Exercise Improves Fitness in PWS Patients, Review Study Shows

Long-term exercise improves physical performance in patients with Prader-Willi syndrome (PWS), but immediate physiological response post-exercise appears unfavorable, a review of published studies shows.

The study, “Physical exercise and Prader-Willi syndrome: A systematic review.” was published in the journal Clinical Endocrinology.

PWS is associated with abnormal body composition and irregular secretion of growth hormones, both of which increase the risk of obesity. Inactivity is also a contributing factor. Therefore, physical exercise is recommended for PWS management in order to improve mobility and lower the chances of obesity development.

But the effects of exercise on PWS patients and its long-term effectiveness are unclear.

Now, researchers in Spain reviewed existing literature published through December 2018. The team analyzed results from 22 relevant studies that described the acute response of 356 PWS patients (and 410 controls) to exercise, and any improvement in symptoms attributable to long-term exercise.

Of the 356 PWS patients analyzed, 242 were children or adolescents, and 114 were adults. Their ages ranged from 4 to 44.

Ten of the 22 studies reported some acute response to exercise in PWS patients. Eight of them assessed the response in children/adolescents. The response was evaluated using exercises such as lower-body strength training, upper-body training, flexibility exercises, treadmill, or some combination of these.

In most studies, the cardiorespiratory response (heart and lung function) post-workout was poor in PWS patients, compared to normal-weight or obese individuals without PWS, as measured by an increased exertional heart rate.

One study also showed that post-exercise blood pressure in PWS children was 11% and 24% higher compared with obese and lean children without PWS, respectively.

Also, physical performance was poor in PWS patients compared to the controls after exercise. The physical performance of non-PWS obese patients was 24% higher than PWS patients, one study noted.

Similarly, muscle strength was about 50% to 70% lower, and flexibility about 42% lower in PWS patients, compared to normal-weight and overweight non-PWS controls.

Of the 22 studies, 12 assessed the impact of long-term exercise programs on the patient’s physical performance and physiological response. Most studies lasted about six months; exercise frequency ranged from one to seven days a week.

Workout routines included resistance training, aerobics, a combination thereof, or home-based physical activity. In some studies, exercise was combined with a nutritional plan, or included educational events for parents to discuss dietary plans.

Overall, long-term exercise significantly improved PWS patients’ physical performance. Researchers found that there was an approximately 15% improvement in cardiorespiratory fitness evaluated through heart rate monitoring and predicted maximum oxygen intake (a measure of lung function). Muscle strength also showed an increase of 7% to 252%.

Five studies assessed improvement in physical activity. Two of those found that long-term exercise resulted in a 12 % to 64% increase in physical activity among PWS patients, while no change was reported in the other three studies.

The impact of long-term exercise on body mass and composition in PWS patients was assessed in nine studies. Most studies showed a 2% to 12% weight loss, or a 4% to 7% reduction in body mass index.

In some cases, long-term aerobic exercise and nutritional planning also lowered glucose and hemoglobin A1c levels (a test for diabetes) in PWS adults with type II diabetes.

Lastly, mixed results were observed regarding the impact of exercise in improving gait, hand strength, coordination, and agility. Some studies showed improvements; others reported no change.

No exercise-related adverse events were reported in patients with PWS.

The team said that “most long-term exercise interventions have proven to decrease body mass while improving physical performance. … Physical exercise seems to be safe and effective for improving several phenotypes in PWS, notably physical fitness.”

They noted, however, that “further research is needed to confirm these results and especially to corroborate whether exercise per se or combined with dietary intervention is an effective co-adjuvant treatment for reducing body mass in these patients.”