Journal of Rehabilitation Medicine 51-7 | Page 49

J Rehabil Med 2019; 51: 518–524 ORIGINAL REPORT AEROBIC EXERCISE IN ADULT NEUROMUSCULAR REHABILITATION: A SURVEY OF HEALTHCARE PROFESSIONALS Eric L. VOORN, PhD, Fieke KOOPMAN, MD, PhD, Frans NOLLET, MD, PhD, and Merel A. BREHM, PhD From the Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, The Netherlands Objective: To evaluate the current application of aerobic exercise in adult neuromuscular rehabilitation. Design: Cross-sectional survey. Participants: Dutch rehabilitation specialists and physical therapists in specialized centres for slowly progressive neuromuscular diseases and in primary care. Methods: Participants received a self-designed, web-based, questionnaire, including 27 close-ended questions covering 4 categories: respondent profile, application of aerobic exercise, barriers to prescri- bing aerobic exercise, and need for support to im- prove the application of aerobic exercise. Results: All respondents (n  =  52) prescribed aero- bic exercise and in a wide variety of neuromuscu- lar diseases, mostly applying sessions of more than 20 min, 2 days per week, over a period of 9–16 weeks, using different exercise modes and methods to target intensity. The majority (81%) agreed that aerobic exercise should be incorporated into neuro- muscular rehabilitation. However, all respondents perceived barriers to the application of aerobic exer- cise in one or more domains, and 77% of the respon- dents indicated needing support to improve applica- tion of this type of training, mostly with respect to screening procedures (54%) and dosing of exercise programmes (48%). Conclusion: Aerobic exercise is widely applied, yet our results raise awareness of the necessity of more evidence based knowledge, in order to develop and implement guidelines in adult neuromuscular reha- bilitation. Key words: aerobic exercise; neuromuscular disease; rehabi- litation; cardiorespiratory fitness. Accepted May 13, 2019; Epub ahead of print May 28, 2019 J Rehabil Med 2019; 51: 518–524 Correspondence address: Eric Voorn, Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sci- ences, Amsterdam, The Netherlands. E-mail: [email protected] I n individuals with neuromuscular diseases (NMD), symptoms of muscle weakness, fatigue and pain limit physical activity and contribute to a sedentary lifestyle (1–3). Physical inactivity causes deconditio- ning (i.e. reduced physical fitness), which in turn wor- sens health and physical functioning, compromising daily activities and societal participation (2). One of LAY ABSTRACT An important goal of rehabilitation programmes in slowly progressive neuromuscular diseases is to promote phy- sical fitness through aerobic exercise programmes. This survey of Dutch rehabilitation specialists and phy- sical therapists, specialized in neuromuscular diseases, aimed to evaluate how often and what way aerobic ex- ercise is applied in clinical practice. The results showed that all respondents prescribed aerobic exercise and in a wide variety of neuromuscular diseases. How­ever, all respondents also experienced one or more barriers to aerobic exercise and, most importantly, more than th- ree-quarters reported a need for support. The preferred method of support is through the development of guide- lines, with a focus on the screening procedures (to as- sess the need for aerobic training) and design of train- ing programmes. In conclusion, more evidence-based knowledge is needed, in order to develop guidelines to support healthcare professionals in prescribing aerobic exercise in neuromuscular rehabilitation. the therapy goals of rehabilitation programmes is to break this vicious cycle through aerobic exercise (AE) to improve physical fitness (4). There is increasing evidence demonstrating the beneficial effects of AE in various slowly progressive NMD (5–9), but clear guidelines specific for NMD are missing. In recent decades, several international consensus conferences have been held to develop recommendations regarding prescription, monitoring and evaluation of aerobic training in NMD (10, 11). These recommendations are, however, quite general, and lack specificity. For instance, the most optimal training dose, in terms of frequency, intensity, time and type (referred to as the FITT factors (12)) are not specified (13, 14). This hampers the adequate applica- tion of AE in this population (15, 16). To evaluate current practice with respect to the app- lication of AE, we conducted a survey among Dutch rehabilitation specialists and physical therapists wor- king in specialized centres for NMD and in primary care. We aimed to obtain insight into how often and in what way AE is applied, with specific emphasis on the training dose in terms of the FITT factors. Perceived barriers to the prescription, monitoring, and evalua- tion of AE in NMD, as well as the need for support to improve application, were assessed. This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2567 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977