Exercise program effects on one woman with dermatomyositis.

A year-long exercise program, designed by the first author to benefit people with dermatomyositis (DM), was offered to a patient we call "Mrs. Casey." This program was approved by the University of North CarolinaGreensboro Institutional Review Board governing research with human subjects in keeping with federal regulations. We are aware of only one other report published in the 1990s (discussed below) about exercise effects on someone with this disorder. Because maintaining function is of paramount importance for those with progressive muscle disorders, we wanted to find out whether exercise might help this woman to remain physically and psychologically strong, so that her life and activities might be positively affected. Because she still was fully functional at the time of the program, she was a good candidate for meaningful help. It is important for rehabilitation nurses to be aware of such findings for possible use in helping their patients. The rehabilitation nurse is in a good position to educate and train the patient early in the rehabilitation process about initiating actions such as exercise, which can be done at no cost and may be very beneficial. DM is characterized as an inflammatory myopathy involving inflammation and degeneration of skeletal muscle tissue. Muscle weakness is often preceded by a distinctive rash and some people develop calcified nodules beneath the skin. Muscles closest to or involving the trunk are usually the first affected. Swallowing problems occur in at least one third of those with DM. Muscle weakness tends to be a greater problem than muscle pain for most patients.DM is more common in females than males. High dose prednisone and various immunosuppressants have remained the standard pharmacological treatments for DM. Many of these drugs have adverse side effects (Myositis Association of America, Inc., 1998). Mrs. Casey, the patient who participated in our exercise program, was white, married, and 60 years old. She was diagnosed using the accepted classification criteria for DM (Tanimoto et aI., 1995) approximately 4 years before this study. She was 5 ft, 4 in. tall and her weight ranged from 145 to 1461bs over the 3day-per-week, 12-month program. During that time, she attended 57% of the exercise sessions. (She missed sessions on occasions throughout the program, with no specific pattern noted.) In addition to DM, she suffered from osteoarthritis (in the knees and ankles), occasional bursitis (in her right shoulder), occasional headaches, rashes that would itch or bum and make her feel hot over her entire body, photosensitivity (she wore sunscreen every day), fatigue, and total body muscle weakness. She regularly took dapsone (75-100 mg/day), diclofenac sodium (75 mg per day as needed), hormone replacement (Premarin®, .625 mg per day; Provera®, 5 mg/day), a multivitamin (Centrum® Silver) and a calcium supplement (1,200 mg/day). In addition to exercising at the program, she walked approximately 30 minutes, 4 or 5 days per week at home at a low intensity.