Chronic inflammatory demyelinating polyneuropathy (CIDP) reduces your ability to perform activities that are considered “standard” or “normal” for a healthy person to complete. This is called exercise intolerance. Physical therapy uses individualized exercise programs to help you carry out daily activities.
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CIDP and Physical Therapy: Understanding the Basics
CIDP (chronic inflammatory demyelinating polyneuropathy) is a neurological disorder.
People with this condition experience progressive loss of muscle strength and senses in their arms and legs. As a result, they have problems with balance and gait, which can affect their ability to perform their normal daily activities.
CIDP also raises your chances of developing depression and anxiety [1]. If you have symptoms of these conditions, seek immediate medical care.
Medical treatments for CIDP include immunosuppressants, steroids, IVIG, and plasmapheresis. Rehabilitative interventions include physical therapy, occupational therapy, adaptive equipment, and emotional support. Medical and rehabilitative therapies go hand-in-hand and are typically used together.
Physical therapy is a critical component of rehabilitative intervention that can help:
- Maintain muscle strength
- Prevent complications such as contractures or respiratory failure
- Improve mobility and functional independence
Physical therapy uses specific exercises and physical activities to help you move better and improve muscle strength.
CIDP and Physical Therapy: What To Expect
Before recommending a CIDP exercise program, your physical therapist will assess your:
- Strength
- Baseline fitness level
- Perceived barriers to exercise
Based on this information, they will customize exercises for CIDP to help you meet your unique needs.
CIDP and Physical Therapy: What Are the Benefits?
Physical therapy benefits anyone with CIDP, regardless of the stage (severity) of the disease.
Physical Therapy During a Flare-up
Most people are unable to move during a CIDP flare-up. In such cases, your physical therapist will educate you and your caregiver about ways to prevent muscle tightness and bedsores. These include:
- Avoiding prolonged hip and knee flexion (bending)
- Changing your position every two hours in bed
- Supporting weak upper limbs using armrests or pillows
In addition, they will teach you how to use assisted devices and perform breathing exercises. During this period, you will do passive exercises, such as gentle body movements. These exercises help improve circulation and reestablish nerve connections.
Physical Therapy During Recovery
As you begin to regain sensation and strength, you will likely be upgraded to active-assisted exercises, such as wrist bends. These exercises aim to help restore muscle strength and range of motion.
Then, you will be allowed to perform more demanding and independent movements. These exercises can mimic daily activities, such as feeding, dressing, writing, typing, etc.
Most CIDP physical therapy guidelines recommend starting all exercises at low repetitions and resistance with frequent breaks. This is because exercising to exhaustion can delay recovery [2].
Once your strength and sensations have been sufficiently restored, your therapist may recommend home-based exercises. At this point, you may also be able to do strength training and aerobic exercises.
Inpatient physical therapy typically lasts 4 weeks. Then, you may continue therapy on an outpatient basis for up to 4 months.
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CIDP and Physical Therapy: Continuation Is the Key to Long-Lasting Gains
Many individuals lose their gains in muscle strength and breathing capacity after discontinuing an exercise program. Thus, it is best to stay physically active even if your symptoms have improved [3].
How Effective Is Physical Therapy for CIDP?
It is important to understand that CIDP treatment involves specialists from multiple disciplines.
Though physical therapy is an integral part of a comprehensive CIDP treatment program, it is just a piece of the puzzle. It works best when you take medications as prescribed, eat a healthy diet, and engage in regular physical activity.
Several studies have established the role of physical therapy in CIDP management and recovery.
For instance, a 2004 study reported improved physical fitness, functional ability, and quality of life following a 12-week bicycle training. The participants in this study completed 3 training sessions (30 minutes each), every week for 12 weeks [4].
Additionally, a 2018 case study found that regular exercise improved gait and balance in people with CIDP [5].
How Do You Exercise With CIDP?
Start with a passive exercise, which involves gentle body movements. Once you have gained enough strength, perform active-assisted exercises, then active exercises. The last item on the list is resistance training. Remaining active even if you feel better is crucial to long-lasting gains.
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REFERENCES:
- Querol, Luis et al. “Systematic literature review of burden of illness in chronic inflammatory demyelinating polyneuropathy (CIDP).” Journal of neurology vol. 268,10 (2021): 3706-3716. doi:10.1007/s00415-020-09998-8
- GBS/CIDP Foundation International Foundation Publications: Guidelines for Physical and Occupational Therapy. [2022-02-02]. https://www.gbs-cidp.org/support/foundation-publications/
- Markvardsen, Lars K et al. “Muscle Strength and Aerobic Capacity in Patients with CIDP One Year after Participation in an Exercise Trial.” Journal of neuromuscular diseases vol. 6,1 (2019): 93-97. doi:10.3233/JND-180344
- Garssen, M P J et al. “Physical training and fatigue, fitness, and quality of life in Guillain-Barré syndrome and CIDP.” Neurology vol. 63,12 (2004): 2393-5. doi:10.1212/01.wnl.0000148589.87107.9c
- Janssen, Jessie et al. ‘A Clinical Case Series Investigating the Effectiveness of an Exercise Intervention in Chronic Inflammatory Demyelinating Polyneuropathy’. 1 Jan. 2018 : 37 – 44.
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Dr. Robert Chad Hakim, PharmD, was born and raised in Northridge, CA. He received his pharmacy degree from the University of Wisconsin-Madison School of Pharmacy. The most rewarding part of his job is taking initiative to advance clinical programs that maximize impact on patient care. He has a board certification in critical care (BCCCP), and his areas of expertise are critical care, drug information, general medicine, and cardiology. In his free time, he enjoys traveling.