H. Hayashi et al. / Open Journal of Therapy and Rehabilitation 1 (2013) 5- 9
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8
Table 1. Three reports on return to sports in MG patients.
Author Year e publication Old Sex MG classification Sports Level
Scheer BV et al. 2012 52 MaleMild generalized (MGFA IIA) Ultra marathon Recreation
Leddy JJ et al. 2000 17 MaleMild generalized Football College
Hayashi H et al. 2013 22 MaleMild generalized (Osserman IIA) (MGFA IIA)Bicycle rider Professional
race cycling. This is not only because of temporary dis-
continuation of training caused by long-term hospitaliza-
tion but also because of the nature of the disease and its
complications (ex. crisis). In many cases, side effects
[9-11] such as osteoporosis and loss of muscle strength
that might occur due to large-dose steroid therapy may
pose additional problems [1].
OPEN ACCESS
In fact, only two reports on athletes affected by MG
and their return to sports activity have been published to
date [12,13] (Table 1). In both cases, patients had mild
generalized MG (class IIA, MGFA) as in our case.
Though their sports disciplines required less muscle
strength and endurance than professional cycling (Ameri-
can football and marathon, respectively) and the level of
activity was comparatively lighter than competitive cy-
cling (one was a student practicing at a college sports
club and another trained recreationally), in both cases
full return to pre-disease sports activity was not possible.
This is the first report on successfully treated profes-
sional athlete with MG class IIA (MGFA classification)
who was able to return to his full pre-disease sports ac-
tivity following steroid-pulse treatment.
We presume that three factors played important roles
in treatment to full recovery in our case. First, patient’s
compliance was excellent and drawn by the strong desire
to return to pre-disease sports activity. Second, rehabili-
tation was initiated early, when the patient was still un-
der large doses of PSL. Therefore, loss in muscle
strength and volume could be minimized and severe
complications (e.g. crisis) avoided. Third, due to young
age of the patient, his originally high bone mineral den-
sity was maintained within the normal range during the
course of treatment. This allowed load training during
rehabilitation.
7. CONCLUSION
We report a case of a professional bicycle rider who
achieved full recovery to competitive sports after re-ac-
tivation of myasthenia gravis (type II Osserman classifi-
cation and class IIA, MGFA classification). Treatment
including steroid-pulse therapy and early rehabilitation
program started while the patient was still on high dose
steroids and during hospitalization. This is the first report
on a professional athlete suffering from MG who suc-
cessfully returned to competitive sports after aggressive
steroid treatment.
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