An updated review on the role of prescribed exercise in the management of Amyotrophic lateral sclerosis

ABSTRACT

Introduction: Amyotrophic Lateral Sclerosis is a group of sporadic or familial disorders, characterized by upper and lower motor neuron involvement, with variable progression.

Areas covered: The authors present the role of exercise in counteracting muscle disuse, particularly on limb weakness, that might antagonize denervation. The persistence of inactivity can affect many systems and the patient can develop deconditioning, muscle joint tightness, which causes contractures and pain. The main area of the review is the evaluation of the studies done on ALS exercise rehabilitation protocols, this was done by the evaluation of outcome function and patient independence exerting a positive psychological impact on both patients and caregivers. A second target is underlying differences between endurance and resistance exercise protocols, which may throw light on the biological mechanism of skeletal muscle repair, functional performance, and metabolism. The authors present not only exercise trials but also molecular biomarkers that might help define changes induced by physical rehabilitation. Our findings might help to achieve the best rehabilitation program. A standardized rehabilitation protocol is important: the instructed patients may continue therapy at home or be followed by telemedicine.

Expert opinion: This review evaluates exercise rehabilitation, a controversial issue, evidence is weak and non-conclusive but represents the art status.

KEYWORDS:

• Amyotrophic lateral sclerosis
• exercise
• rehabilitation
• biomarkers
• mitochondria
• micro-RNA

Article highlights

• The majority of the clinical studies suggest that resistance, endurance, and concurrent training enhance the quality of life of patients with ALS, improve their functionality, and in some cases, improve their cardio-respiratory function and/or muscle strength.

• However, the findings of several studies on exercise prescribed to patients with ALS are preliminary due to inadequate sample sizes, inadequate control of confounding variables, non-representative control populations, and varying disease stages.

• The impact of future research could be strengthened by including larger cohort sizes, minimizing the heterogeneity in the disease stage of the participants, and/or enhancing the control of confounding variables.

• It is important to select a mode of exercise with minimal risk of falling for the patient, that might have a poor balance.

• Avoid high resistance and eccentric mode of exercise, fatigue is an important feature in ALS patients.

• The use of circulating Myo-miRNAs and other biomakers, although still preliminary appears promising to monitor evolution of disease in patients.

• Furthermore, studies involving alternative physical activities or prescribed exercise regimens that present a lower risk of muscle damage and injuries (e.g. swimming) may yield useful data to establish exercise regimens that are optimal for patients with ALS.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was funded in part by the French Muscular Dystrophy Association (AFM-Telethon) Grant 22392.