DIFFERENT TYPES OF UPPER EXTREMITY EXERCISE TRAINING IN DUCHENNE MUSCULAR DYSTROPHY: EFFECTS ON FUNCTIONAL PERFORMANCE, STRENGTH, ENDURANCE, AND AMBULATION Running Title: Upper extremity training in DMD

ĐPEK ALEMDAROĞLU, PhD. Bezmialem Vakıf University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Istanbul, Turkey [email protected] AYŞE KARADUMAN, PhD, Prof. Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey [email protected] ÖZNUR TUNCA YILMAZ, PhD, Prof. Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey [email protected] HALUK TOPALOĞLU, MD, Prof. Hacettepe University, Faculty of Medicine, Đhsan Doğramacı Children Hospital, Pediatric Neurology Department, Ankara, Turkey [email protected] Corresponding Author: Đpek ALEMDAROĞLU, PhD. Address: Bezmialem Vakıf University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, 34100, Fatih, Istanbul, Turkey Phone: +90530 584 07 04 E-mail: [email protected]  The two parts of this study were first presented at the 18th International Congress of the World Muscle Society, California, USA, 1th-5th October 2013, entitled ‘Effects of upper extremity exercise training on upper extremity endurance in patients with Duchenne Muscular Dystrophy’ and ‘Effects of dynamic arm training on trunk muscle strength and lower extremity functions in children with Duchenne Muscular Dystrophy.’

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/mus.24451

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DIFFERENT TYPES OF UPPER EXTREMITY EXERCISE TRAINING IN DUCHENNE MUSCULAR DYSTROPHY: EFFECTS ON FUNCTIONAL PERFORMANCE, STRENGTH, ENDURANCE, AND AMBULATION ABSTRACT Introduction: We investigated and compared the effects of 2 different types of upper extremity exercise training on upper extremity function, strength, endurance, and ambulation in patients with early-stage Duchenne muscular dystrophy (DMD). Methods: The study group (n=12) exercised with an arm ergometer under the supervision of a physiotherapist, while the control group (n=12) underwent a strengthening range of motion (ROM) exercise program under the supervision of their families at home for 8 weeks. Upper extremity functional performance, strength, endurance, and ambulatory status were assessed before and after the training. Results: Ambulation scores, endurance, and arm functions, as well as proximal muscle strength, were improved after the training in the study group (P0.05).

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Muscle strength: Intra-group comparisons of study and control group muscle strength are shown in Tables 3 and 4. The differences of muscle strength values determined by a dynamometer before and after the training were calculated for the inter-group comparison. Significant differences were found in favor of the control group for right wrist flexor and total forearm muscles (P0.05), while in the control group, right-hand grip strength had increased after training (z = −1.54; P0.05). Functional tests (arm functions, timed performance, endurance, and ambulation): The intraand inter-group comparisons of the tests mentioned above are given in Table 6. In the study group, the effect size of arm ergometer training on the standing-fromsupine-position timed performance test results was d = 1.05 (strong effect) with a 95% confidence interval (lower bound = 0.20; upper bound = 1.90), while the effect size of training on the t-shirt donning and removing tests was d = 0.5 (moderate effect) with a 95% confidence interval (lower bound = –0.31; upper bound = 1.31). On the upper extremity endurance assessment with elbow flexion-extension numbers (per minute), which were calculated before and after each exercise session in the study group, the before-training numbers per week were calculated. The elbow flexion-extension beforetraining numbers increased in the first (z = −2.310; P

Different types of upper extremity exercise training in Duchenne muscular dystrophy: effects on functional performance, strength, endurance, and ambulation.

We investigated and compared the effects of 2 different types of upper extremity exercise training on upper extremity function, strength, endurance, a...
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