A meta-analysis of post-exercise outcomes in people with amyotrophic lateral sclerosis

Abstract

Objective: To systematically evaluate post-exercise outcomes related to function and quality of life in people with ALS.

Methods: PRISMA guidelines were used for identifying and extracting articles. Levels of evidence and quality of articles were judged based on The Oxford Centre for Evidence-based Medicine Levels of Evidence and the QualSyst. Outcomes were analyzed with Comprehensive Meta-Analysis V2 software, random effects models, and Hedge's G. Effects were examined at 0-4 months, up to 6 months, and > 6 months. Pre-specified sensitivity analyses were performed for 1) controlled trials vs. all studies and 2) ALSFRS-R bulbar, respiratory, and motor subscales. Heterogeneity of pooled outcomes was computed with the I² statistic.

Results: 16 studies and seven functional outcomes met inclusion for the meta-analysis. Of the outcomes explored, the ALSFRS-R demonstrated a favorable summary effect size and had acceptable heterogeneity and dispersion. While FIM scores demonstrated a favorable summary effect size, heterogeneity limited interpretations. Other outcomes did not demonstrate a favorable summary effect size and/or could not be reported due to few studies reporting outcomes.

Conclusions: This study provides inconclusive guidance regarding exercise regimens to maintain function and quality of life in people with ALS due to study limitations (e.g., small sample size, high attrition rate, heterogeneity in methods and participants, etc.). Future research is warranted to determine optimal treatment regimens and dosage parameters in this patient population.

Keywords: 25FWT, (25 Feet Walk Test); 6MWT, (6 Minute Walk Test); ALS, (amyotrophic lateral sclerosis); ALSFRS-R, (ALS Functional Rating Scale-Revised); Amyotrophic lateral sclerosis; DIGEST, (Dynamic Imaging Grade of Swallowing Toxicity); EAT-10, (Eating Assessment Tool); EMST, (Expiratory muscle strength training); Exercise; FAC, (Functional Ambulation Categories); FIM, (Functional Independence Measurement); FOIS, (Functional Oral Intake Scale); FSS, (Fatigue Severity Scale); FVC, (forced vital capacity); IMST, (Inspiratory muscle strength training); ITT, (intention-to-treat); KEMS, (knee extension muscle strength); MEP, (maximum expiratory pressure); MIP, (maximum inspiratory pressure); MND, (motor neuron disease); MVIC, (maximum voluntary isometric contraction); Motor neuron disease; Outcome measures; PAS, (Penetration Aspiration Scale); PEF, (peak expiratory flow); PRISMA-2009, (Preferred Reporting Items for Systematic Reviews and Meta-Analyses); RCTs, (randomized controlled trials); RPE, (rating of perceived exertion); Rehabilitation; SNIP, (sniff nasal inspiratory pressure).

Fig. 1

Amyotrophic lateral sclerosis rating scale revised (PRISMA) flow diagram.

Fig. 2

Effect of exercise on amyotrophic lateral sclerosis rating scale revised (ALSFRS-R) scores across 7 studies (treatment n = 139, control n = 208).

Fig. 3

Funnel plot demonstrating potential publication bias (fail safe N = 11 studies).

Fig. 4

Effect of exercise on functional independence measure (FIM) scores across 2 studies (treatment n = 31, control n = 27).

Fig. 5

Effect of exercise on amyotrophic lateral sclerosis rating scale revised ALSFRS-R subscale scores.

Fig. 6

Effect of exercise on fatigue severity scale (FSS) scores.

Fig. 7

Effect of exercise on McGill Quality of Life Questionnaire scores.

Fig. 8

Effect of exercise on maximum expiratory pressure (MEP).

Fig. 9

Effect of exercise on swallowing safety (penetration-aspiration scale scores).