Evidence that prednisone-induced myopathy is reversed by physical training

Treatment with glucocorticoids causes wasting of proximal skeletal muscles. There is evidence that physical training improves muscle mass and strength in glucocorticoid-treated rats. Whether this is also true in humans is not known. The present investigation was designed to establish in what respect moderate physical training may alter muscle mass and function as assessed quantitatively by computed tomography (CT) and an isokinetic dynamometer (Cybex II). Compared with matched normal subjects (n = 12), patients (n = 12) treated with prednisone [12.6 +/- 3.3 (+/- SD) mg/day] had a 20% lower midthigh muscle area and a 36% increase in midthigh fat to muscle ratio. The mean peak torque and the total work output of the thigh muscle were lower by more than 20%. Baseline measurements of total work output or peak torque at all tested velocities increased with midthigh muscle area (r = 0.73; n = 24; P less than 0.001). Fifty days of isokinetic training in 12 patients increased the thigh muscle area, decreased the thigh fat area, and normalized the mean peak torque and total work output. The increase in peak torque was inversely correlated with the daily dose of prednisone (r = 0.60; n = 12; P less than 0.05). Thus, glucocorticoid-induced muscle wasting can be reversed by increasing physical activity in patients taking a low to moderate dose of prednisone.