Long-Term Exercise Intervention in Patients with McArdle Disease: Clinical and Aerobic Fitness Benefits
ALFREDO SANTALLA, PEDRO L. VALENZUELA, CARLOS RODRIGUEZ-LOPEZ, IRENE RODRÍGUEZ-GÓMEZ, GISELA NOGALES-GADEA, TOMÀS PINÓS, JOAQUÍN ARENAS, MIGUEL A. MARTÍN, ALEJANDRO SANTOS-LOZANO, MARÍA MORÁN, CARMEN FIUZA-LUCES, IGNACIO ARA, ALEJANDRO LUCIA
Abstract
INTRODUCTION: The long-term effects of exercise in patients with McArdle disease-the paradigm of "exercise intolerance"-are unknown. This is an important question because the severity of the disease frequently increases with time. PURPOSE: This study aimed to study the effects of a long-term exercise intervention on clinical and fitness-related outcomes in McArdle patients. METHODS: Seventeen patients (exercise group: n = 10, 6 male, 38 ± 18 yr; control: n = 7, 4 male, 38 ± 18 yr) participated in a 2-yr unsupervised intervention including moderate-intensity aerobic (cycle-ergometer exercise for 1 h) and resistance (high load-low repetition circuit) training on 5 and 2-3 d·wk -1 , respectively. Patients were assessed at baseline and postintervention. Besides safety, outcomes included clinical severity (e.g., exercise intolerance features) on a 0-3 scale (primary outcome), and aerobic fitness, gross muscle efficiency, and body composition (total/regional fat, muscle, and bone mass; secondary outcomes). RESULTS: The exercise program was safe and resulted in a reduction of 1 point (-1.0; 95% confidence interval, -1.6 to -0.5; P = 0.025) in clinical severity versus the control group, with 60% of participants in the exercise group becoming virtually asymptomatic and with no functional limitation in daily life activities. Compared with controls, the intervention induced significant and large benefits (all P < 0.05) in the workload eliciting the ventilatory threshold (both in absolute (watts, +37%) and relative units (watts per kilogram of total body mass or of lower-limb muscle mass, +44%)), peak oxygen uptake (in milliliters per kilogram per minute, +28%), and peak workload (in absolute (+27%) and relative units (+33%)). However, no significant changes were found for muscle efficiency or for any measure of body composition. CONCLUSIONS: A 2-yr unsupervised intervention including aerobic and resistance exercise is safe and induces major benefits in the clinical course and aerobic fitness of patients with McArdle disease.