Lower limb muscle strengthening exercises in patients with early-stage amyotrophic lateral sclerosis: a case series study.
Naoki Kato, Goichi Hashida, Mizuki Kobayashi and 1 others
PMID 33132518WHAT IT FOUND
After three weeks of weekday physical therapy, knee extension strength rose slightly in 13 early-stage ALS patients, but walking scores did not.
The program combined leg resistance, aerobic and breathing work, and all patients took riluzole while five also took edaravone.
Key findings
01Knee extension strength improved from 1.37 to 1.46 Nm/kg, with a small effect size of 0.13, while walking scores did not improve.
02Lower baseline knee strength was linked to a higher improvement rate, and patients who improved had lower baseline knee strength, walking and ALSFRS-R scores.
03No adverse events were observed, but all patients took riluzole and five took edaravone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 13 patients were studied, and there was no control group, so natural disease progression cannot be separated from exercise. All patients took riluzole and five took edaravone, so medication effects cannot be ruled out. The intervention included lower-limb resistance, cycling, treadmill and respiratory exercises, so the contribution of leg strengthening alone is unknown. Patients were early-stage and ambulatory, so results may not apply to more advanced ALS. Exercise details such as sets, repetitions and the exact mix of activities were not fully standardized.
Declared interests
The paper reports no funding and no conflicts of interest.
The easy way to misread this
Do not read the knee-strength change as proof that lower-limb strengthening alone works. The study had no control group, all patients took riluzole and five took edaravone, and the program combined leg resistance with cycling, treadmill and breathing exercises; walking scores did not improve.