The effects of hydrotherapy on muscle strength, body composition, and quality of life in boys with Duchenne dystrophy

Hosseinpour Motlagh, Zahra; Pournemati, Parisa; Kordi, Mohammadreza

doi:10.22059/sshr.2023.355173.1077

The effects of hydrotherapy on muscle strength, body composition, and quality of life in boys with Duchenne dystrophy

Document Type : Research Paper

Authors

Zahra hosseinpour motlagh

Parisa Pournemati

Mohammadreza Kordi

Exercise Physiology department, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran

10.22059/sshr.2023.355173.1077

Abstract

Background: Duchenne muscular dystrophy (DMD) is one of the most rampant x-linked recessive lethal genetic disease with prevalence of approximately 1 out of 3500-5000 newborn boys worldwide. DMD is mutations-induced in gene encoding dystrophin that prevent the production of the muscle isoform of dystrophin (Dp427m).
Aim: This study aims to evaluate the impact of hydrotherapy on health-related quality of life and body composition changes, as well as how it affects on skeletal muscle strength in boys with DMD.
Materials and Methods: Eight boys, ranging from 6 to 12 years old with DMD were enrolled in this study. The patients were randomly assigned to either a hydrotherapy group as the intervention group (Group 1; n=4) or a non-exercise group as the control group (Group 2; n=4), to receive 12 sessions of a hydrotherapy program. The patients were assessed for changes in muscle strength in the lower limbs and back, left and right quadriceps, left and right-hand grip, LBM, SMM, and general mobility and balance, before and after hydrotherapy.
Results: Significant improvements in general mobility and balance were observed, along with a significant increase in muscle strength and lean body mass (P<0.05).
Conclusion: This study suggests that hydrotherapy with a precise protocol of low to moderate intensity can improve general mobility and balance, increase muscle strength in the lower limbs and back, left and right quadriceps, left and right-hand grip, and LBM in patients with DMD. The increase in strength is accompanied by increase in LBM, which not only has implications for function but also has much broader impacts on the health-related quality of life in patients.

Keywords

body composition

Duchenne muscular dystrophy

exercise

hydrotherapy

strength

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Sport Sciences and Health Research

The effects of hydrotherapy on muscle strength, body composition, and quality of life in boys with Duchenne dystrophy

[1] Tominari T, Aoki Y. “Clinical development of novel therapies for Duchenne muscular dystrophy–current and future”. Neurology and Clinical Neuroscience. 2022. doi: 10.1111/ncn3.12691.

[2] Carcione M, Luce L, Mazzanti C, Mesa L, Dubrovsky A, Corderí J, Giliberto F. “DMD/BMD-genetics: EP. 114 Theragnosis for Duchenne muscular dystrophy”. Neuromuscular Disorders. 2021; 31: S83. doi: 10.3389/fphar.2021.648390.

[3] Aslesh T, Erkut E, Yokota T. “Restoration of dystrophin expression and correction of Duchenne muscular dystrophy by genome editing”. Expert Opinion on Biological Therapy. 2021; 21(8): 1049-61. doi: 10.1080/14712598.2021.1872539.

[4] Duan D, Goemans N, Takeda SI, Mercuri E, Aartsma-Rus A. “Duchenne muscular dystrophy”. Nature Reviews Disease Primers. 2021; 7(1): 13. doi: 10.1038/s41572-021-00248-3.

[5] Dowling P, Gargan S, Murphy S, Zweyer M, Sabir H, Swandulla D, Ohlendieck K. “The dystrophin node as integrator of cytoskeletal organization, lateral force transmission, fiber stability and cellular signaling in skeletal muscle”. Proteomes. 2021; 9(1): 9. doi: 10.3390/proteomes9010009.

[7] Lovering RM, Iyer SR, Edwards B, Davies KE. “Alterations of neuromuscular junctions in Duchenne muscular dystrophy”. Neuroscience Letters. 2020; 737: 135304. doi: 10.1016/j.neulet.2020.135304.

[8] Wilson DG, Tinker A, Iskratsch T. “The role of the dystrophin glycoprotein complex in muscle cell mechanotransduction”. Communications Biology. 2022; 5(1): 1022. https://doi.org/10.1038/s42003-022-03980-y.

[9] Chelly J, Desguerre I. “Progressive muscular dystrophies”. Handbook of Clinical Neurology. 2013; 113: 1343-66. doi: 10.1016/B978-0-444-59565-2.00006-X.

[10] Plack M, Wentzell E, Resetar J, Downton M. “Physical therapy for pediatric conditions”. Introduction to Physical Therapy-E-Book. 2021.

[12] Singh R. “The resistive range of motion exercise training in Duchenne muscular dystrophy: a case study”. TMR Non-Drug Ther. 2023; 6(2) :8. https://doi.org/10.53388/TMRND2022008.

[13] Grange RW, Call JA. “Recommendations to define exercise prescription for Duchenne muscular dystrophy”. Exercise and Sport Sciences Reviews. 2007; 35(1): 12-7. doi: 10.1249/01.jes.0000240020.84630.9d.

[14] Limback KA, Jacobus WD, Wiggins-McDaniel A, Newman R, White RA. “A comprehensive review of Duchenne muscular dystrophy: Genetics, clinical presentation, diagnosis and treatment”. Biotechnology Journal International. 2022; 26(6):1-31. doi: 10.9734/BJI/2022/v26i6662.

[15] Solichin I, Prabowo I, Laras S, Putra NH, Rhatomy S. “Early ambulatory Duchenne muscular dystrophy: First symptomatic stage of ambulation-A case report”. International Journal of Surgery Open. 2021; 33: 100349. doi: 10.1016/j.ijso.2021.100349.

[16] Guglieri M, Bushby K, McDermott MP, Hart KA, Tawil R, Martens WB, Herr BE, McColl E, Wilkinson J, Kirschner J, King WM. “Developing standardized corticosteroid treatment for Duchenne muscular dystrophy. Contemporary clinical trials”. 2017; 58: 34-9. doi: 10.1016/j.cct.2017.04.008.

[18] Anning JH. “Potential benefits of using exercise as a treatment strategy for Duchenne Muscular Dystrophy (DMD)”. Professionalization of Exercise Physiology. 2022; 25(4).

[20] Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. “A tutorial on pilot studies: the what, why and how”. BMC Medical Research Methodology. 2010; 10: 1-0. http://www.biomedcentral.com/1471-2288/10/1.

[21] Hammer S, Toussaint M, Vollsæter M, NESBJØRG M, Røksund OD, Reychler G, Hans LU, Andersen T. “Exercise training in Duchenne muscular dystrophy: A systematic review and meta-analysis”. Journal of Rehabilitation Medicine. 2022; 54. doi: 10.2340/jrm.v53.985.

[22] Furrer R, Hawley JA, Handschin C. “The molecular athlete: exercise physiology from mechanisms to medals”. Physiological Reviews. 2023. https://doi.org/10.1152/physrev.00017.2022.

[23] Lindsay A, Larson AA, Verma M, Ervasti JM, Lowe DA. “Isometric resistance training increases strength and alters histopathology of dystrophin-deficient mouse skeletal muscle”. Journal of Applied Physiology. 2019; 126(2): 363-75. doi: 10.1152/japplphysiol.00948.2018.

[25] Spaulding HR, Selsby JT. “Is exercise the right medicine for dystrophic muscle”. Med. Sci. Sports Exerc. 2018; 50(9): 1723-32. doi: 10.1249/MSS.0000000000001639.

[26] Spangenburg EE, Booth FW. “Molecular regulation of individual skeletal muscle fibre types”. Acta Physiologica Scandinavica. 2003; 178(4): 413-24. doi: 10.1046/j.1365-201X.2003.01158.x.

[28] Anandan D, Anand V, Arunachalam R, Arun B. “Low-intensity aerobic exercises during COVID-19 pandemic in children with Duchenne muscular dystrophy: A home based study”. Indian Journal of Health & Wellbeing. 2022; 13(3). doi: 10.37896/aj11.8/001.

[29] Sayers SP. “The role of exercise as a therapy for children with Duchenne muscular dystrophy”. Pediatric Exercise Science. 2000; 12(1): 23-33. doi: 10.1123/PES.12.1.23.

[30] Atamturk H, Atamturk A. “Therapeutic effects of aquatic exercises on a boy with Duchenne muscular dystrophy”. Journal of Exercise Rehabilitation. 2018; 14(5): 877. doi: 10.12965/jer.1836408.204.

[31] Carayannopoulos AG, Han A, Burdenko IN. “The benefits of combining water and land-based therapy”. Journal of Exercise Rehabilitation. 2020; 16(1): 20. doi: 10.12965/jer.1938742.371.

[32] Chiquoine J, Martens E, McCauley L, Van Dyke JB. “Aquatic therapy”. Canine Sports Medicine and Rehabilitation. 2018: 208-26.

[33] Nelson L, Early D, Iannaccone S. “P. 7.14 effects of a regular aquatic therapy program on one individual with Duchenne Muscular Dystrophy (DMD): A case study”. Neuromuscular Disorders. 2013; 23(9): 777-8. doi: 10.1016/j.nmd.2013.06.495.

[34] McManus BM, Kotelchuck M. “The effect of aquatic therapy on functional mobility of infants and toddlers in early intervention”. Pediatric Physical Therapy. 2007; 19(4): 275-82. doi: 10.1097/PEP.0b013e3181575190.

[35] Ogonowska-Slodownik A, de Lima AA, Cordeiro L, Morgulec-Adamowicz N, Alonso-Fraile M, Güeita-Rodríguez J. “Aquatic therapy for persons with neuromuscular diseases–A scoping review”. Journal of Neuromuscular Diseases. 2022; 9(2): 237-56. doi: 10.3233/JND-210749.

[36] Wells JC, Fewtrell MS. “Measuring body composition”. Archives of Disease in Childhood. 2006; 91(7): 612-7. doi: 10.1136/adc.2005.085522.

[37] Forbes GB. “Human body composition: growth, aging, nutrition, and activity”. Springer Science & Business Media. 2012.

[38] Conable KM, Rosner AL. “A narrative review of manual muscle testing and implications for muscle testing research”. Journal of Chiropractic Medicine. 2011; 10(3): 157-65. doi: 10.1016/j.jcm.2011.04.001.

[39] Bittmann FN, Dech S, Aehle M, Schaefer LV. “Manual muscle testing—force profiles and their reproducibility”. Diagnostics. 2020; 10(12): 996. doi: 10.3390/diagnostics10120996.

[40] Eyuboglu E, Aslan CS, Karakulak I, Sahin FN. “Is there any effect of non-suitable pull technique in back & leg dynamometers on the leg strength test results”. Acta Medica Mediterranea. 2019; 35(3): 1373-8. doi: 10.19193/0393-6384_2019_3_211.

[41] Cuenca-Garcia M, Marin-Jimenez N, Perez-Bey A, Sanchez-Oliva D, Camiletti-Moiron D, Alvarez-Gallardo IC, Ortega FB, Castro-Pinero J. “Reliability of field-based fitness tests in adults: a systematic review”. Sports Medicine. 2022; 52(8): 1961-79. doi: 10.1007/s40279-021-01635-2.

[42] Litchfield RE. Grip strength-What is it? What does it mean. Human Sciences Extension and Outreach Publications. 2013; 38. https://dr.lib.iastate.edu/handle/20.500.12876/33296.

[43] Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA. “A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach”. Age and Ageing. 2011; 40(4): 423-9. doi: 10.1093/ageing/afr051.

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Volume 14, Issue 2July 2022Pages 223-235

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Volume 14, Issue 2
July 2022
Pages 223-235