Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis
1 Rheumatology Unit, Department of Medicine, D2:01, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
2 Rheumatology Unit, Department of Physiotherapy, D2:07, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
3 Muscle Physiology, Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
4 Department of Health Management, School of Health Sciences, Ariel University, Ariel 40700, Israel
5 Department of Laboratory Medicine (LABMED), Division of Clinical Physiology, C188, Karolinska Institutet, SE-141 86, Stockholm, Sweden
6 Rheumatology Unit, Department of Medicine, Område 4, Sahlgrenska University Hospital, SE- 413 45, Gothenburg, Sweden
7 Rheumatology Unit, Department of Medicine, 30B, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
8 Department of NVS, Division of Physiotherapy, D3 Fack 23400, Karolinska Institutet, SE-141 83 Huddinge, Sweden
Arthritis Research & Therapy 2013, 15:R83 doi:10.1186/ar4263Published: 13 August 2013
This randomized, controlled study on patients with polymyositis or dermatomyositis was based on three hypotheses: patients display impaired endurance due to reduced aerobic capacity and muscle weakness, endurance training improves their exercise performance by increasing the aerobic capacity, and endurance training has general beneficial effects on their health status.
In the first part of this study, we compared 23 patients with polymyositis or dermatomyositis with 12 age- and gender-matched healthy controls. A subgroup of patients were randomized to perform a 12-week endurance training program (exercise group, n = 9) or to a non-exercising control group (n = 6). We measured maximal oxygen uptake (VO2 max) and the associated power output during a progressive cycling test. Endurance was assessed as the cycling time to exhaustion at 65% of VO2 max. Lactate levels in the vastus lateralis muscle were measured with microdialysis. Mitochondrial function was assessed by measuring citrate synthase (CS) and β-hydroxyacyl-CoA dehydrogenase (β-HAD) activities in muscle biopsies. Clinical improvement was assessed according to the International Myositis Assessment and Clinical Studies Group (IMACS) improvement criteria. All assessors were blinded to the type of intervention (that is, training or control).
Exercise performance and aerobic capacity were lower in patients than in healthy controls, whereas lactate levels at exhaustion were similar. Patients in the exercise group increased their cycling time, aerobic capacity and CS and β-HAD activities, whereas lactate levels at exhaustion decreased. Six of nine patients in the exercise group met the IMACS improvement criteria. Patients in the control group did not show any consistent changes during the 12-week study.
Polymyositis and dermatomyositis patients have impaired endurance, which could be improved by 12 weeks of endurance training. The clinical improvement corresponds to increases in aerobic capacity and muscle mitochondrial enzyme activities. The results emphasize the importance of endurance exercise in addition to immunosuppressive treatment of patients with polymyositis or dermatomyositis.