Myopathic symptoms in
Glycogen Storage Disease Type IIIa (
GSD IIIa) are generally ascribed to the muscle wasting that these patients suffer in adult life, but an inability to debranch
glycogen likely also has an impact on muscle energy metabolism. We hypothesized that patients with
GSD IIIa can experience exercise intolerance due to insufficient
carbohydrate oxidation in skeletal muscle. Six patients aged 17-36-years were studied. We determined VO 2peak (peak oxygen consumption), the response to forearm exercise, and the metabolic and cardiovascular responses to cycle exercise at 70% of VO 2peak with either a saline or a
glucose infusion. VO 2peak was below normal.
Glucose improved the work capacity by lowering the heart rate, and increasing the peak work rate by 30% (108 W with
glucose vs. 83 W with placebo, p=0.018). The block in muscle glycogenolytic capacity, combined with the liver involvement caused exercise intolerance with dynamic skeletal muscle symptoms (excessive
fatigue and
muscle pain), and
hypoglycemia in 4 subjects. In this study we combined anaerobic and aerobic exercise to systematically study skeletal muscle metabolism and exercise tolerance in patients with
GSD IIIa. Exercise capacity was significantly reduced, and our results indicate that this was due to a block in muscle glycogenolytic capacity. Our findings suggest that the general classification of GSD III as a
glycogenosis characterized by fixed symptoms related to muscle wasting should be modified to include dynamic exercise-related symptoms of muscle fatigue. A proportion of the skeletal muscle symptoms in
GSD IIIa, i.e. weakness and
fatigue, may be related to insufficient energy production in muscle.