Effect of exercise training on clinical and physiological variables in adults with myotonic dystrophy type 1: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Adults with myotonic dystrophy type 1 (DM1) |
| I — Intervention | Exercise training (aerobic or resistance training) |
| C — Comparator | Standard care or control groups |
| O — Outcomes | Clinical and physiological variables including strength, endurance, fatigue, sleep quality, and adverse events |
Bottom Line
This systematic review and meta-analysis of 14 studies provides moderate-quality evidence that exercise training is safe and beneficial for adults with myotonic dystrophy type 1. The analysis demonstrates statistically significant moderate improvements in muscle strength (p=0.022), with large but non-significant effects on endurance. Fatigue and sleep outcomes showed inconclusive results. Importantly, adverse events were rare and similar between intervention and control groups, supporting the safety profile of exercise in this population. While the evidence supports incorporating exercise training into DM1 management, the authors appropriately call for larger, well-powered trials with standardized protocols to optimize exercise prescription. Clinicians should consider supervised exercise programs as part of comprehensive DM1 care, particularly targeting strength improvements, while monitoring individual patient responses and tolerability.
Key Findings
P Value: Strength p=0.022, Endurance p=0.14, Fatigue p=0.49, Sleep p>0.05
Effect Size: Moderate improvement in strength, large but non-significant effect for endurance
Primary Outcome: Strength improvement with moderate effect size
Nnt Or Sensitivity: Standardized mean differences used but specific values not reported in abstract
Confidence Interval: Not reported in abstract
Clinical Application
Exercise training appears safe with minimal adverse events, feasible in clinical practice Relevant to Australian neuromuscular clinics and physiotherapy services; may inform PBS-funded allied health interventions under chronic disease management plans Adults with confirmed myotonic dystrophy type 1 diagnosis
Abstract
Myotonic dystrophy type 1 (DM1) is a progressive neuromuscular disorder characterized by muscle weakness, fatigue, reduced endurance, and impaired quality of life. This systematic review and meta-analysis aimed to evaluate the effects of exercise training on clinical and physiological outcomes in adults with DM1. Six databases were searched for studies published between 2003 and 2023. Randomized controlled trials, quasi-experimental studies, and longitudinal cohort studies involving adults with DM1 undergoing aerobic or resistance training were included, and risk of bias was assessed. Meta-analyses used standardized mean differences with fixed- or random-effects models based on heterogeneity. Fourteen studies were included. Most studies demonstrated low risk of bias. Only one study reported any adverse events, and the incidence of these events was similar in occurrence between the intervention and standard care only groups. Meta-analysis demonstrated a moderate improvement in strength (p = 0.022). Endurance showed a large but non-significant pooled effect (p = 0.14). Meta-analyses for fatigue (p = 0.49) and sleep (p > 0.05) were inconclusive. Narrative synthesis indicated improvements in most clinical and physiological outcomes, while sleep outcomes showed minimal or inconsistent changes across studies. Exercise training appears safe and provides moderate benefits for strength and selected clinical and physiological outcomes in adults with DM1. Future well-powered trials with standardized protocols are needed to optimize exercise prescription.
References
- 1.Shetty, S., Luo, Y., Thomas, A., Gamil, K., Saxena, I., Guha, S., Vohra, R., & Lott, D. J. (2026). Effect of exercise training on clinical and physiological variables in adults with myotonic dystrophy type 1: a systematic review and meta-analysis. Journal of Neurology. https://doi.org/10.1177/22143602241301675
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