Can amyotrophic lateral sclerosis patients with respiratory insufficiency exercise?

The authors have shown in a recent paper that survival with amyotrophic lat eral sclerosis (ALS) can be increased by the use of non-invasive methods of assisted ventilation (Bipap(R)). However, the progression of muscle weakne ss was not affected and the quality of life was not positively enhanced. In ALS, reduced physical activity may partially be secondary to alveolar hypo ventilation syndrome. This leads to deconditioning of ALS/motor neuron dise ase (ALS/MND) patients. The authors decided to investigate the possibility of reducing motor decline by exercising these patients to the anaerobic thr eshold, but simultaneously compensating the respiratory insufficiency with the Bipap STD(R). We conducted a controlled single blind study, exercising eight consecutive ALS/MND patients and used a control group of 12 ALS/MND p atients. The patients were all evaluated during a 1 year period. Respirator y function tests (RFT) were performed at entry and then at 6 month interval s. Barthel, Functional Independent Mobility scale (FIM) and Spinal and Bulb ar Norris scores were recorded every 3 months. There was a significant diff erence between the two groups with respect to FIM scores (P < 0.03), but no t Barthel scores (P < 0.8). A slower clinical course (Spinal Norris score P < 0.02) and a significant difference in the slope of the RFT (P < 0.008) w ere observed in the treated group, suggesting that exercise may be benefici al in ALS patients once Bipap(R) is used to control peripheral and muscle o xygenation. (C) 1999 Elsevier Science BN. All rights reserved.