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Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study

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Abstract

Objective

Although the focus of acromegaly treatment is the hormonal control of the disease, a new perspective must be given to the functional rehabilitation of these patients, especially when considering the recent increase in survival. The aim of this study was to evaluate the effects of therapist-oriented home rehabilitation (TOHR) on patients with acromegaly.

Patients and methods

Seventeen adults with acromegaly followed an exercise programme from a booklet with instructions for each exercise prescribed, for 2 months, and were reassessed after 1 month of washout. At each of the 3 timepoints (before and after the intervention and at the 1-month follow-up), the participants were subjected to the following assessments: body composition through bioimpedance, health-related quality of life (HRQoL) using the Acromegaly Quality of Life (AcroQoL) questionnaire, general fatigue through the Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength, lower extremity functionality using isometric dynamometry and the Lower Extremity Functional Scale (LEFS), body balance through stabilometry, and functional capacity through 6-minute walking distance (6MWD).

Results

After performing TOHR, improvements in general fatigue, quadriceps muscle strength, LEFS, 6MWD, balance control and all AcroQoL dimensions were observed (all P < 0.05). After 1 month of washout, however, these gains were lost for all parameters, except the LEFS and balance control.

Conclusions

In acromegaly, TOHR results in improvements in muscle function, functional capacity, general fatigue, body balance, and HRQoL. Large randomized controlled trials are needed to replicate these benefits and to recommend rehabilitation, especially for those with long-term illness.

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References

  1. A. Lavrentaki, A. Paluzzi, J.A. Wass, N. Karavitaki, Epidemiology of acromegaly: review of population studies. Pituitary 20, 4–9 (2017)

    Article  Google Scholar 

  2. F. Bolfi, A.F. Neves, C.L. Boguszewski, V.S. Nunes-Nogueira, Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur. J. Endocrinol. 179, 59–71 (2018)

    Article  CAS  Google Scholar 

  3. M.R. Gadelha, L. Kasuki, D.S.T. Lim, M. Fleseriu, Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr. Rev. 40, 268–332 (2019)

    Article  Google Scholar 

  4. S. AlDallal, Acromegaly: a challenging condition to diagnose. Int. J. Gen. Med. 11, 337–343 (2018)

    Article  CAS  Google Scholar 

  5. M.J. Wassenaar, N.R. Biermasz, M. Kloppenburg, A.A. van der Klaauw, J. Tiemensma, J.W. Smit, A.M. Pereira, F. Roelfsema, H.M. Kroon, J.A. Romijn, Clinical osteoarthritis predicts physical and psychological QoL in acromegaly patients. Growth Horm. IGF Res. 20, 226–233 (2010)

    Article  CAS  Google Scholar 

  6. A.J. Lopes, D.P. da Silva, L. Kasuki, M.R. Gadelha, G.B. Camilo, F.S. Guimarães, Posture and balance control in patients with acromegaly: results of a cross-sectional study. Gait Posture 40, 154–159 (2014)

    Article  Google Scholar 

  7. T.S. Homem, F.S. Guimarães, M.S. Soares, L. Kasuki, M.R. Gadelha, A.J. Lopes, Balance control and peripheral muscle function in aging: a comparison between individuals with acromegaly and healthy subjects. J. Aging Phys. Act. 25, 218–227 (2017)

    Article  Google Scholar 

  8. E. Hatipoglu, N. Topsakal, O.E. Atilgan, N. Alcalar, A.F. Camliguney, M. Niyazoglu, Impact of exercise on quality of life and body-self perception of patients with acromegaly. Pituitary 17, 38–43 (2014)

    Article  Google Scholar 

  9. E. Hatipoglu, N. Topsakal, O. Erkut Atilgan, A.F. Camliguney, B. Ikitimur, S. Ugurlu, M. Niyazoglu, H.B. Cotuk, P. Kadioglu, Physical and cardiovascular performance in cases with acromegaly after regular short-term exercise. Clin. Endocrinol. 83, 91–97 (2015)

    Article  CAS  Google Scholar 

  10. L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz, J.A. Wass; Endocrine Society, Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–3951 (2014)

    Article  CAS  Google Scholar 

  11. S. Matsudo, T. Araújo, V. Matsudo, D. Andrade, E. Andrade, L.C. Oliveira, G. Braggion, International physical activity questionnaire (IPAQ): study of validity and reliability in Brazil. Ativ. FíSci. Saúde. 6, 5–18 (2001)

    Google Scholar 

  12. J.A. Alison, Z.J. McKeough, Pulmonary rehabilitation for COPD: are programs with minimal exercise equipment effective? J. Thorac. Dis. 6, 1606–1614 (2014)

    PubMed  PubMed Central  Google Scholar 

  13. J. Baltich, C.A. Emery, D. Stefanyshyn, B.M. Nigg, The effects of isolated ankle strengthening and functional balance training on strength, running mechanics, postural control and injury prevention in novice runners: design of a randomized controlled trial. BMC Musculoskelet. Disord. 15, 407 (2014)

    Article  Google Scholar 

  14. L. Ganderton, S. Jenkins, K. Gain, R. Fowler, P. Winship, D. Lunt, E. Gabbay, Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial. BMC Pulm. Med. 23, 11–25 (2011)

    Google Scholar 

  15. M.N. Rodrigues, S.C. Silva, W.D. Monteiro, P.T.V. Farinatti, Comparison of body fat estimation by bioelectric impedance, skinfold thickness, and underwater weighing. Rev. Bras. Med. Esport. 7, 125–131 (2001)

    Article  Google Scholar 

  16. S.M. Webb, X. Badia, N.L. Surinach, Validity and clinical applicability of the acromegaly quality of life questionnaire, AcroQoL: a 6-month prospective study. Eur. J. Endocrinol. 155, 269–277 (2006)

    Article  CAS  Google Scholar 

  17. C.E. Mosher, K.N. Duhamel, An examination of distress, sleep, and fatigue in metastatic breast cancer patients. Psychooncology 21, 100–107 (2012)

    Article  Google Scholar 

  18. T.R.L. Lima, L. Kasuki, M.R. Gadelha, A.J. Lopes, The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: a case study. J. Bodyw. Mov. Ther. (2019) https://doi.org/10.1016/j.jbmt.2019.01.006

    Article  Google Scholar 

  19. C.A. Crosby, M.A. Wehbe, B. Mawr, Hand strength: normative values. J. Hand. Surg. Am. 19, 665–670 (1994)

    Article  CAS  Google Scholar 

  20. A.S. Ferreira, F.S. Guimarães, J.G. Silva, Aspectos metodológicos da eletromiografia de superfície: considerações sobre os sinais e processamentos para estudo da função neuromuscular. Rev. Bras. Cienc. Esport. 31, 11–30 (2010)

    Article  Google Scholar 

  21. J.C. Ferreira, C.M. Patino, Randomization: beyond tossing a coin. J. Bras. Pneumol. 42, 310 (2016)

    Article  Google Scholar 

  22. T.R. Lima, F.S. Guimarães, R.S. Neves, S.L. Menezes, A.J. Lopes, Scleroderma: assessment of posture, balance and pulmonary function in a cross-sectional controlled study. Clin. Biomech. 30, 438–443 (2015)

    Article  Google Scholar 

  23. R.R. Britto, V.S. Probst, A.F. de Andrade, G.A. Samora, N.A. Hernandes, P.E. Marinho, M. Karsten, F. Pitta, V.F. Parreira, Reference equations for the six-minute walk distance based on a Brazilian multicenter study. Braz. J. Phys. Ther. 17, 556–563 (2013)

    Article  Google Scholar 

  24. L.J. Woodhouse, A. Mukherjee, S.M. Shalet, S. Ezzat, The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr. Rev. 27, 287–317 (2006)

    Article  CAS  Google Scholar 

  25. J. Tiemensma, A.A. Kaptein, A.M. Pereira, J.W. Smit, J.A. Romijn, N.R. Biermasz, Affected illness perceptions and the association with impaired quality of life in patients with long-term remission of acromegaly. J. Clin. Endocrinol. Metab. 96, 3550–3558 (2011)

    Article  CAS  Google Scholar 

  26. N. Kyriakakis, J. Lynch, S.G. Gilbey, S.M. Webb, R.D. Murray, Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study. Clin. Endocrinol. 86, 806–815 (2017)

    Article  Google Scholar 

  27. E. Solomon, D. Brănișteanu, A. Dumbravă, R.G. Solomon, L. Kiss, M. Glod, C. Preda, Executive functioning and quality of life in acromegaly. Psychol. Res. Behav. Manag. 12, 39–44 (2019)

    Article  Google Scholar 

  28. X. Guo, L. Gao, X. Shi, H. Li, Q. Wang, Z. Wang, W. Chen, B. Xing, Pre- and postoperative body composition and metabolic characteristics in patients with acromegaly: a prospective study. Int. J. Endocrinol. 2018, 4125013 (2018)

    Article  Google Scholar 

  29. E.M. Walchan, F.S. Guimarães, M.S. Soares, L. Kasuki, M.R. Gadelha, A.J. Lopes, Parameters of knee isokinetic dynamometry in individuals with acromegaly: association with growth hormone levels and general fatigue. Isokinet. Exerc. Sci. 24, 331–340 (2016)

    Article  Google Scholar 

  30. L. Füchtbauer, D.S. Olsson, B.Å. Bengtsson, L.L. Norrman, K.S. Sunnerhagen, G. Johannsson, Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up. Eur. J. Endocrinol. 177, 217–226 (2017)

    Article  Google Scholar 

  31. J.B. Pickett, R.B. Layzer, S.R. Levin, V. Scheider, M.J. Campbell, A.J. Sumner, Neuromuscular complications of acromegaly. Neurology 1975 25, 638–645 (1975)

    Article  CAS  Google Scholar 

  32. D.P. Guedes da Silva, F.S. Guimarães, C.M. Dias, A. Guimarães Sde, L. Kasuki, M.R. Gadelha, G.B. Camilo, A.J. Lopes, On the functional capacity and quality of life of patients with acromegaly: are they candidates for rehabilitation programs? J. Phys. Ther. Sci. 25, 1497–1501 (2013)

    Article  Google Scholar 

  33. M.D. Smith, A.T. Chang, H.E. Seale, J.R. Walsh, P.W. Hodges, Balance is impaired in people with chronic obstructive pulmonary disease. Gait Posture 31, 456–460 (2010)

    Article  Google Scholar 

  34. I. Crespo, S.M. Webb, Perception of health and cognitive dysfunction in acromegaly patients. Endocrine 46, 365–367 (2014)

    Article  CAS  Google Scholar 

  35. A.J. Lopes, D.P. Guedes da Silva, S. Ferreira Ade, L. Kasuki, M.R. Gadelha, F.S. Guimarães, FS, What is the effect of peripheral muscle fatigue, pulmonary function, and body composition on functional exercise capacity in acromegalic patients? J. Phys. Ther. Sci. 27, 719–724 (2015)

    Article  Google Scholar 

  36. A. Colao, D. Ferone, P. Marzullo, G. Lombardi, Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr. Rev. 25, 102–152 (2004)

    Article  CAS  Google Scholar 

  37. S.G. Thomas, L.J. Woodhouse, S.M. Pagura, S. Ezzat, Ventilation threshold as a measure of impaired physical performance in adults with growth hormone excess. Clin. Endocrinol. 56, 351–358 (2002)

    Article  CAS  Google Scholar 

  38. A.M. Pereira, J. Tiemensma, J.A. Romijn, N.R. Biermasz, Cognitive impairment and psychopathology in patients with pituitary diseases. Neth. J. Med. 70, 255–260 (2012)

    CAS  PubMed  Google Scholar 

  39. C.L. Coulter, J.M. Scarvell, T.M. Neeman, P.N. Smith, Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. J. Physiother. 59, 219–226 (2013)

    Article  Google Scholar 

  40. J.J. Kraal, M.E. Van den Akker-Van Marle, A. Abu-Hanna, W. Stut, N. Peek, H.M. Kemps, Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study. Eur. J. Prev. Cardiol. 24, 1260–1273 (2017)

    Article  Google Scholar 

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Acknowledgements

The authors thank the participants for their continuing participation in this research effort.

Funding

This study was funded by the Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (grant number 304625/2016-7), the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (grant number E-26/202.679/2018), and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001).

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Authors and Affiliations

  1. Rehabilitation Sciences Post-graduate Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil

    Tatiana Rafaela Lemos Lima & Agnaldo José Lopes

  2. Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil

    Leandro Kasuki & Monica Gadelha

  3. Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil

    Leandro Kasuki & Monica Gadelha

  4. Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of the Rio de Janeiro (UERJ), Rio de Janeiro, Brazil

    Agnaldo José Lopes

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  1. Tatiana Rafaela Lemos Lima
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Correspondence to Agnaldo José Lopes.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lima, T.R.L., Kasuki, L., Gadelha, M. et al. Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study. Endocrine 66, 301–309 (2019). https://doi.org/10.1007/s12020-019-02011-x

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  • DOI: https://doi.org/10.1007/s12020-019-02011-x

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