Resistance Training and Muscular Dystrophy 1

Resistance Training Within the Muscular Dystrophy Population

Lara Nasser

HSC 631T: Exercise Physiology

Dr. Betts

September 19, 2017

Resistance Training and Muscular Dystrophy 2

“Muscular Dystrophy is a group of inherited diseases in which the muscles that control

movement, more specifically the voluntary muscles progressively weaken.”1 There are various

types of Muscular Dystrophy, therefore some with the disease have a normal life span with mild

symptoms that progress very slowly; others experience rapid and severe muscle weakness and

degeneration. Duchenne is the most common form of Muscular Dystrophy in children, affecting

only males.1 Disease progression may vary, but many with this form become wheelchair

dependent by age twelve. Muscles decrease in size and grow weaker over time. Becker Muscular

Dystrophy is similar to Duchenne, but is a milder form. The symptoms appear later and progress

more slowly.1 Limb-Girdle is another form of Muscular Dystrophy that affects both males and

females, typically appearing in teen to early adulthood years. This form causes progressive

weakness that begins in the hips and moves to the shoulders, arms, and legs. As time continues

walking becomes difficult or impossible.1 Due to the progression of muscle weakness,

individuals living with Muscular Dystrophy may seek physical therapy to improve the strength

of the affected muscles.

Resistance or strength training is a type of physical exercise that specializes in the use of

resistance to induce a muscular contraction, which builds strength and the size of skeletal

muscle.2 “Supervised resistance training improves muscular strength of children and adolescents

without adverse effect on bone, muscle, or connective tissue.”2 With middle-age adults, the focus

is on maintenance of muscle and bone mass and muscular strength to enhance overall health.2

Muscular Dystrophy and the use of resistance training has become a disputed subject but, as

research progresses more knowledge is gained on the issue.

A study completed by Sveen et al., 2013 evaluated resistance training in patients with

Limb-Girdle and Becker Muscular Dystrophy. The researchers completed two studies, the first
Resistance Training and Muscular Dystrophy 3

utilizing low-intensity resistance training (LOIT) and the second study utilizing high-intensity

resistance training (HIT). Patients in this study had 1) a diagnosis of Limb-Girdle or Becker

Muscular Dystrophy; 2) a sedentary lifestyle and 3) no concurrent medical condition. The first

trial focused on two muscle groups for the training program, the quadriceps and bicep brachii.

The high-intensity training program focused on five muscle groups: the biceps femoris,

quadriceps, gastrocnemius/soleus, and wrist flexors and extensors.3 The subjects participated in

LOIT and HIT programs for six and three months, respectively. Both trials consisted of utilizing

the 1-Repetition Maximum protocol for assessment. The low-intensity training program

concluded that there was no significant difference in strength between patients in the control

group versus the patients that completed the protocol. The high-intensity training program

observed strength increase in wrist flexion and extension, but the improvement in the remaining

muscle groups was not significant and considerable variation was observed.3 The researchers

overall suggested that both LOIT and HIT resistance training could be used for patients with

Limb-Girdle Muscular Dystrophy.

It has been debated for many years whether or not muscle exercise is beneficial or

harmful for patients with myopathic disorders.4 Exercise tolerance is affected in patients with

Limb-Girdle Muscular Dystrophy, either as a direct consequence of the loss of muscle fibers or

secondary to the sedentary lifestyle.4 Angelini et al., 2015 generated a study that included low

and high intensity resistance training protocol. The type of participants and training protocol was

consistent with the previous study conducted by Sveen et al., 2013. These researchers concluded

that resistance training could be safe and effective in increasing muscle strength in Muscular

Dystrophy with proximal weakness, such as Limb-Girdle. The authors of this study highlighted
Resistance Training and Muscular Dystrophy 4

that until more knowledge has been uncovered, training should be supervised carefully to avoid

muscle overload injuries especially in patients with a structural defect of the sarcolemma.4

The next study, conducted by Gianola et al., 2013 identified that weakness is the main

problem and muscular exercise would be valuable if it helped to counteract the loss of muscle

tissue and strength. After analyzing their trials, Gianola et al., 2013 concluded that the five

randomized controlled trials offered results that were inconclusive. They stated that “exercise

might be useful, not useful or even detrimental.”5 The pool of participants the researchers studied

included patients with Duchenne’s, Becker’s and Limb-Girdle Muscular Dystrophy. Eligibility

was not restricted by the patient’s age. Muscle exercise was the core of the intervention and the

protocol was assessed on the basis of muscular strengthening and expressed as a peak torque of

strength, motor function or fatigue.5 The study consisted of two hundred and forty-two

participants. Having a large participant pool along with patients of all ages contributing to the

study may have been a factor of inconclusive outcomes.

Due to the progressive nature of Duchenne’s Muscular Dystrophy, upper extremity

weakness and hand/arm limitations weaken the ability of patients with Duchenne’s to perform

daily activities. Lower extremity training is more common in physical therapy programs for

children with Muscular Dystrophy due to the importance of activities related to ambulation.

Consequently, when the upper extremity functional inability is finally addressed, intervention is

usually of little help.6 A study conducted by Alemdaroglu et al., 2014 focused on upper

extremity functional performance, strength, and ambulation in early-stage Duchenne’s Muscular

Dystrophy patients. The study included twenty-four children ages eight to twelve years old and

muscle strength measurements were assessed with a hand-held dynamometer and an arm

ergometer tested separately for the right and left upper extremeties.6 The researchers concluded
Resistance Training and Muscular Dystrophy 5

that exercise training with an arm ergometer was shown to protect proximal muscle strength.

They highly recommended including upper extremity exercises with an arm ergometer in

rehabilitation programs as early as possible.6 Overall, researchers believed that muscle strength

may be improved by the proper type of exercises performed with adequate intensity and

resistance.

The final study that was reviewed consisted of improving strength in patients with Becker

Muscular Dystrophy. Sveen et al., 2008 participant pool included eleven men with Becker

Muscular Dystrophy and seven healthy, sedentary men. The conclusion of this study was that

there was a significant increase in muscle strength after twelve weeks of training in hip

abduction and foot dorsiflexion and plantar flexion.7 This increase was maintained after twelve

months of training. In patients training for a year, there was a 40% improvement in knee

extension strength. A self-reported questionnaire showed that a majority of subjects with Becker

Muscular Dystrophy felt an improvement in leg muscle strength and walking distance after

twelve weeks of training. Although the researcher’s findings show a positive response to their

training protocols, further studies are warranted to optimize the effects of exercise without

causing damage to the muscle7.

The consensus of the studies examining Muscular Dystrophy specified that it can be

beneficial to participate in resistance training exercises. The topic needs to be researched further

to uncover the most appropriate protocol due to a high risk of causing more damage to the

integrity of the muscle.3,4 But researchers suggest, with the proper supervision and an adequate

protocol, resistance training has assisted patients with Muscular Dystrophy. Studies indicates that

muscle weakness attributed to Muscular Dystrophy has improved in patients through resistance

training protocol.4 Improvement has been indicated through the strength achieved in the lower
Resistance Training and Muscular Dystrophy 6

extremity muscles such as the quadriceps. Strength has similarly been achieved in the upper

extremity muscles such as the biceps brachii and the flexors and extensors. Ambulation has

improved in Muscular Dystrophy patients through participation of resistance training

exercises.3,6 In patients with Becker Muscular Dystrophy, hip abduction strength was increased

versus patients who did not incorporate resistance training protocol.7

“Endurance training may also inhibit signaling to the muscles’ protein synthesis

machinery, which would definitely be counterproductive to the goals of resistance training”.2

Subsequently, the case studies that were conducted coupled endurance and resistance training.

The combination of the two could have been the reason researchers did not produce definitive

outcomes. If researchers solely focused on resistance training exercises in future studies we may

see a change in total outcome. Overall, the benefits of resistance training in individuals with

Muscular Dystrophy should be considered and is indicated due to the positive results produced in

the studies reviewed.

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References

1. Muscular Dystrophy. Center for Disease Control and Prevention.

https://www.cdc.gov/ncbddd/musculardystrophy/facts.html. Updated on April 7, 2016. Accessed

on September 13, 2017.

2. McArdle WD, Katch FI, Katch VL. Exercise Physiology: Nutrition, Energy, and Human

Performance. Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015.

3. Sveen ML, Anderson SP, Ingelsrud LH, et al. Resistance Training in Patients with Limb-

Girdle and Becker Muscular Dystrophies. Muscle and Nerve. June 2012:163-169.

doi:10.1002/mus.23491.

4. Giciliano G, Simoncini C, Giannotti S, et al. Muscle Exercise in Limb Girdle Muscular

Dystrophies: Pitfall and Advantages. Acta Myologica. 2015:3-8.

5. Gianola S, Pecoraro V, Lambiase S, et al. Efficacy of Muscular Exercise in Patients with

Muscular Dystrophy: A Systematic Review Showing a Missed Opportunity to Improve

Outcomes. PLoS ONE. 2013;8(6):1-9. doi:10.1371.

6. Alemdaroglu I, Karaduman A, Yilmaz IT, et al. Different Types of Upper Extremity Exercise

Training in Duchenne Muscular Dystrophy: Effects on Functional Performance, Strength,

Endurance and Ambulation. Muscle and Nerve. September 2014:697-705.

doi:10.1002/mus.24451.

7. Sveen ML, Jeppesen TD, Hauerslev S, et al. Endurance Training Improves Fitness and

Strength in Patients with Becker Muscular Dystrophy. Brain. July 2008:2824-2831