Article

OBJECTIVES: To determine the feasibility, tolerability, safety, and exercise
treatment-effect size of repetitive rhythmic exercise mediated by supported
treadmill ambulation training (STAT) for patients with amyotrophic lateral
sclerosis (ALS). DESIGN: Interventional with repeated-measures design. SETTING:
Multidisciplinary ALS clinic at academic medical center.
Convenience sample of patients with ALS (N=9) who were ambulatory with assistive
devices (Sinaki-Mulder stages II-III). INTERVENTIONS: Repetitive rhythmic
exercise-STAT (30min total; 5min of exercise intercalated with 5min of rest)
performed 3 times a week for 8 weeks. MAIN OUTCOME MEASURE: ALS Functional Rating
Scale-Revised (ALSFRS-R), percentage of predicted vital capacity (VC), total
lower-extremities manual muscle test (MMT), rate of perceived exertion (RPE),
Fatigue Severity Scale (FSS), and maximum voluntary isometric contraction (MVIC)
in 10 lower and 10 upper extremities. Gait performance, which included walking
distance, speed, steps, and stride length, was evaluated during treadmill and
ground 6-minute walk tests (6MWTs) and 25-foot walk test (25FWT). RESULTS:
Feasibility issues decreased screened participants by 4 patients (31%). Nine
patients were enrolled, but 6 patients (67%) completed the study and 3 (23% of
original cohort; 33% of enrolled cohort) could not complete the exercise
intervention because of non-ALS-related medical problems. Tolerability of the
intervention measures during the treadmill 6MWT showed improvement in RPE
(P/=.05). Safety measures (ALSFRS-R, VC, MMT) showed no
decrease and showed statistical improvement in ALSFRS-R score (P</=.05) during
the study interval. Exercise treatment-effect size showed variable improvements.
Gait speed, distance, and stride length during the treadmill 6MWT improved
significantly (P</=.05) after 4 weeks and improvements were maintained after 8
weeks compared with baseline. Walking distance during the ground 6MWT increased
significantly after 4 weeks and was maintained after 8 weeks compared with
baseline (P</=.05). Walking speed during the 25FWT and lower-extremity MVIC
improved, but were not statistically significant. CONCLUSIONS: Repetitive
rhythmic exercise-STAT is feasible, tolerated, and safe for patients with ALS.
Repetitive rhythmic exercise-STAT treatment-effect size across a number of
ALS-related measures was consistent with improved work capacity and gait function
in patients with ALS who are dependent on assistive devices for ambulation.
Repetitive rhythmic exercise-STAT should be evaluated further in larger studies
to determine the stability of this improved function in relation to the rate of progression of the underlying ALS.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS