Rehabilitación basada en ejercicio físico en pacientes con esclerosis lateral amiotrófica

Autores/as

  • Sergio Augusto Gaitán Caicedo Residente de Medicina física y rehabilitación. Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá D.C. Colombia https://orcid.org/0009-0009-4310-9106
  • Diego Mauricio Chaustre Ruiz Médico fisiatra. Docente del Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá D.C. Colombia. https://orcid.org/0000-0002-2795-8740

DOI:

https://doi.org/10.28957/rcmfr.413

Palabras clave:

Esclerosis lateral amiotrófica, ejercicio físico, rehabilitación

Resumen

Introducción. La esclerosis lateral amiotrófica (ELA) es una enfermedad degenerativa del sistema nervioso en la cual las neuronas motoras se desgastan y mueren, lo que se manifiesta con la aparición de debilidad muscular progresiva, espasmos e incapacidad para mover los brazos, las piernas y, finalmente, todo el cuerpo. Los estándares de cuidado para pacientes con ELA recomiendan atención multidisciplinaria que incluya intervenciones de rehabilitación. El ejercicio físico ha sido utilizado para su tratamiento; sin embargo, existen pocas recomendaciones específicas respecto a su prescripción.

Desarrollo. Se realizó una revisión de la literatura disponible respecto a la rehabilitación basada en ejercicio físico en pacientes con ELA. Se describen los efectos de los diferentes tipos de ejercicio, los parámetros de prescripción, los aspectos de seguridad de la intervención y las recomendaciones específicas de las guías de práctica clínica y los documentos de consenso. La mejor evidencia disponible indica que el ejercicio físico terapéutico en sus diferentes modalidades produce efectos positivos o neutros en las medidas de desenlace y no se asocia a eventos adversos serios.

Conclusión. La rehabilitación basada en ejercicio físico puede ser una intervención factible, tolerable, segura y efectiva para disminuir el deterioro de la funcionalidad y la calidad de vida en pacientes con ELA.

Referencias bibliográficas

van Es MA, Hardiman O, Chio A, Al-Chalabi A, Pasterkamp RJ, Veldink JH, et al. Amyotrophic lateral sclerosis. Lancet. 2017;390(10107): 084-98. Disponible en: http://dx.doi.org/10.1016/S0140-6736(17)31287-4.

Longinetti E, Fang F. Epidemiology of amyotrophic lateral sclerosis: an update of recent literature. Curr Opin Neurol. 2019;32(5):771-6. Disponible en: http://dx.doi.org/10.1097/WCO.0000000000000730.

Zapata-Zapata CH, Franco-Dáger E, Aguirre-Acevedo DC, de Carvalho M, Solano-Atehortúa J. Prevalence, Incidence, and Clinical-Epidemiological Characterization of Amyotrophic Lateral Sclerosis in Antioquia: Colombia. Neuroepidemiology. 2020;54(3):251-7. Disponible en: http://dx.doi.org/10.1159/000504549.

Pinilla-Monsalve GD, Vergara-Aguilar JP, Machado-Noguera B, Gutiérrez-Baquero J, Cabezas-Vargas Z, Bejarano-Hernández J. Estudio de la epidemiología neurológica en Colombia a partir de información administrativa (ESENCIA). Resultados preliminares 2015-2017. Salud UIS. 2021;53:e21025. Disponible en: https://doi.org/10.18273/saluduis.53.e:21025.

Masrori P, Van Damme P. Amyotrophic lateral sclerosis: a clinical review. Eur J Neurol. 2020;27(10):1918-29. Disponible en: http://dx.doi.org/10.1111/ene.14393.

Hardiman O, Al-Chalabi A, Chio A, Corr EM, Logroscino G, Robberecht W, et al. Amyotrophic lateral sclerosis. Nat Rev Dis Primers. 2017;3:17085. Disponible en: http://dx.doi.org/10.1038/nrdp.2017.85.

Nowicka N, Juranek J, Juranek JK, Wojtkiewicz J. Risk Factors and Emerging Therapies in Amyotrophic Lateral Sclerosis. Int J Mol Sci.2019;20(11):2616. Disponible en: http://dx.doi.org/10.3390/ijms20112616.

Ingre C, Roos PM, Piehl F, Kamel F, Fang F. Risk factors for amyotrophic lateral sclerosis. Clin Epidemiol. 2015;7:181-93. Disponible en: http://dx.doi.org/10.2147/CLEP.S37505.

Westeneng HJ, Debray TPA, Visser AE, van Eijk RPA, Rooney JPK, Calvo A, et al. Prognosis for patients with amyotrophic lateral sclerosis: development and validation of a personalised prediction model. Lancet Neurol. 2018;17(5):423-33. Disponible en: http://dx.doi.org/10.1016/S1474-4422(18)30089-9.

Pirola A, De Mattia E, Lizio A, Sannicolò G, Carraro E, Rao F, et al. The prognostic value of spirometric tests in Amyotrophic Lateral Sclerosis patients. Clin Neurol Neurosurg. 2019;184:105456. Disponible en: http://dx.doi.org/10.1016/j.clineuro.2019.105456.

Shoesmith C, Abrahao A, Benstead T, Chum M, Dupre N, Izenberg A, et al. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ. 2020;192(46):E1453-68. Disponible en: http://dx.doi.org/10.1503/cmaj.191721.

EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis; Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force. Eur J Neurol. 2012;19(3):360-75. Disponible en: http://dx.doi.org/10.1111/j.1468-1331.2011.03501.x.

Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73(15):1227-33. Disponible en: http://dx.doi.org/10.1212/WNL.0b013e3181bc01a4.

Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73(15):1218-26. Disponible en: http://dx.doi.org/10.1212/WNL. b013e3181bc0141.

Majmudar S, Wu J, Paganoni S. Rehabilitation in amyotrophic lateral sclerosis: why it matters. Muscle Nerve. 2014;50(1):4-13. Disponible en: http://dx.doi.org/10.1002/mus.24202.

Paganoni S, Karam C, Joyce N, Bedlack R, Carter GT. Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis. NeuroRehabilitation. 2015;37(1):53-68. Disponible en: http://dx.doi.org/10.3233/NRE-151240.

Carreras I, Yuruker S, Aytan N, Hossain L, Choi JK, Jenkins BG, et al. Moderate exercise delays the motor performance decline in a transgenic model of ALS. Brain Res. 2010;1313:192-201. Disponible en: http://dx.doi.org/10.1016/j.brainres.2009.11.051.

Gillon A, Nielsen K, Steel C, Cornwall J, Sheard P. Exercise attenuates age-associated changes in motoneuron number, nucleocytoplasmic transport proteins and neuromuscular health. Geroscience. 2018;40(2):177-92. Disponible en: http://dx.doi.org/10.1007/s11357-018-0020-4.

Sassani M, Alix JJ, McDermott CJ, Baster K, Hoggard N, Wild JM, et al. Magnetic resonance spectroscopy reveals mitochondrial dysfunction in amyotrophic lateral sclerosis. Brain. 2020;143(12):3603-18. Disponible en: http://dx.doi.org/10.1093/brain/awaa340.

He J, Fu J, Zhao W, Ren C, Liu P, Chen L, et al. Exercise Physiology Impairments of Patients With Amyotrophic Lateral Sclerosis: Cardiopulmonary Exercise Testing Findings. Front Physiol. 2022;13:792660. Disponible en: http://dx.doi.org/10.3389/fphys.2022.792660.

Sanjak M, Paulson D, Sufit R, Reddan W, Beaulieu D, Erickson L, et al. Physiologic and metabolic response to progressive and prolonged exercise in amyotrophic lateral sclerosis. Neurology. 1987;37(7):1217-20. Disponible en: http://dx.doi.org/10.1212/wnl.37.7.1217.

Siciliano G, Pastorini E, Pasquali L, Manca ML, Iudice A, Murri L. Impaired oxidative metabolism in exercising muscle from ALS patients. J Neurol Sci. 2001;191(1-2):61-5. Disponible en: http://dx.doi.org/10.1016/s0022-510x(01)00620-7.

Siciliano G, D’Avino C, Del Corona A, Barsacchi R, Kusmic C, Rocchi A, et al. Impaired oxidative metabolism and lipid peroxidation in exercising muscle from ALS patients. Amyotroph Lateral Scler Other Motor Neuron Disord. 2002;3(2):57-62. Disponible en: http://dx.doi.org/10.1080/146608202760196011.

Meng L, Li X, Li C, Tsang RCC, Chen Y, Ge Y, et al. Effects of Exercise in Patients With Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 2020;99(9):801-10. Disponible en: http://dx.doi.org/10.1097/PHM.0000000000001419.

Ortega-Hombrados L, Molina-Torres G, Galán-Mercant A, Sánchez-Guerrero E, González-Sánchez M, Ruiz-Muñoz M. Systematic Review of Therapeutic Physical Exercise in Patients with Amyotrophic Lateral Sclerosis over Time. Int J Environ Res Public Health. 2021;18(3):1074. Disponible en: http://dx.doi.org/10.3390/ijerph18031074.

Park D, Kwak SG, Park JS, Choo YJ, Chang MC. Can Therapeutic Exercise Slow Down Progressive Functional Decline in Patients With Amyotrophic Lateral Sclerosis? A Meta-Analysis. Front Neurol. 2020;11:853. Disponible en: http://dx.doi.org/10.3389/fneur.2020.00853.

Zhu Y, Xu Y, Xuan R, Huang J, István B, Fekete G, et al. Mixed Comparison of Different Exercise Interventions for Function, Respiratory, Fatigue, and Quality of Life in Adults With Amyotrophic Lateral Sclerosis: Systematic Review and Network Meta-Analysis. Front Aging Neurosci. 2022;14:919059. Disponible en: http://dx.doi.org/10.3389/fnagi.2022.919059.

de Almeida JPL, Silvestre R, Pinto AC, de Carvalho M. Exercise and amyotrophic lateral sclerosis. Neurol Sci. 2012;33(1):9-15. Disponible en: http://dx.doi.org/10.1007/s10072-011-0921-9.

Su CL, Tam KW, Fang TP, Chiang LL, Chen HC. Effects of pulmonary rehabilitation program on amyotrophic lateral sclerosis: A meta-analysis of randomized controlled trials. NeuroRehabilitation. 2021;48(3):255-65. Disponible en: http://dx.doi.org/10.3233/NRE-210052.

Rahmati M, Malakoutinia F. Aerobic, resistance and combined exercise training for patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis. Physiotherapy. 2021;113:12-28. Disponible en: http://dx.doi.org/10.1016/j.physio.2021.04.005.

Lunetta C, Lizio A, Sansone VA, Cellotto NM, Maestri E, Bettinelli M, et al. Strictly monitored exercise programs reduce motor deterioration in ALS: preliminary results of a randomized controlled trial. J Neurol. 2016;263(1):52-60. Disponible en: http://dx.doi.org/10.1007/s00415-015-7924-z.

Kirkinezos IG, Hernandez D, Bradley WG, Moraes CT. Regular exercise is beneficial to a mouse model of amyotrophic lateral sclerosis. Ann Neurol. 2003;53(6):804-7. Disponible en: http://dx.doi.org/10.1002/ana.10597.

Deforges S, Branchu J, Biondi O, Grondard C, Pariset C, Lécolle S, et al. Motoneuron survival is promoted by specific exercise in a mouse model of amyotrophic lateral sclerosis. J Physiol. 2009;587(Pt 14):3561-72. Disponible en: http://dx.doi.org/10.1113/jphysiol.2009.169748.

Tsitkanou S, Della-Gatta P, Foletta V, Russell A. The Role of Exercise as a Non-pharmacological Therapeutic Approach for Amyotrophic Lateral Sclerosis: Beneficial or Detrimental? Front Neurol. 2019;10:783. Disponible en: http://dx.doi.org/10.3389/fneur.2019.00783.

Angelini C, Siciliano G. An updated review on the role of prescribed exercise in the management of Amyotrophic lateral sclerosis. Expert Rev Neurother. 2021;21(8):871-9. Disponible en: http://dx.doi.org/10.1080/14737175.2021.1951706.

Chen A, Montes J, Mitsumoto H. The role of exercise in amyotrophic lateral sclerosis. Phys Med Rehabil Clin N Am. 2008;19(3):545-57. Disponible en: http://dx.doi.org/10.1016/j.pmr.2008.02.003.

Lisle S, Tennison M. Amyotrophic lateral sclerosis: the role of exercise. Curr Sports Med Rep. 2015;14(1):45-6. Disponible en: http://dx.doi.org/10.1249/JSR.0000000000000122.

Shefner JM. Effects of Strength Training in Amyotrophic Lateral Sclerosis: How Much Do We Know? Muscle Nerve. 2019;59(1):6-7. Disponible en: http://dx.doi.org/10.1002/mus.26347.

Bello-Haas VD. Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degener Neurol Neuromuscul Dis. 2018;8:45-54. Disponible en: http://dx.doi.org/10.2147/DNND.S146949.

Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am. 2012;23(3):675-87. Disponible en: http://dx.doi.org/10.1016/j.pmr.2012.06.009.

Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci. 1999;169(1-2):13-21. Disponible en: http://dx.doi.org/10.1016/s0022-510x(99)00210-5.

Gordon PH, Miller RG, Moore DH. ALSFRS‐R. Amyotroph Lateral Scler Other Motor Neuron Disord. 2004;5(Suppl 1):90-3. Disponible en: https://doi.org/10.1080/17434470410019906.

Sanjak M, Langford V, Holsten S, Rozario N, Patterson CGM, Bravver E, et al. Six-Minute Walk Test as a Measure of Walking Capacity in Ambulatory Individuals With Amyotrophic Lateral Sclerosis. Arch Phys Med Rehabil. 2017;98(11):2301-7. Disponible en: http://dx.doi.org/10.1016/j.apmr.2017.04.004.

Heiman-Patterson TD, Khazaal O, Yu D, Sherman ME, Kasarskis EJ, Jackson CE, et al. Pulmonary function decline in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2021;22(Suppl 1):54-61. Disponible en: http://dx.doi.org/10.1080/21678421.2021.1910713.

Enache I, Pistea C, Fleury M, Schaeffer M, Oswald-Mammosser M, Echaniz-Laguna A, et al. Ability of pulmonary function decline to predict death in amyotrophic lateral sclerosis patients. Amyotroph Lateral Scler Frontotemporal Degener. 2017;18(7-8):511-8. Disponible en: http://dx.doi.org/10.1080/21678421.2017.1353097.

Zhang QJ, Huang JC, Chen J, Hu W, Xu LQ, Guo QF. Peak expiratory flow is a reliably household pulmonary function parameter correlates with disease severity and survival of patients with amyotrophic lateral sclerosis. BMC Neurol. 2022;22(1):105. Disponible en: http://dx.doi.org/10.1186/s12883-022-02635-z.

Javad-Mousavi SA, Zamani B, Shahabi-Shahmiri S, Rohani M, Shahidi GA, Mostafapour E, et al. Pulmonary function tests in patients with amyotrophic lateral sclerosis and the association between these tests and survival. Iran J Neurol. 2014;13(3):131-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25422731.

Pegoraro V, Merico A, Angelini C. MyomiRNAs Dysregulation in ALS Rehabilitation. Brain Sci. 2019;9(1):8. Disponible en: http://dx.doi.org/10.3390/brainsci9010008.

Zucchi E, Vinceti M, Malagoli C, Fini N, Gessani A, Fasano A, et al. High-frequency motor rehabilitation in amyotrophic lateral sclerosis: a randomized clinical trial. Ann Clin Transl Neurol. 2019;6(5):893-901. Disponible en: http://dx.doi.org/10.1002/acn3.765.

Clawson LL, Cudkowicz M, Krivickas L, Brooks BR, Sanjak M, Allred P, et al. A randomized controlled trial of resistance and endurance exercise in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2018;19(3-4):250-8. Disponible por: http://dx.doi.org/10.1080/21678421.2017.1404108.

van Groenestijn AC, Schröder CD, van Eijk RPA, Veldink JH, Kruitwagen-van Reenen ET, Groothuis JT, et al. Aerobic Exercise Therapy in Ambulatory Patients With ALS: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2019;33(2):153-64. Disponible en: http://dx.doi.org/10.1177/1545968319826051.

Pinto AC, Alves M, Nogueira A, Evangelista T, Carvalho J, Coelho A, et al. Can amyotrophic lateral sclerosis patients with respiratory insufficiency exercise? J Neurol Sci. 1999;169(1-2):69-75. Disponible en: http://dx.doi.org/10.1016/s0022-510x(99)00218-x.

Kalron A, Mahameed I, Weiss I, Rosengarten D, Balmor GR, Heching M, et al. Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial. J Neurol. 2021;268(5):1857-66. Disponible en: http://dx.doi.org/10.1007/s00415-020-10354-z.

Merico A, Cavinato M, Gregorio C, Lacatena A, Gioia E, Piccione F, et al. Effects of combined endurance and resistance training in Amyotrophic Lateral Sclerosis: A pilot, randomized, controlled study. Eur J Transl Myol. 2018;28(1):7278. Disponible en: http://dx.doi.org/10.4081/ejtm.2018.7278.

Ferri A, Lanfranconi F, Corna G, Bonazzi R, Marchese S, Magnoni A, et al. Tailored Exercise Training Counteracts Muscle Disuse and Attenuates Reductions in Physical Function in Individuals With Amyotrophic Lateral Sclerosis. Front Physiol. 2019;10:1537. Disponible en: http://dx.doi.org/10.3389/fphys.2019.01537.

Braga ACM, Pinto A, Pinto S, de Carvalho M. The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS. Neurol Res Int. 2018;2018:8218697. Disponible en: http://dx.doi.org/10.1155/2018/8218697.

Bello-Haas VD, Florence JM, Kloos AD, Scheirbecker J, Lopate G, Hayes SM, et al. A randomized controlled trial of resistance exercise in individuals with ALS. Neurology. 2007;68(23):2003-7. Disponible en: http://dx.doi.org/10.1212/01.wnl.0000264418.92308.a4.

Drory VE, Goltsman E, Reznik JG, Mosek A, Korczyn AD. The value of muscle exercise in patients with amyotrophic lateral sclerosis. J Neurol Sci. 2001;191(1-2):133-7. Disponible en: http://dx.doi.org/10.1016/s0022-510x(01)00610-4.

Psalidas CP, Kottaras A, Lytras D, Iakovidis P, Leptourgos G, Moutaftsis K. The role of therapeutic exercise as a means of intervention for the treatment of amyotrophic lateral sclerosis. Int J Adv Community Med. 2021;4(2):29-31. Disponible en: http://dx.doi.org/10.33545/comed.2021.v4.i2a.193.

Pinto S, de Carvalho M. Can inspiratory muscle training increase survival in early-affected amyotrophic lateral sclerosis patients? Amyotroph Lateral Scler Frontotemporal Degener. 2013;14(2):124-6. Disponible en: http://dx.doi.org/10.3109/17482968.2012.726227.

Plowman EK, Tabor-Gray L, Rosado KM, Vasilopoulos T, Robison R, Chapin JL, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham-controlled trial. Muscle Nerve. 2019;59(1):40-6. Disponible en: http://dx.doi.org/10.1002/mus.26292.

Cheah BC, Boland RA, Brodaty NE, Zoing MC, Jeffery SE, McKenzie DK, et al. INSPIRATIonAL--INSPIRAtory muscle training in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2009;10(5-6):384-92. Disponible en: https://doi.org/10.3109/17482960903082218.

Kitano K, Asakawa T, Kamide N, Yorimoto K, Yoneda M, Kikuchi Y, et al. Effectiveness of Home-Based Exercises Without Supervision by Physical Therapists for Patients With Early-Stage Amyotrophic Lateral Sclerosis: A Pilot Study. Arch Phys Med Rehabil. 2018;99(10):2114-7. Disponible en: http://dx.doi.org/10.1016/j.apmr.2018.02.015.

Lui AJ, Byl NN. A systematic review of the effect of moderate intensity exercise on function and disease progression in amyotrophic lateral sclerosis. J Neurol Phys Ther. 2009;33(2):68-87. Disponible en: http://dx.doi.org/10.1097/NPT.0b013e31819912d0.

Mahoney DJ, Rodriguez C, Devries M, Yasuda N, Tarnopolsky MA. Effects of high-intensity endurance exercise training in the G93A mouse model of amyotrophic lateral sclerosis. Muscle Nerve. 2004;29(5):656-62. Disponible en: http://dx.doi.org/10.1002/mus.20004.

Gonçalves F, Magalhães B. Effects of prolonged interruption of rehabilitation routines in amyotrophic lateral sclerosis patients. Palliat Support Care. 2022;20(3):369-74. Disponible en: http://dx.doi.org/10.1017/S1478951521000584.

Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, et al. Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis. Eur J Phys Rehabil Med. 2022;58(2):271-9. Disponible en: http://dx.doi.org/10.23736/S1973-9087.21.07120-3.

Cómo citar

1.
Gaitán Caicedo SA, Chaustre Ruiz DM. Rehabilitación basada en ejercicio físico en pacientes con esclerosis lateral amiotrófica. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 10 de mayo de 2024 [citado 21 de julio de 2024];34(1). Disponible en: https://revistacmfr.org/index.php/rcmfr/article/view/413

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2024-05-10

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