Skip to main content

Advertisement

SpringerLink
Log in

New Insights into the Benefits of Exercise for Muscle Health in Patients with Idiopathic Inflammatory Myositis

  • Inflammatory Muscle Disease (RG Cooper, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

With recommended treatment, a majority with idiopathic inflammatory myopathy (IIM) develop muscle impairment and poor health. Beneficial effects of exercise have been reported on muscle performance, aerobic capacity and health in chronic polymyositis and dermatomyositis and to some extent in active disease and inclusion body myositis (IBM). Importantly, randomized controlled trials (RCTs) indicate that improved health and decreased clinical disease activity could be mediated through increased aerobic capacity. Recently, reports seeking mechanisms underlying effects of exercise in skeletal muscle indicate increased aerobic capacity (i.e. increased mitochondrial capacity and capillary density, reduced lactate levels), activation of genes in aerobic phenotype and muscle growth programs, and down regulation in genes related to inflammation. Altogether, exercise contributes to both systemic and within-muscle adaptations demonstrating that exercise is fundamental to improve muscle performance and health in IIM. There is a need for RCTs to study effects of exercise in active disease and IBM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular importance, published recently, have been highlighted as: • of importance •• of major importance

  1. Hengstman GJ, van den Hoogen FH, van Engelen BG. Treatment of the inflammatory myopathies: update and practical recommendations. Expert Opin Pharmacother. 2009;10:1183–90.

    Article  CAS  PubMed  Google Scholar 

  2. Harris-Love MO et al. Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis. Rheumatology (Oxford). 2009;48:134–9.

    Article  CAS  Google Scholar 

  3. Fathi M, Lundberg IE. Interstitial lung disease in polymyositis and dermatomyositis. Curr Opin Rheumatol. 2005;17:701–6.

    Article  PubMed  Google Scholar 

  4. Zong M, Lundberg IE. Pathogenesis, classification and treatment of inflammatory myopathies. Nat Rev Rheumatol. 2011;7:297–306.

    Article  CAS  PubMed  Google Scholar 

  5. Miller FW. New approaches to the assessment and treatment of the idiopathic inflammatory myopathies. Ann Rheum Dis. 2012;71 Suppl 2:i82–5.

    Article  CAS  PubMed  Google Scholar 

  6. Marie I et al. Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol. 2001;28:2230–7.

    CAS  PubMed  Google Scholar 

  7. Sultan SM et al. Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford). 2002;41:22–6.

    Article  CAS  Google Scholar 

  8. Ponyi A et al. Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis. Rheumatology (Oxford). 2005;44:83–8.

    Article  CAS  Google Scholar 

  9. Bronner IM et al. Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis. 2006;65:1456–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Regardt M et al. Patients with polymyositis or dermatomyositis have reduced grip force and health-related quality of life in comparison with reference values: an observational study. Rheumatology (Oxford). 2011;50:578–85.

    Article  Google Scholar 

  11. Dimachkie MM, Barohn RJ. Inclusion body myositis. Curr Neurol Neurosci Rep. 2013;13:321.

    Article  PubMed  Google Scholar 

  12. Cox FM et al. Magnetic resonance imaging of skeletal muscles in sporadic inclusion body myositis. Rheumatology (Oxford). 2011;50:1153–61.

    Article  Google Scholar 

  13. Cortese A et al. Longitudinal observational study of sporadic inclusion body myositis: implications for clinical trials. Neuromuscul Disord : NMD. 2013;23:404–12.

    Article  CAS  PubMed  Google Scholar 

  14. Greenberg SA. Biomarkers of inclusion body myositis. Curr Opin Rheumatol. 2013;25:753–62.

    Article  CAS  PubMed  Google Scholar 

  15. Sadjadi R, Rose MR. What determines quality of life in inclusion body myositis? J Neurol Neurosurg Psychiatry. 2010;81:1164–6.

    Article  CAS  PubMed  Google Scholar 

  16. Lundberg IE. The physiology of inflammatory myopathies: an overview. Acta Physiol Scand. 2001;171:207–13.

    Article  CAS  PubMed  Google Scholar 

  17. Nader GA, Lundberg IE. Exercise as an anti-inflammatory intervention to combat inflammatory diseases of muscle. Curr Opin Rheumatol. 2009;21:599–603.

    Article  CAS  PubMed  Google Scholar 

  18. Hanaoka BY, Peterson CA, Crofford LJ. Glucocorticoid effects on skeletal muscle: benefit and risk in patients with autoimmune inflammatory rheumatoid diseases. Expert Rev Clin Immunol. 2012;8:695–7.

    Article  CAS  PubMed  Google Scholar 

  19. Rayavarapu S, Coley W, Nagaraju K. An update on pathogenic mechanisms of inflammatory myopathies. Curr Opin Rheumatol. 2011;23:579–84.

    Article  CAS  PubMed  Google Scholar 

  20. Rayavarapu S, Coley W, Nagaraju K. Endoplasmic reticulum stress in skeletal muscle homeostasis and disease. Curr Rheumatol Rep. 2012;14:238–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Henriques-Pons A, Nagaraju K. Nonimmune mechanisms of muscle damage in myositis: role of the endoplasmic reticulum stress response and autophagy in the disease pathogenesis. Curr Opin Rheumatol. 2009;21:581–7.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Loell I, Lundberg IE. Can muscle regeneration fail in chronic inflammation: a weakness in inflammatory myopathies? J Intern Med. 2011;269:243–57.

    Article  CAS  PubMed  Google Scholar 

  23. Nader GA et al. A longitudinal, integrated, clinical, histological and mRNA profiling study of resistance exercise in myositis. Mol Med. 2010;16:455–64.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Westerblad H, Bruton JD, Katz A. Skeletal muscle: energy metabolism, fiber types, fatigue and adaptability. Exp Cell Res. 2010;316:3093–9.

    Article  CAS  PubMed  Google Scholar 

  25. Booth FW, Thomason DB. Molecular and cellular adaptation of muscle in response to exercise: perspectives of various models. Physiol Rev. 1991;71:541–85.

    CAS  PubMed  Google Scholar 

  26. Hepple RT et al. Resistance and aerobic training in older men: effects on VO2peak and the capillary supply to skeletal muscle. J Appl Physiol Respir Environ Exerc Physiol. 1997;82:1305–10.

    CAS  Google Scholar 

  27. Hood DA. Invited Review: contractile activity-induced mitochondrial biogenesis in skeletal muscle. J Appl Physiol Respir Environ Exerc Physiol. 2001;90:1137–57.

    CAS  Google Scholar 

  28. McCarthy JJ, Esser RA. Skeletal Muscle Adaptation to Exercise. In: Hill J, editor. Muscle Fundamental Biology and Mechanisms of Disease: Elsevier Inc; 2012: 911-20.

  29. Okuma H et al. Muscle metabolism in patients with polymyositis simultaneously evaluated by using 31P-magnetic resonance spectroscopy and near-infrared spectroscopy. Int J Clin Pract. 2007;61:684–9.

    Article  CAS  PubMed  Google Scholar 

  30. Park JH, Olsen NJ. Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies. Curr Rheumatol Rep. 2001;3:334–45.

    Article  CAS  PubMed  Google Scholar 

  31. Chung YL et al. Urinary levels of creatine and other metabolites in the assessment of polymyositis and dermatomyositis. Rheumatology (Oxford). 2003;42:298–303.

    Article  CAS  Google Scholar 

  32. Dastmalchi M et al. Effect of physical training on the proportion of slow-twitch type I muscle fibers, a novel nonimmune-mediated mechanism for muscle impairment in polymyositis or dermatomyositis. Arthritis Rheum. 2007;57:1303–10.

    Article  PubMed  Google Scholar 

  33. Cea G et al. Reduced oxidative phosphorylation and proton efflux suggest reduced capillary blood supply in skeletal muscle of patients with dermatomyositis and polymyositis: a quantitative 31P-magnetic resonance spectroscopy and MRI study. Brain. 2002;125:1635–45.

    Article  PubMed  Google Scholar 

  34. Grundtman C et al. Vascular endothelial growth factor is highly expressed in muscle tissue of patients with polymyositis and patients with dermatomyositis. Arthritis Rheum. 2008;58:3224–38.

    Article  CAS  PubMed  Google Scholar 

  35. Blume G et al. Polymyositis with cytochrome oxidase negative muscle fibres. Early quadriceps weakness and poor response to immunosuppressive therapy. Brain. 1997;120(Pt 1):39–45.

    Article  PubMed  Google Scholar 

  36. Temiz P, Weihl CC, Pestronk A. Inflammatory myopathies with mitochondrial pathology and protein aggregates. J Neurol Sci. 2009;278:25–9.

    Article  PubMed  Google Scholar 

  37. Varadhachary AS, Weihl CC, Pestronk A. Mitochondrial pathology in immune and inflammatory myopathies. Curr Opin Rheumatol. 2010;22:651–7.

    Article  CAS  PubMed  Google Scholar 

  38. Alemo Munters L et al. Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis. Arthritis Res Therapy. 2013;15(R83). This study indicates low aerobic capacity in patients with chronic polymyositis and dermatomyositis compared to healthy controls. Also, a randomized controlled trial suggests that endurance exercise contributes to improvement in exercise performance in these patients through increased aerobic capacityc and within-muscle adaptations such as increased mitochondrial capacity.

  39. Bertolucci F, et al. Abnormal lactate levels in patients with polymyositis and dermatomyositis: the benefits of a specific rehabilitative program. European journal of physical and rehabilitation medicine 2013. This study indicates low aerobic capacity in skeletal muscle in patients with polymyositis or dermatomyositis compared to healthy, and in an open design a shift to aerobic metabolism concurrent with improved muscle perfomance by physical exercise in these patients.

  40. Wiesinger GF et al. Aerobic capacity in adult dermatomyositis/polymyositis patients and healthy controls. Arch Phys Med Rehabil. 2000;81:1–5.

    Article  CAS  PubMed  Google Scholar 

  41. Someya F, Mugii N. Limitations to the 6-minute walk test in dermatomyositis with interstitial lung disease in comparison with idiopathic interstitial pneumonia. Clin Med Insights Circ, Respir Pulm Med. 2013;7:1–6.

    Google Scholar 

  42. Alexanderson H, Lundberg IE. Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol. 2012;24:201–7.

    Article  PubMed  Google Scholar 

  43. Habers GE, Takken T. Safety and efficacy of exercise training in patients with an idiopathic inflammatory myopathy–a systematic review. Rheumatology (Oxford). 2011;50:2113–24.

    Article  Google Scholar 

  44. Escalante A, Miller L, Beardmore TD. Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. J Rheumatol. 1993;20:1340–4.

    CAS  PubMed  Google Scholar 

  45. Alexanderson H et al. The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol. 2000;29:295–301.

    Article  CAS  PubMed  Google Scholar 

  46. Varju C et al. The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil. 2003;17:83–7.

    Article  PubMed  Google Scholar 

  47. de Salles PV et al. The possible role of physical exercise on the treatment of idiopathic inflammatory myopathies. Autoimmun Rev. 2009;8:355–9.

    Article  Google Scholar 

  48. Perandini LA et al. Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun Rev. 2012;12:218–24.

    Article  PubMed  Google Scholar 

  49. Alemo Munters L et al. Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res. 2013;65:1959–68. This randomized controlled trial suggests that a reduction in disease activity and improvement in health by endurance exercise is mediated through improved aerobic capacity.

    Article  Google Scholar 

  50. Alemo Munters L, et al. A Randomized Controlled, Clinical, Histological and mRNA Profiling Pilot Study Of Endurance Exercise In Myositis. Arthritis and rheumatism 2013; [abstract]. This controlled study describes potential mechanisms underlying the benefial effects of endurance exercixe such as increased capillary density in chronic polymyositis or dermatomyositis.

  51. Dalise S et al. Intensive aerobic training improves motor performances and oxidative metabolism efficiency in chronic polymyositis: a case report. Neuromuscul Disord : NMD. 2012;22 Suppl 3:S221–5.

    Article  PubMed  Google Scholar 

  52. Hejazi SM, Engkasan JP, Qomi MS. Intensive exercise and a patient in acute phase of polymyositis. J Back Musculoskelet Rehabil. 2012;25:231–4.

    PubMed  Google Scholar 

  53. Mattar MA et al. Exercise as an adjuvant treatment in persistent active polymyositis. J Clin Rheumatol : Practical Reports Rheumatic & Musculoskelet Diseases. 2014;20:11–5. This case series study suggests benefical effects of physical exercise and saftey in patients with active polymyositis.

    Article  Google Scholar 

  54. Alexanderson H, et al. Resistive Home Exercise in Patients with Recent Onset Polymyositis and Dermatomyositis - a Randomized Controlled Single-blinded Study with a 2-Year Follow-up. J Rheumatol. 2014. doi:10.3899/jrheum.131145. This is the first publication to evaluate effects of physical exercise in active polymyositis or dermatomyositis in a randomized controlled trial.

  55. Isenberg DA et al. International consensus outcome measures for patients with idiopathic inflammatory myopathies. Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford). 2004;43:49–54.

    Article  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Li Alemo Munters, Helene Alexanderson, and Ingrid E. Lundberg declare that they have no conflict of interest.

Leslie J. Crofford wishes to acknowledge that her contribution to this paper is supported in part by NIH AR R01AR06083.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, D2:01, 171 76, Stockholm, Sweden

    Li Alemo Munters & Ingrid E. Lundberg

  2. Department of Physical Therapy, Orthopedic/Rheumatology Unit, Karolinska University Hospital, D2:07, 171 76, Stockholm, Sweden

    Helene Alexanderson

  3. Department of NVS, Division of Physical therapy, Karolinska Institutet, Alfred Nobels allé 23, 141 52, Huddinge, Sweden

    Helene Alexanderson

  4. Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University, 1161 21st Avenue S., T-3113 MCN, Nashville, TN, 37232, USA

    Li Alemo Munters & Leslie J. Crofford

Authors
  1. Li Alemo Munters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helene Alexanderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leslie J. Crofford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingrid E. Lundberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li Alemo Munters.

Additional information

Topical Collection on Inflammatory Muscle Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alemo Munters, L., Alexanderson, H., Crofford, L.J. et al. New Insights into the Benefits of Exercise for Muscle Health in Patients with Idiopathic Inflammatory Myositis. Curr Rheumatol Rep 16, 429 (2014). https://doi.org/10.1007/s11926-014-0429-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-014-0429-4

Keywords

Search

Navigation