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Does physical exercise training improve functional performance in type 3 spinal muscular atrophy? A Cochrane Review summary with commentary

BACKGROUND Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by the degeneration of anterior horn cells in the spinal cord. It is characterized by progressive muscle weakness, which can lead to loss of motor function and physical disability; more severely affected patients may have autonomic and pulmonary insufficiency. SMA is classified into five clinical types (0–4) depending on motor function and the age at which symptoms develop. SMA type 3 is also known as Kugelberg Welander disease or mild SMA. It usually develops after 18 months of age and most patients acquire the ability to walk, although a proportion will lose this ability over time. People with SMA type 3 are expected to have a normal life span. SMA type 3 can be further divided into two subgroups based on age of onset: SMA type 3a, where symptoms begin before age 3 years; and SMA type 3b, where symptoms begin after age 3 years and usually progress more slowly. Exercise training including aerobic exercise and strength training has been proposed to improve motor function in people with type 3 SMA. PHYSICAL EXERCISE TRAINING FOR TYPE 3 SPINAL MUSCULAR ATROPHY What is the aim of this Cochrane Review? The aim of this Cochrane Review was to evaluate the effects of physical exercise training on functional performance in people with SMA type 3, and to identify any adverse effects of physical exercise training.