Physical Activity and Periodic Leg Movements
Restless legs syndrome and the associated phenomena of periodic limb movement have been noted to occur relatively frequently in persons with SCI (de Mello et al. 1996; Lee et al.1996). In particular, periodic leg movements are characterized by rapid leg movements during sleep, especially ankle dorsiflexion combined with extension of the large toe and less frequently knee and/or hip flexion. These may occur for several minutes to several hours and may be associated with insomnia and daytime somnolence and the inherent effects this can have on one’s quality of life.
Total Sample Size
|De Mello et al. 2002
BrazilDowns & Black score=18Pre-PostN=12
|Population: Mean age: 31.6 yrs; Gender: 13 males; Level of injury: T7 and T12; Severity of injury: complete (13)
Treatment: SCI volunteers participated in physical training program using an arm crank ergometer for 44 days.Outcome Measures: Rate of periodic leg movement (PLM). Measurements were taken before training, 12 h after maximum effort test, 36 h after maximum effort test, 44 days after training, and 12 h after the last training (45th day), 36 h after last day of physical training.
- A significant decline in PLM rate was seen at 36h after maximum effort test, 12 h after last training, and 36 h after the last day of training (p<0.05).
|De Mello et al. 2004
BrazilDowns & Black score=17Prospective controlled trialN=13
|Population: Mean age: 31.6 yrs; Gender: 13 males; Height: 162-180 cm; Weight: 42.8-72.7 kg; Level of injury: T7 and T12; Severity of injury: AISA A (13); Time since injury: 10-231 mo
Treatment: Subjects received L-DOPA (200mg) in combination with benserazide chloride (50mg) or placebo, 1 hr before sleeping for 30d followed by a 15d washout period. Physical training was then administered on the subjects for 45d, 3 d/wk for an average of 30 min/dOutcome Measures: Rate of periodic limb movement (PLM). Measurements were taken 30d after drug treatment and 45d after physical training.
- Significant reduction in PLM rate was seen after administration of L-DOPA (p<0.03) and physical training (p<0.02).
- No significant difference were seen between the two treatments.
|De Mello et al. 1996
BrazilDowns & Black score=17Pre-PostN=11
|Population: Mean age: 28 yrs; Gender: 11 males; Level of injury: T7 – T12; Severity of injury: complete (11)
Treatment: Effect of physical training session. Subjects were admitted to a sleep clinic for 3 consecutive nights. Physiological evaluation was conducted on the first day and after physical training on the 3rd day.Outcome Measures: Total sleep time, time in REM, number of awakenings, number of leg movements.
|Significant decrease was seen after physical activity in:
- Total sleep time (p<0.04).
- Time in REM (p<0.01).
- Number of awakenings (p<0.03).
- Number of leg movements (p<0.03).
Following 2 pilot studies showing positive effects with either a single session (de Mello et al. 1996) or multiple sessions (de Mello et al. 2002) of exercise training, de Mello and colleagues conducted a prospective controlled trial comparing the effect of 30 days of initial L-dopa or placebo treatment versus 45 days of three/week 30 minute aerobic arm ergometry exercise training sessions in reducing the incidence of periodic limb movements during sleep (de Mello et al. 2004). Participants were all male, with complete chronic paraplegia (AISA A, lesion levels between T7-T12) with participants crossing over from 1 treatment to the next. The incidence of periodic limb movements was determined with polysomnographic analysis conducted as part of a sleep study and the effect of each treatment was noted relative to a baseline period. There was a 15 day washout period between the drug and exercise treatments to limit any carry-over effects. Both treatments were equally effective in reducing the amount of periodic limb movements such that the authors suggested a physical activity intervention as the first line of treatment and treatment with dopaminergic agonists to be reserved for persons who prove refractory to the exercise approach (De Mello et al. 2004).
There is level 2 evidence from a single study and support from two additional pre-post trials that a 45 day period of 3/week 30 minute aerobic exercise sessions (arm cycle ergometry) is equally effective as L-dopa in reducing night-time periodic limb movements in persons with complete paraplegia.