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Meta-Analysis
. 2022 Jan 11:54:jrm00250.
doi: 10.2340/jrm.v53.985.

Exercise Training in Duchenne Muscular Dystrophy: A Systematic Review and Meta-Analysis

Stian Hammer  1 , Michel Toussaint, Maria Vollsæter, Marianne Nesbjørg Tvedt, Ola Drange Røksund, Gregory Reychler, Hans Lund, Tiina Andersen
Affiliations
Meta-Analysis

Exercise Training in Duchenne Muscular Dystrophy: A Systematic Review and Meta-Analysis

Stian Hammer et al. J Rehabil Med. .

Abstract

Objective: To evaluate the effects and safety of exercise training, and to determine the most effective exercise intervention for people with Duchenne muscular dystrophy. Exercise training was compared with no training, placebo or alternative exercise training. Primary outcomes were functioning and health-related quality of life. Secondary outcomes were muscular strength, endurance and lung function. Data sources: A systematic literature search was conducted in Medline, EMBASE, CINAHL, Cochrane Central, PEDro and Scopus. Study selection and data extraction: Screening, data extraction, risk of bias and quality assessment were carried out. Risk of bias was assessed using the Cochrane Collaborations risk of bias tools. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.

Data synthesis: Twelve studies with 282 participants were included. A narrative synthesis showed limited or no improvements in functioning compared with controls. Health-related quality of life was assessed in only 1 study. A meta-analysis showed a significant difference in muscular strength and endurance in favour of exercise training compared with no training and placebo. However, the certainty of evidence was very low.

Conclusion: Exercise training may be beneficial in Duchenne muscular dystrophy, but the evidence remains uncertain. Further research is needed on exercise training to promote functioning and health-related quality of life in Duchenne muscular dystrophy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow chart of identified, screened, excluded and included articles. DMD: Duchenne muscular dystrophy.
Fig. 2
Fig. 2
Risk of bias of the included randomized controlled studies.
Fig. 3
Fig. 3
Risk of bias by study level for the non-randomized studies.
Fig. 4
Fig. 4
Forest plot of the effect on muscular strength of any exercise vs no exercise (1.1.1) and any exercise vs placebo (1.1.2) in persons with Duchenne muscular dystrophy (DMD), with pooled effects of these 2 comparisons (Total). 95% CI: 95% confidence interval; df: degrees of freedom; I2: measure of heterogeneity; Tau2: measure of variance; SD: standard deviation.
Fig. 5
Fig. 5
Forest plot of the effect on endurance after any exercise vs no exercise (2.1.1) and any exercise vs placebo (2.1.2) in persons with Duchenne muscular dystrophy (DMD), with pooled effects of these 2 comparisons (Total). 95% CI: 95% confidence interval; df: degrees of freedom; I2: measure of heterogeneity; Tau2: measure of variance; SD: standard deviation.
Fig. 6
Fig. 6
Forest plot of the effect on muscular strength of the different types of exercise, exercise of limbs and postural muscle vs no exercise (3.1.1), respiratory muscle training (RMT) and breathing exercises vs no exercise (3.1.2), and RMT vs placebo (3.1.3) in persons with Duchenne muscular dystrophy (DMD). 95% CI: 95% confidence interval; df: degrees of freedom; I2: measure of heterogeneity; Tau2: measure of variance; SD: standard deviation.
Fig. 7
Fig. 7
Forest plot of effects on endurance of the different types of exercise training, exercises of limb and postural muscle vs no exercise (4.1.1), respiratory muscle training (RMT) and breathing exercises vs no exercise (4.1.2), and RMT vs placebo (4.1.3) in persons with DMD. 95% CI: 95% confidence interval; df: degrees of freedom; I2: measure of heterogeneity; Tau2: measure of variance; SD: standard deviation.
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