Top

Published in:

Open Access 01-10-2014 | Research article

Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis

Authors: Melina Andrade Mattar, Bruno Gualano, Luiz Augusto Perandini, Samuel Katsuyuki Shinjo, Fernanda Rodrigues Lima, Ana Lúcia Sá-Pinto, Hamilton Roschel

Published in: Arthritis Research & Therapy | Issue 5/2014

Abstract

Introduction

Our aim was to evaluate the safety and efficacy of a low-intensity resistance training program combined with partial blow flow restriction (BFR training) in a cohort of patients with polymyositis (PM) and dermatomyositis (DM).

Methods

In total, 13 patients with PM and DM completed a 12-week twice a week low-intensity (that is, 30% one-repetition-maximum (1RM)) resistance exercise training program combined with partial blood flow restriction (BFR). Assessments of muscle strength, physical function, quadriceps cross sectional (CSA) area, health-related quality of life, and clinical and laboratory parameters were assessed at baseline and after the intervention.

Results

The BFR training program was effective in increasing the maximal dynamic strength in both the leg-press (19.6%, P <0.001) and knee-extension exercises (25.2% P <0.001), as well as in the timed-stands (15.1%, P <0.001) and timed-up-and-go test (-4.5%, P =0.002). Quadriceps CSA was also significantly increased after the intervention (4.57%, P =0.01). Similarly, all of the components of the Short Form-36 Health Survey, the Health Assessment Questionnaire scores, and the patient- and physician reported Visual Analogue Scale were significantly improved after training (P <0.05). Importantly, no clinical evidence or any other self-reported adverse event were found. Laboratory parameters (creatine kinase and aldolase) were also unchanged (P >0.05) after the intervention.

Conclusions

We demonstrated that a 12-week supervised low-intensity resistance training program associated with partial blood flow restriction may be safe and effective in improving muscle strength and function as well as muscle mass and health-related quality of life in patients with PM and DM.

Trial registration

Clinicaltrials.gov NCT01501019. Registered November 29, 2011.

Available only for authorised users

Hengstman GJ, van den Hoogen FH, van Engelen BG: Treatment of the inflammatory myopathies: update and practical recommendations. Expert Opin Pharmacother. 2009, 10: 1183-1190. 10.1517/14656560902913815.CrossRefPubMed

Alexanderson H, Broman L, Tollback A, Josefson A, Lundberg IE, Stenstrom CH: Functional index-2: validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis. Arthritis Rheum. 2006, 55: 114-122. 10.1002/art.21715.CrossRefPubMed

Lundberg IE: Idiopathic inflammatory myopathies: why do the muscles become weak?. Curr Opin Rheumatol. 2001, 13: 457-460. 10.1097/00002281-200111000-00001.CrossRefPubMed

Ponyi A, Borgulya G, Constantin T, Vancsa A, Gergely L, Danko K: Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis. Rheumatology (Oxford). 2005, 44: 83-88. 10.1093/rheumatology/keh404.CrossRef

Alexanderson H, Lundberg IE: Inflammatory muscle disease: clinical presentation and assessment of patients. Curr Rheumatol Rep. 2007, 9: 273-279. 10.1007/s11926-007-0044-8.CrossRefPubMed

Alexanderson H, Dastmalchi M, Esbjornsson-Liljedahl M, Opava CH, Lundberg IE: Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum. 2007, 57: 768-777. 10.1002/art.22780.CrossRefPubMed

Alexanderson H, Lundberg IE: Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol. 2012, 24: 201-207. 10.1097/BOR.0b013e32834f19f5.CrossRefPubMed

Mattar MA, Gualano B, Roschel H, Perandini LA, Dassouki T, Lima FR, Shinjo SK, de Sa Pinto AL: Exercise as an adjuvant treatment in persistent active polymyositis. J Clin Rheumatol. 2014, 20: 11-15. 10.1097/RHU.0000000000000056.CrossRefPubMed

Spector SA, Lemmer JT, Koffman BM, Fleisher TA, Feuerstein IM, Hurley BF, Dalakas MC: Safety and efficacy of strength training in patients with sporadic inclusion body myositis. Muscle Nerve. 1997, 20: 1242-1248. 10.1002/(SICI)1097-4598(199710)20:10<1242::AID-MUS6>3.0.CO;2-C.CrossRefPubMed

10.

Alexanderson H, Stenstrom CH, Lundberg I: Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study. Rheumatology (Oxford). 1999, 38: 608-611. 10.1093/rheumatology/38.7.608.CrossRef

11.

Alexanderson H, Stenstrom CH, Jenner G, Lundberg I: The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol. 2000, 29: 295-301. 10.1080/030097400447679.CrossRefPubMed

12.

Chung YL, Alexanderson H, Pipitone N, Morrison C, Dastmalchi M, Stahl-Hallengren C, Richards S, Thomas EL, Hamilton G, Bell JD, Lundberg IE, Scott DL: Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment: six-month, double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007, 57: 694-702. 10.1002/art.22687.CrossRefPubMed

13.

Dastmalchi M, Alexanderson H, Loell I, Stahlberg M, Borg K, Lundberg IE, Esbjornsson M: Effect of physical training on the proportion of slow-twitch type I muscle fibers, a novel nonimmune-mediated mechanism for muscle impairment in polymyositis or dermatomyositis. Arthritis Rheum. 2007, 57: 1303-1310. 10.1002/art.22996.CrossRefPubMed

14.

Kraemer WJ, Ratamess NA: Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004, 36: 674-688. 10.1249/01.MSS.0000121945.36635.61.CrossRefPubMed

15.

Abe T, Fujita S, Nakajima T, Sakamaki M, Ozaki H, Ogasawara R, Sugaya M, Kudo M, Kurano M, Yasuda T, Sato Y, Ohshima H, Mukai C, Ishii N: Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2MAX in young men. J Sports Sci Med. 2010, 9: 452-458.PubMedCentralPubMed

16.

Karabulut M, Abe T, Sato Y, Bemben MG: The effects of low-intensity resistance training with vascular restriction on leg muscle strength in older men. Eur J Appl Physiol. 2010, 108: 147-155. 10.1007/s00421-009-1204-5.CrossRefPubMed

17.

Laurentino GC, Ugrinowitsch C, Roschel H, Aoki MS, Soares AG, Neves M, Aihara AY, da Rocha Correa Fernandes A, Tricoli V: Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc. 2012, 44: 406-412. 10.1249/MSS.0b013e318233b4bc.CrossRefPubMed

18.

Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N: Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol. 2000, 88: 61-65.PubMed

19.

Takarada Y, Sato Y, Ishii N: Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. Eur J Appl Physiol. 2002, 86: 308-314. 10.1007/s00421-001-0561-5.CrossRefPubMed

20.

Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N: Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol. 2000, 88: 2097-2106.PubMed

21.

Gualano B, Neves M, Lima FR, Pinto AL, Laurentino G, Borges C, Baptista L, Artioli GG, Aoki MS, Moriscot A, Lancha AH, Bonfa E, Ugrinowitsch C: Resistance training with vascular occlusion in inclusion body myositis: a case study. Med Sci Sports Exerc. 2010, 42: 250-254. 10.1249/MSS.0b013e3181b18fb8.CrossRefPubMed

22.

Bohan A, Peter JB: Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975, 292: 403-407. 10.1056/NEJM197502202920807.CrossRefPubMed

23.

Gualano B, Ugrinowitsch C, Neves M, Lima FR, Pinto AL, Laurentino G, Tricoli VA, Lancha AH, Roschel H: Vascular occlusion training for inclusion body myositis: a novel therapeutic approach. J Vis Exp. 2010, 40: 1894-PubMed

24.

Brown LE, Weir JP: ASEP procedures recommendation I: accurate assessmente of muscular strength and power. J Exerc Physiol Online. 2001, 4: 21-

25.

Wasserman K, Whipp BJ, Koyl SN, Beaver WL: Anaerobic threshold and respiratory gas exchange during exercise. J Appl Physiol. 1973, 35: 236-243.PubMed

26.

Cohen J: Statistical Power Analysis for the Behavioral Sciences. 1988, Lawrence Erlbaum Associates, Hillsdale, USA

27.

Varju C, Petho E, Kutas R, Czirjak L: The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil. 2003, 17: 83-87. 10.1191/0269215503cr572oa.CrossRefPubMed

28.

Loenneke JP, Fahs CA, Wilson JM, Bemben MG: Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses. 2011, 77: 748-752. 10.1016/j.mehy.2011.07.029.CrossRefPubMed

29.

Meyer RA: Does blood flow restriction enhance hypertrophic signaling in skeletal muscle?. J Appl Physiol. 2006, 100: 1443-1444. 10.1152/japplphysiol.01636.2005.CrossRefPubMed

30.

Abe T, Yasuda T, Midorikawa T, Sato Y, Kearns CF, Inoue K, Koizume K, Ishii N: Skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily “KAATSU” resistance training. Int J Kaatsu Training Res. 2005, 1: 6-12. 10.3806/ijktr.1.6.CrossRef

31.

Takano H, Morita T, Iida H, Asada K, Kato M, Uno K, Hirose K, Matsumoto A, Takenaka K, Hirata Y, Eto F, Nagai R, Sato Y, Nakajima T: Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow. Eur J Appl Physiol. 2005, 95: 65-73. 10.1007/s00421-005-1389-1.CrossRefPubMed

32.

Fry CS, Glynn EL, Drummond MJ, Timmerman KL, Fujita S, Abe T, Dhanani S, Volpi E, Rasmussen BB: Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol. 2010, 108: 1199-1209. 10.1152/japplphysiol.01266.2009.CrossRefPubMedCentralPubMed

33.

Fujita S, Abe T, Drummond MJ, Cadenas JG, Dreyer HC, Sato Y, Volpi E, Rasmussen BB: Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol. 2007, 103: 903-910. 10.1152/japplphysiol.00195.2007.CrossRefPubMed

34.

Park JH, Olsen NJ, King L, Vital T, Buse R, Kari S, Hernanz-Schulman M, Price RR: Use of magnetic resonance imaging and P-31 magnetic resonance spectroscopy to detect and quantify muscle dysfunction in the amyopathic and myopathic variants of dermatomyositis. Arthritis Rheum. 1995, 38: 68-77. 10.1002/art.1780380111.CrossRefPubMed

35.

Cea G, Bendahan D, Manners D, Hilton-Jones D, Lodi R, Styles P, Taylor DJ: Reduced oxidative phosphorylation and proton efflux suggest reduced capillary blood supply in skeletal muscle of patients with dermatomyositis and polymyositis: a quantitative 31P-magnetic resonance spectroscopy and MRI study. Brain. 2002, 125: 1635-1645. 10.1093/brain/awf163.CrossRefPubMed

36.

Chung YL, Smith EC, Williams SC, Wassif WS, Salisbury JR, Simmons A, Howlett DC, Scott DL: In vivo proton magnetic resonance spectroscopy in polymyositis and dermatomyositis: a preliminary study. Eur J Med Res. 1997, 2: 483-487.PubMed

Title: Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis
Authors: Melina Andrade Mattar
Bruno Gualano
Luiz Augusto Perandini
Samuel Katsuyuki Shinjo
Fernanda Rodrigues Lima
Ana Lúcia Sá-Pinto
Hamilton Roschel
Publication date: 01-10-2014
Publisher: BioMed Central
Published in: Arthritis Research & Therapy / Issue 5/2014
Electronic ISSN: 1478-6362
DOI: https://doi.org/10.1186/s13075-014-0473-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 5/2014

Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial

Bevacizumab, an anti-vascular endothelial growth factor antibody, inhibits osteoarthritis

Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial

Genotype-phenotype correlation in Japanese patients with familial Mediterranean fever: differences in genotype and clinical features between Japanese and Mediterranean populations

Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis – a probabilistic approach

Soluble OX40L is associated with presence of autoantibodies in early rheumatoid arthritis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page