# Exercise as it relates to Disease/Resistance Training is Safe and Improves Well-being in Patients with Chronic Lyme Disease

This is an analysis of the journal article "Supervised Resistance Exercise for Patients with Persistent Symptoms of Lyme Disease" by D’Adamo et al (2015).

## What is the background to this research?

Lyme disease is a common tick-borne illness in the United States with an array of symptoms including rash, fatigue, headache, and muscle pain. Often these symptoms are misattributed to other causes or don’t occur immediately after infection leading to a high number of misdiagnoses. Additionally, some patients do not respond to antibiotic treatment. Many patients who were not successfully treated (or remained undiagnosed) go on to experience persistent symptoms affecting their entire body and causing poor health-related quality of life. This may last from six months to over three years in 12% of cases.
Incidences of Lyme disease have increased ten-fold, since previous estimates, to approximately 300,000 new cases in the USA per year. Originally thought to be primarily limited to the north-eastern and upper-midwestern areas of the USA, Lyme disease is becoming more prevalent in other areas of America, as well as Europe and Asia.
Accordingly, Lyme disease is becoming a greater international public health problem, and evidence-based treatment for patients with persistent symptoms is controversial. There are contradictory results for long-term antibiotic therapy, and no published trials assessing the effectiveness of common non-pharmacological therapies.
One alternate therapy is resistance exercise. Previous studies exist showing its effectiveness at treating similar symptoms in other chronic disease populations. As such, this study aims to assess the viability and effect of resistance exercise on patients with persistent symptoms of Lyme disease in order to improve the quality of life and health of sufferers.

## Where is the research from?

The research was conducted and approved by the University of Maryland School of Medicine, United States. Participants were recruited locally through community-based medical practices in Baltimore, MD.

## What kind of research was this?

The researchers conducted an uncontrolled quantitative longitudinal experiment with four weeks of treatment on a single group of non-randomized volunteers with chronic Lyme disease.

## What did the research involve?

8 eligible volunteers recruited from a local medical practice participated in the study. Participants had to be between 18-60 years of age, with a previous clinical diagnosis of Lyme disease and persistent symptoms for at least 3 months. Participants also required a medical clearance for resistance exercise to minimises safety concerns.
Under supervision from an exercise trainer, patients performed one set of five resistance exercises for 45 minutes, three times a week for four weeks. An exercise exertion scale was developed for the intervention to ensure participant safety and promote feasibility. A variety of outcomes assessing the patients’ symptoms were collected at baseline (prior to the intervention), and at the end of each week. These were participant-reported. Statistical analysis was conducted on the collected data to attain the results.

## What were the basic results?

All participants completed the entire exercise intervention without adverse events. There was a consistent significant week-to-week increase in exercise volume and number of repetitions performed. Additionally, although patients reported a higher number of “days without enough rest or sleep,” there were improvements in all measures of health-related quality of life and vitality from the beginning to the end of the program. The researchers, however, admit that most of these improvements were statistically insignificant; only one measure, the number of days participants felt healthy and full of energy, was significant (p = 0.05).

## What conclusions can we take from this research?

This pilot study has revealed that a supervised, low-intensity resistance exercise program is safe and feasible in patients with chronic Lyme disease with no adverse side effects noted. Due to the small sample size, no significant findings were made regarding patient vitality, however the study is still clinically meaningful in establishing some basic guidelines for resistance exercise in this population.
It is plausible that the improvements noted were due to the exercise intervention, however further studies will be required to confirm this and due to the relative promise of this pilot study, furthering research with larger controlled studies is recommended.

## Practical Advice

Exercising, including doing resistance-based programs, has been shown to have a significant effect on health and quality of life in populations suffering from similar symptoms as well as the widespread well known health benefits of exercise in the general population. Whilst no major benefits have yet been confirmed for patients with chronic Lyme disease, a strong general recommendation to participate in resistance exercise can be made regardless. With no adverse affects, supervised low intensity exercise is very viable in this population; with only benefits to potentially reap, there appears to be no reason not to exercise. However, due to the limited research, patients should consult their physician before continuing.

## Further Information

Whilst very minimal research exists on Lyme disease and it’s relationship with physical activity, some additional information regarding the disease and prevention/treatment can be found here.
The Tick Management Handbook: http://www.cdc.gov/nciclod/dvbid/lyme/resources/handbook.pdf
Identifying and treating Lyme Disease: Moser, M. C. (2011). Treatment for a 14-Year-Old Girl With Lyme Disease Using Therapeutic Exercise and Gait Training. Physical Therapy, 91(9), 1412-1423.

## References

* 1 2 3 D’Adamo CR, McMillin CR, Chen KW, Lucas EK, Berman BM. Supervised Resistance Exercise for Patients with Persistent Symptoms of Lyme Disease. Medicine & Science in Sports & Exercise [Internet]. 2015 Nov;47(11):2291–8.
* ↑ Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis. 2009; 9: 79.
* ↑ Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43( 9): 1089–134.
* ↑ Hook S, Nelson C, Mead P. Self-reported Lyme disease diagnosis, treatment, and recovery: results from 2009, 2011, & 2012 HealthStyles nationwide surveys. In: Proceedings of the 13th International Conference on Lyme Borreliosis and other Tick-Borne Diseases; 2013 Aug 18–21: Boston (MA). Harvard Medical School; 2013. p. 187.
* ↑ Newschaffer CJ. Validation of Behavioral Risk Factor Surveillance System HRQOL Measures in a Statewide Sample. Atlanta (GA): Centers for Disease Control and Prevention; 1998.
* ↑ Sjöwall J, Ledel A, Ernerudh J, Ekerfelt C, Forsberg P. Doxycycline-mediated effects on persistent symptoms and systemic cytokine responses post-neuroborreliosis: a randomized, prospective, cross-over study. BMC Infect Dis. 2012; 12: 186.
* ↑ Fallon BA, Keilp JG, Corbera KM, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008; 70( 13): 992–1003.
* ↑ Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J. Is strength training the more efficient training modality in chronic heart failure? Med Sci Sports Exerc. 2007; 39( 11): 1910–7.
* ↑ Toth C, Brady S, Gagnon F, Wigglesworth K. A randomized, single-blind, controlled, parallel assignment study of exercise versus education as adjuvant in the treatment of peripheral neuropathic pain. Clin J Pain. 2014; 30( 2): 111–18.
* ↑ Larsson A, Palstam A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, et al. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia—a randomized controlled trial. Arthritis Research & Therapy [Internet]. 2015 Jun 18;17(1).