Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach

Inclusion body Myo or IBM is a rare inflammatory myopathy occurring at approximately 15 people per million, and it usually affects people at mid age and beyond. The pathogen is of this acquired myopathy is still unknown, but some studies have reviewed histological evidence of inflammation in the affected muscle. The major feature of this disease is a remarkable muscular atrophy leading to proximal and distal weakness.

Evidence-based IBM treatment is lacking largely due to a very low prevalence of this disease. The clinical practice suggests that most patients are not responsible to treatment with immunosuppressive drugs until few years ago. Physicians have contraindicated physical exercise to patients with inflammatory myopathies because they believe that it could increase inflammation in the affected muscles.

These recommendations have changed after a few recent studies suggesting that physical exercise is safe for these patients. Therefore, low intensity physical training has been prescribed for patient with stable disease in order to improve muscle function. However, low intensity exercise does not seem affected to improve muscle hypertrophy and strength.

Instead, high intensity exercise is required to achieve these goals since high intensity exercise may increase the inflammatory response. The ideal type of exercise intervention for IBM patients should increase muscle strength and cross-sectional area while minimizing exercise intensity. A new approach to exercise training has been suggested recently.

In this regard, it has been observed that restricting muscle blood flow using tourniquet cuts during moderating test exercise, produce a greater benefits as compared to high intense exercise training. These findings have been demonstrating athletes, the frail, elderly, and inpatients undergoing rehabilitation after surgery. The clinic complication of this intervention may be of particular interest to IBM patients, even though the mechanisms by which vascular occlusion affects muscle mass and strains remaining clear following, we are going to introduce you to the details of the use of vascular occlusion training protocol.

The patient lies in a supine position while a customized blood pressure cuff is fixed on his thigh. The tibial artery location is detected. A vascular dopper is used in order to determine the blood pressure for full vascular occlusion.

The Doppler probe is placed over the determined spot in the patient's leg. A sound signal is generated by the Doppler machine as it captures the arterial pulse. The customized blood pressure cuff is then inflated until it interrupts the exclusatory pulse of the tibial artery.

The pressure required for full vascular occlusion is registered for future use during training.Wow.Wow. Wow, wow, wow, wow. The patient is submitted to a brief warmup on a treadmill.

Two pressure cuffs are positioned near the inguinal fold region on both sides and inflated to the training pressure. In our study involving IM patients, the training pressure protocol was established as 50%of the full vascular occlusion pressure. The conventional leg press machine is used.

The patient performs three sets of 15 repetition maximum. He takes a 32nd rest between sets. The cuffs pressure is maintained during the whole session, including intervals leg extension.

Exercise is the next step in our program. The same protocol is used on this exercise. The occlusion pressure is again, kept constant.

The last exercise is the half squat. A chair is used for safety reasons since the impaired strength ability of the IBN patient blood flow occlusion follows the same pattern as the previous exercises. Training intensity was adjusted according to the gradual increase in the patient's strength.

In order to maintain exercise volume within a 15 repetition maximum, we recommend that training sessions are monitored by at least two physical trainers, each one controlling the occlusion pressure on each leg. Resistance exercise training with vascular occlusion is a relatively novel training method, but results are very encouraging. There is a growing body of evidence indicating the safety of short-term training with cuff occlusion.

Moreover, it has recently been reported that except for acute muscle pain, no adverse effects are observed when using this exercise method. In fact, we have employed the previously suggested exercise program with very interesting results in an IBM patient thigh, cross-sectional area, and all the SF 36 subscales. A quality of life inventory indicated significant patient progress.