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      Safety and efficacy of exercise training in adults with Pompe disease: evalution of endurance, muscle strength and core stability before and after a 12 week training program

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          Abstract

          Background

          Pompe disease is a proximal myopathy. We investigated whether exercise training is a safe and useful adjuvant therapy for adult Pompe patients, receiving enzyme replacement therapy.

          Methods

          Training comprised 36 sessions of standardized aerobic, resistance and core stability exercises over 12 weeks. Before and after, the primary outcome measures safety, endurance (aerobic exercise capacity and distance walked on the 6 min walk test) and muscle strength, and secondary outcome measures core stability, muscle function and body composition, were evaluated.

          Results

          Of 25 patients enrolled, 23 successfully completed the training. Improvements in endurance were shown by increases in maximum workload capacity (110 W before to 122 W after training, [95 % CI of the difference 6 · 0 to 19 · 7]), maximal oxygen uptake capacity (69 · 4 % and 75 · 9 % of normal, [2 · 5 to 10 · 4]), and maximum walking distance (6 min walk test: 492 meters and 508, [−4 · 4 to 27 · 7] ). There were increases in muscle strength of the hip flexors (156 · 4 N to 180 · 7 N [1 · 6 to 13 · 6) and shoulder abductors (143 · 1 N to 150 · 7 N [13 · 2 to 35 · 2]). As an important finding in secondary outcome measures the number of patients who were able to perform the core stability exercises rose, as did the core stability balancing time ( p < 0.05, for all four exercises). Functional tests showed small reductions in the time needed to climb four steps (2 · 4 sec to 2 · 1, [− 0 · 54 to −0 · 04 ]) and rise to standing position (5 · 8 sec to 4 · 8, [−2 · 0 to 0 · 0]), while time to run, the quick motor function test results and body composition remained unchanged.

          Conclusions

          Our study shows that a combination of aerobic, strength and core stability exercises is feasible, safe and beneficial to adults with Pompe disease.

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          Most cited references16

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          Exercise-Induced Muscle Damage in Humans

          Exercise-induced muscle injury in humans frequently occurs after unaccustomed exercise, particularly if the exercise involves a large amount of eccentric (muscle lengthening) contractions. Direct measures of exercise-induced muscle damage include cellular and subcellular disturbances, particularly Z-line streaming. Several indirectly assessed markers of muscle damage after exercise include increases in T2 signal intensity via magnetic resonance imaging techniques, prolonged decreases in force production measured during both voluntary and electrically stimulated contractions (particularly at low stimulation frequencies), increases in inflammatory markers both within the injured muscle and in the blood, increased appearance of muscle proteins in the blood, and muscular soreness. Although the exact mechanisms to explain these changes have not been delineated, the initial injury is ascribed to mechanical disruption of the fiber, and subsequent damage is linked to inflammatory processes and to changes in excitation-contraction coupling within the muscle. Performance of one bout of eccentric exercise induces an adaptation such that the muscle is less vulnerable to a subsequent bout of eccentric exercise. Although several theories have been proposed to explain this "repeated bout effect," including altered motor unit recruitment, an increase in sarcomeres in series, a blunted inflammatory response, and a reduction in stress-susceptible fibers, there is no general agreement as to its cause. In addition, there is controversy concerning the presence of sex differences in the response of muscle to damage-inducing exercise. In contrast to the animal literature, which clearly shows that females experience less damage than males, research using human studies suggests that there is either no difference between men and women or that women are more prone to exercise-induced muscle damage than are men.
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            Enzyme replacement therapy in late-onset Pompe disease: a systematic literature review.

            Glycogen storage disease type 2/Pompe disease is a progressive muscle disorder with a wide range of phenotypic presentations, caused by an inherited deficiency of acid alpha-glucosidase. Since 2004 only a limited number of patients have been treated with recombinant human alpha-glucosidase from rabbit milk whereas since 2006 enzyme replacement therapy (ERT) with alglucosidase alfa has been licensed for the treatment of Pompe disease. This systematic review evaluates the clinical efficacy and safety of alglucosidase alfa treatment of juvenile and adult patients with late-onset Pompe disease (LOPD). Studies of alglucosidase alfa treatment of LOPD patients-published up to January 2012-were identified by electronic searching of the EMBASE and MEDLINE databases, and manual searching of the reference lists. Data on ERT outcomes were extracted from selected papers and analyzed descriptively. No statistical analysis was performed owing to data heterogeneity. Twenty-one studies containing clinical data from 368 LOPD patients were analyzed. Overall, at least two-thirds of patients were stabilized or had improved creatine kinase levels and muscular and/or respiratory function following treatment with alglucosidase alfa. ERT was well tolerated; most adverse events were mild or moderate infusion-related reactions. In conclusion, alglucosidase alfa treatment is effective and well tolerated and attenuates progression of LOPD in most patients. Further research is required to investigate factors such as age at diagnosis, phenotypic presentation, and genotypic characteristics, identification of which may enable better clinical and therapeutic management of LOPD patients.
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              Training and detraining effects of the resistance vs. endurance program on body composition, body size, and physical performance in young men.

              The purpose of this study was to investigate the changes in the body composition, body size, muscle strength, and VO2max after 24 weeks of resistance or endurance training and detraining in young men. Thirty healthy college-aged men (20.4 ± 1.36 years) participated in the study. Subjects were assigned to resistance training group (RTG, n = 10), endurance training group (ETG, n = 10), and control group (CG, n = 10). The training program consisted of running or weight-resistance exercise for 3 sessions per week under supervision. VO2max, upper and lower body strength (UBS, LBS), body fat, lean body mass, and body circumference were measured at baseline and after training and detraining. After the training period, the exercise groups demonstrated significant increases in VO2max and LBS (p < 0.05). The UBS, lean mass (LM), and body size of arm and calf were significantly greater in the RTG than in the other 2 groups (p<0.05). In addition, the strength and LM of the RTG were still greater than the baseline values after 24 weeks of detraining (p < 0.05). The conclusions of this study are (a) that endurance or resistance training alone led to training-specific improvements in physical performance, body composition, and body size of the arms for the young men examined and (b) that the RTG maintained the gains in strength and LM for more prolonged periods after training ceased than the endurance training group.
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                Author and article information

                Contributors
                +31 10 703 2076 , a.vanderploeg@erasmusmc.nl
                Journal
                Orphanet J Rare Dis
                Orphanet J Rare Dis
                Orphanet Journal of Rare Diseases
                BioMed Central (London )
                1750-1172
                19 July 2015
                19 July 2015
                2015
                : 10
                : 87
                Affiliations
                [ ]Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center – Sophia Children’s Hospital, PO Box 2040, 3000 CA Rotterdam, The Netherlands
                [ ]Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
                [ ]Center for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
                [ ]Center for Lysosomal and Metabolic Diseases, Department of Clinical Genetics, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
                Article
                303
                10.1186/s13023-015-0303-0
                4506616
                26187632
                cd4665e0-6ae9-4eb9-b567-0b2aae45a41d
                © van den Berg et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 March 2015
                : 7 July 2015
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Infectious disease & Microbiology
                glycogen storage disorder type ii,endurance training,strength training,core stability,muscle function

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