Neuroimaging markers of physical therapy safety in children with muscular dystrophy

Muscular dystrophies are a large group of neuromuscular diseases. Currently, neuroimaging markers of the safety of physical exercise in patients with hereditary myopathies have not been developed.The aim of the study: to assess the safety of therapeutic exercise using neuroimaging, clinical and laboratory research methods in patients with muscular dystrophies. The study included 86 patients with Duchenne muscular dystrophy (DMD) and 42 patients with limb-girdle muscular dystrophy (LGMD). All patients underwent a 8-month course of medical rehabilitation. A safety clinical, MRI and laboratory assessments was performed. Results: no statistically significant increase in water T2 signal was detected after aerobic exercise in muscle groups of the pelvis, shoulder girdle, thighs and legs, which indicates the absence of an increase in non-specific inflammation and edema. Adverse events were characterized by a mild short-term course, did not affect the course of rehabilitation and did not require the appointment of concomitant drug and non-drug therapy. There were 8 cases of skeletal muscle damage caused by concentric or eccentric exercise. In the group of patients with DMD, the average signal intensity in skeletal muscles before physical activity was 34,9±1,0 ms and 44,1±3,7 ms (p<0.01) during dynamic observation. In the group of patients with LGMD, the signal intensity was 33,6±2,3 ms and 44,3±4,1 ms (p<0.01), respectively. Thus, the developed medical rehabilitation complex, including aerobic exercises without weights, does not lead to damage to skeletal muscles in patients with different forms of muscular dystrophy, which is confirmed by neuroimaging, clinical and laboratory methods. The increase in the intensity of the MR signal in skeletal muscles from water from baseline values ​​in patients with DMD by an average of 20.4±5.8% and in patients with LGMD by 23.8±6.3% is clinically significant and is associated with damage to skeletal muscles accompanied by clinical symptoms.