Wegener’S Granulomatosis, The Use Of Resistance, Mobility And Neuromuscular Exercise Training In A Community Clinic

HISTORY: A 59-year-old Female, Height: 172 cm Weight: 99.2 kg. BMI: 33.5 kg/m2 with Wegener's Granulomatosis with polyangiitis, cardiomyopathy LVEF 35-40% 2021, Breast cancer left breast with left breast mastectomy 2020 attends a community clinic for exercise rehabilitation. PHYSICAL EXAMINATION: Client reported symptoms: Low confidence in walking/balance, frequent trips and falls, Reduced ADLs and independence, and extreme fatigue. Unable to walk ~100 m unassisted. DIFFERENTIAL DIAGNOSIS: Poor lower body strength, poor upper body strength, poor balance, high levels of fatigue. TEST AND RESULTS: Fatigue Assessment Scale: 41, Strength assessments: maximal body weight seated leg extensions: Left: 7 reps max, Right: 7 reps. 5-Rep Sit to stand: Unable to do (fatigue/balance). 60 sec Maximum 1 kg biceps curl test: Left 1 kg: 20 reps max, Right: unable to complete one repetition (pain/fatigue). Berg Balance: 26 (moderate/high fall risk). Tandem balance: Left: 6 sec, Right: 3.49 sec. Romberg: Left Leg Eyes Open: 0.80 sec, Right Leg Eyes Open: 0.61 sec. Forward reach: 4.5 cm. Posture: Right shoulder raised and rounded, head tilt to right, back lordosis. Gait: Limited natural arm wing on right arm, right hip elevated, out-toeing while walking. Poor balance when walking. FINAL WORKING DIAGNOSIS: Wegener's Granulomatosis with polyangiitis and cardiomyopathy with associated poor overall muscle strength, poor balance, high fall risk, and high levels of fatigue. TREATMENT AND OUTCOMES: 1. Improve ADLs and independence, 2. Reduce fall risk, improve muscle strength, 3. Improve walking distance. 4. Exercise training 12 weeks, 1x30min supervised sessions, ~5 min recumbent cycle ~25 Watts, with activation-based, mobility, full body strength, and neuromuscular training exercises. 5. Outcomes: Fatigue Assessment Scale: 35. Strength assessment: maximal body weight seated leg extensions: Left: 36 reps max Right: 23 reps. 5-Rep Sit to stand: 16.85 sec. 60 sec Maximum 1 kg biceps curl test: Left 1 kg: 20 reps max, Right: 14 reps. Berg Balance: 44 (low fall risk). Tandem balance: Left: 43 sec, Right: 30 sec. Romberg: Left Leg Eyes Open: 1.45 sec, Right Leg Eyes Open: 3.67 sec. Forward reach: 19.5 cm. 1 km walking unassisted.