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DOI: 10.1055/s-0040-1708859
Is Exercise-Induced Fatigue a Problem in Children with Duchenne Muscular Dystrophy?

Abstract
Objective Duchenne muscular dystrophy (DMD) is a devastating X-linked muscular disorder. The number of studies investigating new therapeutic approaches is substantially increasing. This study aims to investigate the impact and diagnostic value of exercise-induced fatigue in DMD, which has been proposed as a suitable outcome parameter in other conditions like spinal muscular atrophy.
Patients and Methods A cohort of 55 DMD patients (49 of them treated with steroids and 9 with ataluren) underwent a total of 241 6MWT (mean 4.4 tests/patient) which were retrospectively analyzed. Exercise-induced fatigue was assessed by the ratio between the distance achieved in the sixth minute and the distance in the second minute of the 6MWT. In previous studies a quotient above 1 was defined as a sign of fatigue.
Results The average fatigue quotient in the whole cohort of patients was 1.0. In a further analysis no impact of age, steroid therapy, ataluren therapy, overall disability, and distance in the 6-minute walk test (6MWT) on fatigue in DMD patients could be shown.
Conclusion Our data show that fatigue does not play a relevant role in DMD. Analysis of fatigue is not a useful outcome parameter in DMD studies. For this reason we suggest the 2MWT, which is better accepted by the patients, as an alternative to the commonly 6MWT.
Keywords
Duchenne muscular dystrophy - outcome measures - clinical trials - 6-minute walk test - fatigue* The authors contributed equally to the manuscript.
Publikationsverlauf
Eingereicht: 09. November 2019
Angenommen: 12. Februar 2020
Artikel online veröffentlicht:
05. Mai 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
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References
- 1 Emery AE. The muscular dystrophies. Lancet 2002; 359 (9307): 687-695
- 2 Zubrzycka-Gaarn EE, Bulman DE, Karpati G. , et al. The Duchenne muscular dystrophy gene product is localized in sarcolemma of human skeletal muscle. Nature 1988; 333 (6172): 466-469
- 3 Brooke MH, Fenichel GM, Griggs RC. , et al. Duchenne muscular dystrophy: patterns of clinical progression and effects of supportive therapy. Neurology 1989; 39 (04) 475-481
- 4 McDonald CM, Abresch RT, Carter GT. , et al. Profiles of neuromuscular diseases. Duchenne muscular dystrophy. Am J Phys Med Rehabil 1995; 74 (Suppl. 05) S70-S92
- 5 Kohler M, Clarenbach CF, Bahler C, Brack T, Russi EW, Bloch KE. Disability and survival in Duchenne muscular dystrophy. J Neurol Neurosurg Psychiatry 2009; 80 (03) 320-325
- 6 Villanova M, Kazibwe S. New survival target for Duchenne muscular dystrophy. Am J Phys Med Rehabil 2017; 96 (02) e28-e30
- 7 El-Aloul B, Altamirano-Diaz L, Zapata-Aldana E. , et al. Pharmacological therapy for the prevention and management of cardiomyopathy in Duchenne muscular dystrophy: a systematic review. Neuromuscul Disord 2017; 27 (01) 4-14
- 8 Brooke MH, Fenichel GM, Griggs RC. , et al. Clinical investigation of Duchenne muscular dystrophy. Interesting results in a trial of prednisone. Arch Neurol 1987; 44 (08) 812-817
- 9 Le Guiner C, Servais L, Montus M. , et al. Long-term microdystrophin gene therapy is effective in a canine model of Duchenne muscular dystrophy. Nat Commun 2017; 8: 16105
- 10 Robinson-Hamm JN, Gersbach CA. Gene therapies that restore dystrophin expression for the treatment of Duchenne muscular dystrophy. Hum Genet 2016; 135 (09) 1029-1040
- 11 Reinig AM, Mirzaei S, Berlau DJ. Advances in the treatment of Duchenne muscular dystrophy: new and emerging pharmacotherapies. Pharmacotherapy 2017; 37 (04) 492-499
- 12 McDonald CM, Henricson EK, Han JJ. , et al. The 6-minute walk test as a new outcome measure in Duchenne muscular dystrophy. Muscle Nerve 2010; 41 (04) 500-510
- 13 Davidson ZE, Ryan MM, Kornberg AJ, Walker KZ, Truby H. Strong correlation between the 6-minute walk test and accelerometry functional outcomes in boys with Duchenne muscular dystrophy. J Child Neurol 2015; 30 (03) 357-363
- 14 Montes J, Blumenschine M, Dunaway S. , et al. Weakness and fatigue in diverse neuromuscular diseases. J Child Neurol 2013; 28 (10) 1277-1283
- 15 Montes J, Dunaway Young S, Mazzone ES. , et al. Nusinersen improves walking distance and reduces fatigue in later-onset SMA. Muscle Nerve 2019; 60 (04) 409-414
- 16 Witherspoon JW, Vuillerot C, Vasavada RP. , et al. Motor function performance in individuals with RYR1-related myopathies. Muscle Nerve 2019; 60 (01) 80-87
- 17 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166 (01) 111-117
- 18 Vill K, Ille L, Schroeder SA, Blaschek A, Müller-Felber W. Six-minute walk test versus two-minute walk test in children with Duchenne muscular dystrophy: is more time more information?. Eur J Paediatr Neurol 2015; 19 (06) 640-646
- 19 Bartels B, de Groot JF, Terwee CB. The six-minute walk test in chronic pediatric conditions: a systematic review of measurement properties. Phys Ther 2013; 93 (04) 529-541
- 20 McDonald CM, Campbell C, Torricelli RE. , et al; Clinical Evaluator Training Group; ACT DMD Study Group. Ataluren in patients with nonsense mutation Duchenne muscular dystrophy (ACT DMD): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017; 390 (10101): 1489-1498
- 21 Shieh PB, Mcintosh J, Jin F. , et al; THE ACT DMD STUDY GROUP. Deflazacort versus prednisone/prednisolone for maintaining motor function and delaying loss of ambulation: a post HOC analysis from the ACT DMD trial. Muscle Nerve 2018; 58 (05) 639-645
- 22 Victor RG, Sweeney HL, Finkel R. , et al; Tadalafil DMD Study Group. A phase 3 randomized placebo-controlled trial of tadalafil for Duchenne muscular dystrophy. Neurology 2017; 89 (17) 1811-1820
- 23 McDonald CM, Henricson EK, Abresch RT. , et al; PTC124-GD-007-DMD Study Group. The 6-minute walk test and other endpoints in Duchenne muscular dystrophy: longitudinal natural history observations over 48 weeks from a multicenter study. Muscle Nerve 2013; 48 (03) 343-356
- 24 McDonald CM, Henricson EK, Abresch RT. , et al; PTC124-GD-007-DMD Study Group. The 6-minute walk test and other clinical endpoints in Duchenne muscular dystrophy: reliability, concurrent validity, and minimal clinically important differences from a multicenter study. Muscle Nerve 2013; 48 (03) 357-368
- 25 Nardes F, Araújo AP, Ribeiro MG. Mental retardation in Duchenne muscular dystrophy. J Pediatr 2012; 88 (01) 6-16
- 26 Witherspoon JW, Vasavada R, Logaraj RH. , et al. Two-minute versus 6-minute walk distances during 6-minute walk test in neuromuscular disease: is the 2-minute walk test an effective alternative to a 6-minute walk test?. Eur J Paediatr Neurol 2019; 23 (01) 165-170
- 27 Morice A, Smithies T. The 100 m walk: a simple and reproducible exercise test. Br J Dis Chest 1984; 78 (04) 392-394