Trunk-Oriented Exercise Shows Positive Effects for Duchenne Muscular Dystrophy

Gökçe Yağmur Güneş Gencer, MSc, PhD

Recently published findings in Clinical Rehabilitation concluded that trunk control, arm, and respiratory function may be improved through the integration of trunk-oriented exercise in patients with Duchenne muscular dystrophy (DMD).

The randomized control study included a total of 26 children between the ages of 5 and 16 with DMD. Participants were divided into a study group (n = 13) to undergo a trunk-oriented exercise program, and a control group (n = 13) to undergo traditional exercise programs.

Those in the study group saw increases in all evaluated trunk control scores, arm function scores, and respiratory function values, except for middle and shoulder levels scores of the Performance of Upper Limb Scale. Those in the study group underwent both a conventional exercise program and a trunk-oriented exercise program, which included stretching exercises, active or active-assisted stabilization exercises, trunk mobilization, among other trunk-oriented and functional reaching exercises.

Investigators Gökçe Yağmur Güneş Gencer, MSc, PhD, lecturer, faculty of health sciences, department of gerontology, Akdeniz University, Antalya, Turkey, and Öznur Yilmaz, PhD, faculty of physical therapy and rehabilitation, department of physiotherapy and rehabilitation, Hacettepe University, Ankara, Turkey, found significant differences between the study group and control group in total, static, sitting balance, dynamic sitting balance, and dynamic reaching Trunk Control Measurement Scores (P <.01), total and distal scores of The Performance of Upper Limb Scale (P <.01); respiratory function values of Forced Vital Capacity and Forced Expiratory Volume in 1 second (P <.01); as well as Peak Expiratory Flow Volume (P <.05). 

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Investigators found significant differences between groups over the course of the 8-week study, with a strong effect (d > 0.8) in the intergroup comparison of the effect size of trunk-oriented exercises on the Trunk Control Measurement Scale, the Performance of Upper Limb Scale total, Percentage of Forced Vital Capacity, Percentage of Forced Expiratory Volume in 1 second, and the performance of upper limbal scale distal test results. Moderate effect was observed for size of training on the Peak Expiratory Flow Volume percentage (d >0.5). 

“In the later stages of [DMD], patients need help in daily life activities such as dressing and personal hygiene, due to the deterioration of stabilization in the extremities and trunk. The trunk provides stability of the body for the control of the upper limb and head,” Gencer and Yilmaz wrote. “In our study, it was observed that the total and distal scores of arm function increased with trunk-oriented exercises. These results show that trunk training may be effective in developing the arm function of [DMD] patients.” 

No statistically significant differences were found in patients’ age, height, weight, body mass index, Trunk Control Measurement Scale, Performance of Upper Limb Scale, and respiratory function scores when comparing both groups, which were homogenous prior to the start of the study (P >.05).

Patients included in the study group had an average age of 11.6 years (standard deviation [SD], 2.6) and 10.6 years (SD, 3.4) in the control group. Included patients had been on steroids for less than 6 months and were able to listen and adhere to instructions. Exclusion criteria consisted of upper or lower extremity contractures that could limit assessment, severe systemic disease that would prevent exercise, or an injury or operation within 6 months. 

The study was limited due to its small sample size, as well as some patients’ declination to participate due to transportation issues. According to Gender and Yilmaz, additional research will be necessitated to study the effect of trunk-training exercises in patients with DMD. 

REFERENCE

Güneş Gencer GY, Yilmaz Ö. The effect of trunk training on trunk control, upper extremity, and pulmonary function in children with Duchenne muscular dystrophy: A randomized clinical trial. Clinical Rehabilitation. Published online September 2, 2021. doi:10.1177/02692155211043265