13.2±8.7
Alemo-Munters et al., 2016²¹	7		30-min cycling (70% of VO_2max)	12	3	60	Cycling test until exhaustion	VO_2max (l.min^-1)	Pre: 1.54±0.43
			20-min resistance exercise (30-40% 1 RM)				Cycling test until exhaustion	VO_2max (l.min^-1)	Post: 1.69±0.46
							Submaximal cycling until exhaustion - 65% of VO_2max	Exercise duration (min)	Pre: 14.6±7.3
							Submaximal cycling until exhaustion - 65% of VO_2max	Exercise duration (min)	Post: 32.6±15.4
Alexanderson, Stenstrom, Lundberg, 1999²²	10	53	Warm-up	12	5	30	7-min submaximal walking	Distance (m)	Pre: 312
			15-min resistance exercise						Post: 404*
			15-min walking						Post: 404*
Alexanderson et al., 2007²³	8	53	10-min warm-up - cycling (50% of FC_max)	7	3	45	10-15 max repetitions	Right deltoid muscle - load (kg)	Pre: 4.7±3.1
			45-min resistance exercise (10 RM)					Right deltoid muscle - load (kg)	Post: 6.9±4.0*
			5-min stretching					Right quadriceps muscle - load (kg)	Pre:13.1±2.9
								Right quadriceps muscle - load (kg)	Post: 18.9±5.7*
								Latissimus dorsi muscle - load (kg)	Pre:53.1±16.0
								Latissimus dorsi muscle - load (kg)	Post: 57.5±30.6
								Gastrocnemius muscle - load (kg)	Pre: 103.8±19.8
								Gastrocnemius muscle - load (kg)	Post: 138.7±26.7
								Abdominal muscles - load (kg)	Pre: 0.6±1.7
								Abdominal muscles - load (kg)	Post: 1.2±1.6
Habers et al., 2016²⁴	14	12.6 (8.7-17.6)	Interval exercise - treadmill running (65-90% FC_peak)	12	3	40-60	Progressive test on the treadmill until exhaustion	VO_2max (ml.kg^-1.min^-1)	Pre: 38.6
			Resistance exercise				Progressive test on the treadmill until exhaustion	VO_2max (ml.kg^-1.min^-1)	Post: 38.6
							Progressive test on the treadmill until exhaustion	Exercise duration (min)	Pre: 11.9
							Progressive test on the treadmill until exhaustion	Exercise duration (min)	Post: 11.8
							6-min walking test	Distance (m)	Pre: 559
							6-min walking test	Distance (m)	Post: 561
							Dynamometry	Isometric force - Knee extensors D (N)	Pre: 255
							Dynamometry	Isometric force - Knee extensors D (N)	Post: 286
							Dynamometry	Isometric force - hip extensors D (N)	Pre: 225
							Dynamometry	Isometric force - hip extensors D (N)	Post: 221
Mattar et al., 2014²⁵	13	45.6±8.8	Low-intensity resistance exercise combined with partial blood flow restriction (30% 1 RM)	12	2	25-30	1 RM	Leg press - load	Increase of 19.6% *
							1 RM	Knee extenders - Load	Increase of 25.2%*
							Sit-to-stand test	Repetitions	Increase of 15%*
							Timed get up and go test	Duration (sec)	Reduction of 4.5%*
Nader et al., 2010²⁶	8	51 (44-61)	Resistance exercise (10 RM)	7	3	Not reported	Progressive test until exhaustion	VO_2max (ml.min^-1.kg^-1)	Pre: 26±3
Nader et al., 2010²⁶	8	51 (44-61)	Resistance exercise (10 RM)	7	3	Not reported	Progressive test until exhaustion	VO_2max (ml.min^-1.kg^-1)	Post: 31±3*
Oliveira et al., 2019²⁷	9	46.7±7.8	Resistance exercise	12	2	Not reported	Progressive test on the treadmill until exhaustion	VO_2max (ml.min^-1.kg^-1)	Pre: 18.5±4.1
			5-min warm-up				Progressive test on the treadmill until exhaustion	VO_2max (ml.min^-1.kg^-1)	Post: 20.9±5.2
			30-50-min walking/running				Progressive test on the treadmill until exhaustion	Time until exhaustion (min)	Pre: 10.6±2.1
			5-min relaxation				Progressive test on the treadmill until exhaustion	Time until exhaustion (min)	Post: 13.2±1.8
							Timed get up and go test	Duration (sec)	Pre: 7.3±1.1
							Timed get up and go test	Duration (sec)	Post: 6.7±1.1
							30-sec sit-to-stand test	Repetitions	Pre: 13.9±2.8
							30-sec sit-to-stand test	Repetitions	Post: 16.0±3.7
							1 RM	Leg-press - Load (kg)	Pre: 71.7±14.8
							1 RM	Leg-press - Load (kg)	Post: 82.9±14.0
							1 RM	Supine - Load (kg)	Pre: 28.6±9.6
							1 RM	Supine - Load (kg)	Post: 32.3±10.5
Omori et al., 2012²⁸	10	12±3.2	5-min warm-up on the treadmill	12	2	60	Progressive test on the treadmill until exhaustion	VO_2peak	Increase of 13.3%*
			20-min resistance exercise				Progressive test on the treadmill until exhaustion	Exercise duration	Increase of 18.2%*
			30-min treadmill running.				Timed get up and go test	Duration (sec)	Reduction of 10.3%*
			5-min stretching				1 RM	Leg-press - Load (kg)	Increase of 22%*
							1 RM	Supine - Load (kg)	Increase of 17.4%*
							1 RM	Handgrip - Load (kg)	Increase of 15.3%*
Riisager et al., 2013²⁹	10	16-42	Cycl ergometer (65% of VO_2max)	12	3-4	40	Progressive test until exhaustion - cycling	VO_2max (ml.kg^-1.min^-1)	Pre: 22.7 ± 4.1
							Progressive test until exhaustion - cycling	VO_2max (ml.kg^-1.min^-1)	Post: 28.6±6,3
							Progressive test until exhaustion - cycling	Maximum work (W)	Pre: 125±37.9
							Progressive test until exhaustion - cycling	Maximum work (W)	Post: 162±50.5
							6-min walking test	Distance (m)	Pre: 622±107
							6-min walking test	Distance (m)	Post: 657±110
Varjú et al., 2003 (1)³⁰	10	50.6±14.2	Early recovery	3	5	40-60	Dynamometry	Knee extensors - Muscular strength (N)	Pre: 168±47
			Resistance exercise					Knee extensors - Muscular strength (N)	Post: 179±52
			Isotonic muscle training					Shoulder abductors - Muscular strength (N)	Pre: 48±31
			Respiratory training					Shoulder abductors - Muscular strength (N)	Post: 61±34*
								Elbow flexors - Muscular strength (N)	Pre: 85±56
								Elbow flexors - Muscular strength (N)	Post: 99±43
								Hand flexors - Muscular strength (N)	Pre: 144±45
								Hand flexors - Muscular strength (N)	Post: 181±64
Varjú et al., 2003 (2)³⁰	11	44.1±14.6	Chronic recovery	3	5	40-60	Dynamometry	Knee extensors - Muscular strength (N)	Pre: 141±48
			Resistance exercise					Knee extensors - Muscular strength (N)	Post: 188±41*
			Isotonic muscle training					Shoulder abductors - Muscular strength (N)	Pre: 53±26
			Respiratory training					Shoulder abductors - Muscular strength (N)	Post: 81±30*
								Elbow flexors - Muscular strength (N)	Pre: 77±20
								Elbow flexors - Muscular strength (N)	Post: 118±44
								Hand flexors - Muscular strength (N)	Pre: 142±62
								Hand flexors - Muscular strength (N)	Post: 169±75*
Wiesinger et al., 1998³¹	8	47	Warm-up	24	1-4	60	Progressive test on cycle ergometer	VO_2peak (ml/min/kg)	Pre: 17.5±3.3
			Cycling and step (60% of FC)				Progressive test on cycle ergometer	VO_2peak (ml/min/kg)	Post: 22.3±6*
			Relaxation and stretching				Progressive test on cycle ergometer	Exercise duration (min)	Pre: 377±130*
			Indoor Walking (3h/week)				Progressive test on cycle ergometer	Exercise duration (min)	Post: 536±152*
							Isokinetic dynamometry	Isometric torque peak (Nm)	Pre: 530.2±295.1
							Isokinetic dynamometry	Isometric torque peak (Nm)	Post: 712.1±364.2*
Wiesinger et al., 1998³²	7	56 (44-68)	Warm-up	6	2-3	60	Progressive test on cycle ergometer	VO_2max (ml/min/kg)	Pre: 17.4±2.6*
			Cycling and step (60% of FC)				Progressive test on cycle ergometer	VO_2max (ml/min/kg)	Post: 22,5±2.6*
			Relaxation and stretching				Isokinetic dynamometry	Isometric torque peak (Nm)	Pre: 633.1±260
							Isokinetic dynamometry	Isometric torque peak (Nm)	Post: 819.2±277.9*

Reference	Absence of allocation secrecy	Absence of masking	Incomplete follow-up	Selective reporting of outcomes	Other limitation	Quality
Alemo-Munters et al., 201319	No	No	No	No	No	High
Alemo-Munters, 201320	No	No	No	No	No	High
Alemo-Munters et al., 201621	No	No	No	No	No	High
Alexanderson, 1999 22	Yes	Yes	Yes	No	No	Very low
Alexanderson, 200723	Yes	Yes	No	No	No	Low
Habers, 201624	No	No	No	No	No	Low
Mattar et al., 201425	Yes	Yes	No	No	No	Low
Nader et al., 201026	No	No	No	No	No	High
Oliveira, 201927	Yes	Yes	No	No	No	Low
Omori et al., 201228	Yes	Yes	No	No	No	Low
Riisager et al., 201329	Yes	Yes	Yes	No	No	Very low
Varjú et al., 2003 (1)30	Yes	Yes	No	No	No	Low
Wiesinger et al., 199831	No	No	No	No	No	High
Wiesinger et al., 199832	No	No	No	No	No	High

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[TFN2] *: It indicates statistical difference between post vs. pre exercise.