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There is an abundance of evidence that support increased cardiorespiratory exercise capacity with progressive endurance training, especially among active individuals [247]. This is consistent with the widespread physiological adaptations that occur after any progressive training program. Indeed an important result of regular physical activity is an increase in the aerobic capacity, which has been observed in both healthy active and sedentary individuals. Conversely, chronic physical inactivity is associated with a decrease in cardiorespiratory fitness. However, similar to the paradigm for physical activity — physical inactivity also leads to decrements in muscular strength and associated metabolic fitness responses to training [248, 249]. Although alterations in muscle strength, muscle mass, and metabolic characteristics have been reported after chronic aerobic exercise, the majority of the studies are chronic exercise on resistance-trained athletes [250-254]. However, a recent study on male patients with DM1 (n = 8) compared before and after 14 months of endurance training on a quadriceps ergometer [255]. Endothelial dysfunction was improved as determined by largely reduced expression of tumor necrosis factor alpha (TNFα), interleukin 8(IL-8), and monocyte chemoattractant protein-1(MCP-1) [255]. The chronic exercise protocol led to multiple improvements in strength, muscle mass, and metabolic function in DM1 patients.

Recent evidence indicates that genetic factors as well as environment, i.e. socio-economic status, are important determinants of psychological and emotional well-being. Besides a contribution from genetic factors, psychological well-being has been associated with specific programs of care for children and adult patients with chronic diseases [256]. Poor quality of life has been found in a variety of neurodegenerative diseases, and is mainly associated with mental, emotional and social functions [257]. Genetic factors play a significant role in explaining the prevalence of these diseases. Given the frequency of SMA, we need to be aware of the importance of well-being.] d2c66b5586

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