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Daniel N, Bruns I, Casey B, Coote S, Daubmann A, Heesen C, Riemann-Lorenz K. "Activity Matters was great - I now realize: if I move, I'm fitter.": development and process evaluation of a web-based program for persons with multiple sclerosis. Disabil Rehabil 2024; 46:4216-4225. [PMID: 37861220 DOI: 10.1080/09638288.2023.2269845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Research shows that persons with mild to moderate multiple sclerosis are less physically active than healthy controls even though they would benefit from it. This study focusses on the feasibility testing and process evaluation of the pilot study of Activity Matters, a twelve-week web-based program, from Ireland, to increase physical activity in this population. MATERIALS AND METHODS The intervention was adapted to local circumstances in Hamburg, Germany and consists of eleven modules incorporating behavior change techniques. After feasibility had been confirmed, 43 persons with multiple sclerosis participated in a pilot study with a pre-post, single-group intervention design. Qualitative data was collected with questionnaires and semi structured interviews. Physical activity level and stage of change was measured quantitatively. RESULTS Participants had a mean age of 49.5 years (SD 9.29) and an average Patient Determined Disease Step Score of 2.2 (SD 1.47). Thirty-six participants answered the follow-up questionnaire. On average 9.8 modules were processed within 13 weeks. Each tool for behavior change was perceived as helpful except the chat group. Physical activity levels increased significantly from pre- to post intervention (p-value 0.042, Cohen's d = 0.35). CONCLUSIONS The results indicate that Activity Matters is feasible and satisfactory and may change activity levels.
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Affiliation(s)
- N Daniel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Bruns
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Casey
- Healthy Eating Active Living Programme, Health and Wellbeing Division, HSE, Dublin, Ireland
| | - S Coote
- MS Society and Physical Activity for Health Group, Health Research Institute, Limerick, Ireland
| | - A Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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2
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Lewis JE, Beattie EH, Ylitalo KR. The Association Between Physical Activity and Fatigue Among Adults With Rheumatic Disease in a Nationally Representative Sample. J Phys Act Health 2024; 21:560-566. [PMID: 38508179 DOI: 10.1123/jpah.2023-0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Adults with rheumatic disease (RD) experience high levels of fatigue. Regular physical activity has been shown to reduce fatigue among adults. Despite this evidence, adults with RD are more likely to be physically inactive compared with those without RD. Little information is known about the association of physical activity level and fatigue among adults with RD. This study investigated the association of physical activity level and fatigue among adults with and without RD. METHODS Adults (≥18 y) who participated in the 2018 National Health Interview Survey (unweighted n = 25,471) were included in this cross-sectional study. Physical activity and fatigue were self-reported. Statistical analyses were weighted to account for complex survey sampling design. RESULTS Significantly more adults with RD experience fatigue compared with adults without RD (26.19% vs 13.23%). Adults with RD who were inactive had 2.81 times (95% CI, 2.37-3.34) higher odds of experiencing fatigue compared to adults with RD who were sufficiently active, after adjusting for covariates. CONCLUSIONS Overall, fatigue was more common among adults with RD than it was in the population without RD.
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Affiliation(s)
- Jordan E Lewis
- Department of Public Health, Baylor University, Waco, TX, USA
- Baylor Scott and White Warriors Research Institute, Waco, TX, USA
| | - Emily H Beattie
- Baylor Scott and White Warriors Research Institute, Waco, TX, USA
| | - Kelly R Ylitalo
- Department of Public Health, Baylor University, Waco, TX, USA
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3
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Phelan R, Potter K. High-Intensity Gait Training in an Individual With Neuromyelitis Optica and Research Recommendations for Individuals With Multiple Sclerosis. Int J MS Care 2024; 26:108-112. [PMID: 38765297 PMCID: PMC11096854 DOI: 10.7224/1537-2073.2023-035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Neuromyelitis optica (NMO), similar to multiple sclerosis (MS), is an autoimmune disorder affecting the central nervous system. In people with central nervous system diagnoses, high-intensity gait training (HIGT) can support neuroplasticity, improving functional mobility. While low- to moderate-intensity exercise is beneficial in improving outcomes in individuals with NMO and MS, the impact of HIGT has not been thoroughly explored. This case study explores the safety and efficacy of HIGT in an individual with NMO. METHODS A 43-year-old man with NMO participated in a HIGT program utilizing the least amount of body weight support necessary to achieve a target heart rate of 60% to 80% of heart rate reserve or a Borg Rating of Perceived Exertion score of 15 to 17 during an in-patient rehabilitation stay. Interventions incorporated stair training, gait variances, and virtual reality. RESULTS The patient successfully completed a 90-minute training session 4 to 7 times per week for 6 weeks following a HIGT regimen for 40% to 60% of each session. Meaningful gains in bed mobility, transfers, and gait allowed for discharge to his home. CONCLUSIONS This case suggests that HIGT in patients with NMO can be safe and effective in improving functional mobility. Due to the similarities between NMO and MS, this case provides a framework to assist clinicians in developing a HIGT plan of care for individuals with MS. Additional research is needed to clarify HIGT parameters, including intensity and duration, to improve functional mobility in individuals with MS.
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Affiliation(s)
- Rebecca Phelan
- From the Department of Physical Therapy, Spaulding Rehabilitation, Charlestown, MA, USA
| | - Kirsten Potter
- the Program in Physical Therapy, Department of Rehabilitation Sciences, Tufts University, Boston, MA, USA
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Du L, Xi H, Zhang S, Zhou Y, Tao X, Lv Y, Hou X, Yu L. Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Front Public Health 2024; 12:1387658. [PMID: 38660348 PMCID: PMC11039920 DOI: 10.3389/fpubh.2024.1387658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background A growing body of studies have examined the effect of exercise in people with multiple sclerosis (MS), while findings of available studies were conflicting. This meta-analysis aimed to explore the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Methods We searched PubMed, Web of Science, Scopus, and Cochrane databases, through March 1, 2024. Inclusion criteria were: (1) RCTs; (2) included an intervention and control group; (3) had people with MS as study subjects; (4) had balance, walking ability, walking endurance, fatigue, or quality of life as the outcome measures. Exclusion criteria were: (1) non-English publications; (2) animal model publications; (3) review articles; and (4) conference articles. A meta-analysis was conducted to calculate weighted mean difference (WMD) and 95% confidence interval (CI). Cochrane risk assessment tool and Physiotherapy Evidence Database (PEDro) scale were used to evaluate the methodological quality of the included studies. Results Forty studies with a total of 56 exercise groups (n = 1,300) and 40 control groups (n = 827) were eligible for meta-analysis. Exercise significantly improved BBS (WMD, 3.77; 95% CI, 3.01 to 4.53, P < 0.00001), TUG (WMD, -1.33; 95% CI, -1.57 to -1.08, P < 0.00001), MSWS-12 (WMD, -2.57; 95% CI, -3.99 to -1.15, P = 0.0004), 6MWT (WMD, 25.56; 95% CI, 16.34 to 34.79, P < 0.00001), fatigue (WMD, -4.34; 95% CI, -5.83 to -2.84, P < 0.00001), and MSQOL-54 in people with MS (WMD, 11.80; 95% CI, 5.70 to 17.90, P = 0.0002) in people with MS. Subgroup analyses showed that aerobic exercise, resistance exercise, and multicomponent training were all effective in improving fatigue in people with MS, with resistance exercise being the most effective intervention type. In addition, a younger age was associated with a larger improvement in fatigue. Furthermore, aerobic exercise and multicomponent training were all effective in improving quality of life in people with MS, with aerobic exercise being the most effective intervention type. Conclusion Exercise had beneficial effects in improving balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Resistance exercise and aerobic exercise are the most effective interventions for improving fatigue and quality of life in people with MS, respectively. The effect of exercise on improving fatigue was associated with the age of the participants, with the younger age of the participants, the greater the improvement in fatigue. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371056, identifier: CRD42022371056.
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Affiliation(s)
- Liwen Du
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Haoyu Xi
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yilun Zhou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xifeng Tao
- School of Physical Education, Xihua University, Chengdu, China
| | - Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Xiao Hou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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Apollonatou V, Lykouras D, Kargiotis O, Kasdagli MI, Lagiou O, Papathanasopoulos P, Spiropoulos K, Karkoulias K. Cardiopulmonary exercise testing in people with minimally impaired multiple sclerosis. Mult Scler Relat Disord 2023; 79:105016. [PMID: 37748258 DOI: 10.1016/j.msard.2023.105016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic demyelinating inflammatory disorder of the central nervous system that may affect respiratory system at the later stages of the disease. The aim of our study was to evaluate respiratory function and cardiopulmonary exercise testing in ambulatory without aid people with MS (pwMS), and to investigate quality of life parameters and fatigue in this population. METHODS 25 pwMS and 16 healthy controls were included in this study. Pulmonary function tests were performed and were followed by proper cardiopulmonary exercise testing with the use of treadmill. Quality of life assessment was done with SF-36 questionnaire. RESULTS The mean age of the patient group was 38.4 ± 8.2 years. Spirometric values were within normal limits, and so did lung diffusion capacity, while maximal voluntary ventilation was reduced. In cardiopulmonary exercise testing the patient group showed impairment compared to control group. The statistically significant lower parameters were V'O2 peak, V'CO2 peak, RER, V'O2/kg peak, V'CO2/kg peak, oxygen pulse peak and V'E/V'CO2 slope. Moreover, there was a negative and statistically significant correlation between CPET values and BMI and MFIS, while there was a positive and statistically significant correlation with quality of life, evaluated by SF-36. CONCLUSION Our study showed that the main cardiopulmonary exercise testing parameters were affected in ambulatory pwMS, even without evidence of respiratory symptoms. Therefore, these people should be evaluated for pulmonary function compromise.
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Affiliation(s)
- Vasiliki Apollonatou
- 2nd Pulmonary Medicine Department, Athens Medical School, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece.
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Odysseas Kargiotis
- Department of Neurology, University General Hospital of Patras, Patras, Greece; Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga Lagiou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | | | - Kiriakos Karkoulias
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
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6
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Li G, You Q, Hou X, Zhang S, Du L, Lv Y, Yu L. The effect of exercise on cognitive function in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. J Neurol 2023; 270:2908-2923. [PMID: 36864256 DOI: 10.1007/s00415-023-11649-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE A growing body of research examining the effect of exercise on cognitive function in people with multiple sclerosis (MS), while findings of available studies were conflicting. We aimed to explore the effect of exercise on cognitive function in MS patients. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, EBSCO, Cochrane, and Scopus electronic databases, through July 18, 2022. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. RESULTS Twenty-one studies with a total of 23 experimental groups and 21 control groups met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in MS patients, while the effect size was small (Cohen's d = 0.20, 95% CI 0.06-0.34, p < 0.001, I2 = 39.31%). Subgroup analysis showed that exercise significantly improved memory (Cohen's d = 0.17, 95% CI 0.02-0.33, p = 0.03, I2 = 7.59%). In addition, multicomponent training, exercise conducted 8 weeks and 10 weeks, up to 60 min per session, 3 times or more per week, 180 min or more per week increased cognitive function significantly. Furthermore, a worse basal MS status (defined by the Expanded Disability Status Scale) and an older age were associated with greater improvement in cognitive function. CONCLUSION MS patients are recommended to participate in at least three multicomponent training sessions per week, with each session lasting up to 60 min, and the exercise goal of 180 min per week can be achieved by increasing the frequency of exercise. Exercise lasting 8 or 10 weeks is best for cognitive function improvement. Additionally, a worse basal MS status, or the older the age, the greater effect on cognitive function.
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Affiliation(s)
- Gen Li
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China.,School of Physical Education & Sports Science, South China Normal University, Guangzhou, China
| | - Qiuping You
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
| | - Xiao Hou
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Liwen Du
- Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China. .,China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China. .,Department of Sports Performance, Beijing Sport University, Beijing, China.
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Shobeiri P, Seyedmirzaei H, Karimi N, Rashidi F, Teixeira AL, Brand S, Sadeghi-Bahmani D, Rezaei N. IL-6 and TNF-α responses to acute and regular exercise in adult individuals with multiple sclerosis (MS): a systematic review and meta-analysis. Eur J Med Res 2022; 27:185. [PMID: 36156182 PMCID: PMC9511785 DOI: 10.1186/s40001-022-00814-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background In both the general population and people with multiple sclerosis (PwMS), physical exercise is associated with improved mental well-being. Moreover, there is evidence of the possible protection of physical activity against disease progression in multiple sclerosis (MS). However, the question arises if acute or regular exercise has any impact on the immune system in PwMS. To answer this question, we performed a systematic review and meta-analysis on both plasma and serum cytokine levels (IL-6 and TNF-α) before and after acute and regular exercise among PwMS and compared to healthy controls. Method We performed an online search via PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library till September 2021 to identify original studies on IL-6 and TNF-α changes after acute and regular exercise in PwMS and controls. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 11 original studies were included in the meta-analysis. Sensitivity analyses were used to identify the origins of heterogeneity. R 4.0.4 was used to perform the meta-analysis of IL-6 and TNF-α levels before and after acute and regular exercise in PwMS, compared to controls. This study does not qualify for a clinical trial number. Results IL-6 levels did neither increase nor decrease after acute and regular exercise in PwMS, and compared to controls (pre- vs. post-intervention: Standardized Mean Difference (SMD) -0.09, 95% CI [−0.29; 0.11], p-value = 0.37, PwMS vs. Control: SMD −0.08, 95% CI [−0.33; 0.16], p-value = 0.47). In PwMS, TNF-α levels decreased after regular exercise and when TNF-α levels of both acute and regular exercise were pooled (pre- vs. post-intervention: SMD −0.51, 95% CI [-0.91; 0.11], p-value = 0.01, PwMS vs. Control: SMD −0.23, 95% CI [−0.66; 0.18], p-value = 0.26). TNF-α levels did neither increase nor decrease after acute and regular exercise in PwMS, when compared to controls. Conclusion This systematic review and meta-analysis show that exercise does not lead to significant changes in peripheral levels of IL-6 in PwMS in contrast to the observed response in healthy subjects and other medical contexts. However, regular exercise had a specific anti-inflammatory effect on blood TNF-α levels in PwMS. It remains to be investigated why PwMS display this different exercise-induced pattern of cytokines. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00814-9.
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Affiliation(s)
- Parnian Shobeiri
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Seyedmirzaei
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Karimi
- School of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Fatemeh Rashidi
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran
| | - Antônio L Teixeira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Neuropsychiatry Program, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Serge Brand
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi-Bahmani
- Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Department of Psychology, Stanford University, Stanford, CA, USA
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kazeminia M, Salari N, Shohaimi S, Akbari H, Khaleghi AA, Bazrafshan MR, Mohammadi M. Assessing the effects of exercise on post-partum fatigue symptoms: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2022; 15:100155. [PMID: 35647520 PMCID: PMC9136263 DOI: 10.1016/j.eurox.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background The level of activity in women who have given birth is very low despite the great benefits of exercise on their physical and mental health. There are some contradictories between the results of several preliminary studies on the effects of exercise on post-partum fatigue reduction. Therefore, the aim of this study was to assess the effects of exercise on decreasing postpartum fatigue in general and, specifically, in Iran using meta-analysis. Methods In this study, the articles printed in international and national centres of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (WoS), were used to find the studies electronically published up to 2021. The studies' heterogeneity was examined using the I2 index, and subsequently, a random-effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Results Finally, nine articles met the inclusion criteria in this systematic and meta-analysis review. The included samples were 456 patients in the intervention group and 446 in the control group. The mean score of fatigue after the intervention was 8.1 ± 1.1 lower than before intervention in the experimental group, and this difference was statistically significant (p ≤ 0.001). Conclusion The results of this study indicate that exercise reduces postpartum fatigue, which can be used for counseling and treatment by gynecologists. Reduce postpartum problems in women and increase the quality of life after childbirth.
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Affiliation(s)
- Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hakimeh Akbari
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Ali Asghar Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Mohammad-Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
- Corresponding author.
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Gervasoni E, Bertoni R, Anastasi D, Solaro C, Di Giovanni R, Grange E, Gunga HC, Rovaris M, Cattaneo D, Maggioni MA, Merati G. Acute Thermoregulatory and Cardiovascular Response to Submaximal Exercise in People With Multiple Sclerosis. Front Immunol 2022; 13:842269. [PMID: 35874684 PMCID: PMC9296825 DOI: 10.3389/fimmu.2022.842269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heat sensitivity occurs in a high percentage of people with multiple sclerosis (PwMS), in response to environmental or exercise-induced increase in body temperature. However, the kinetic and magnitude of adaptation of the internal load and of the core body temperature (CBT) to a submaximal continuous exercise has been poorly addressed in PwMS; this may be relevant for the brief exercise bouts usually occurring in normal daily life. The aim of this work was to evaluate whether multiple sclerosis influences the acute adaptation of the internal load, the CBT and the perceptual load in response to a constant submaximal work step. Methods CBT has been continuously monitored (0.5 Hz) by a validated wearable heat-flux sensor and electrocardiography was recorded (250 Hz) by a wearable device during a standard 6-minute walk test (6MWT) in 14 PwMS (EDSS, 4.7 ± 1.2; disease duration: 13.0 ± 10.2 years; m ± SD) and 14 age, sex and BMI-matched healthy subjects (HS). The rate of perceived exertion (RPE) of the lower limbs was assessed during the 6MWT by the Borg scale (6-20). Results As expected, PwMS walked a significantly shorter distance (361 ± 98 m) than the HS group (613 ± 62 m, p<0.001 vs PwMS). However, the kinetics of adaptation of CBT and the magnitude of CBT change from baseline did not differ between groups. Similarly, heart rate (HR) kinetics and HR change from baseline were comparable between groups during the 6MWT. Finally, lower limbs RPE gradually increased during the exercise test, but without significant differences between groups. Conclusion The internal load, the metabolic heat production, and the perceptive load due to a standard submaximal walking exercise seems to be preserved in PwMS, suggesting a comparable acute heat production and dissipation during exercise. Therefore, it is unlikely that the different distance achieved during the 6MWT may be caused by altered thermoregulatory responses to exercise. Rather, this appears to be a consequence of the known increased energy cost of locomotion in PwMS.
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Affiliation(s)
| | | | | | - Claudio Solaro
- Rehabilitation Department, CRRF Mons. L. Novarese, Moncrivello, Italy
| | | | - Erica Grange
- Rehabilitation Department, CRRF Mons. L. Novarese, Moncrivello, Italy
| | - Hanns-Christian Gunga
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
| | | | - Davide Cattaneo
- IRCCS Fondazione Don Gnocchi, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Martina Anna Maggioni
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Milan, Italy
| | - Giampiero Merati
- IRCCS Fondazione Don Gnocchi, Milano, Italy
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
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10
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Therapeutic Effects of the Pilates Method in Patients with Multiple Sclerosis: A Systematic Review. J Clin Med 2022; 11:jcm11030683. [PMID: 35160134 PMCID: PMC8836864 DOI: 10.3390/jcm11030683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/18/2022] Open
Abstract
The Pilates Method is a rehabilitation tool with verified benefits in pain management, physical function, and quality of life in many different physiotherapy areas. It could be beneficial for patients with multiple sclerosis (pwMS). The aim of the study was to summarize current evidence for the effectiveness of Pilates in pwMS. A comprehensive search of Cinahl, Scopus, Web of Science, PEDro, and PubMed (including PubMed Central and Medline) was conducted to examine randomized controlled trials (RCT) that included Pilates intervention in multiple sclerosis. The PEDro scale and the Cochrane risk-of-bias tool, RoB-2, were used to evaluate risk of bias for RCT. Twenty RCT (999 patients) were included. Ten were of good quality (PEDro), and seven had low risk of bias (RoB-2). Pilates improves balance, gait, physical-functional conditions (muscular strength, core stability, aerobic capacity, and body composition), and cognitive functions. Fatigue, quality of life, and psychological function did not show clear improvement. There was good adherence to Pilates intervention (average adherence ≥ 80%). Cumulative data suggest that Pilates can be a rehabilitation tool for pwMS. High adherence and few adverse effects were reported. Future research is needed to develop clinical protocols that could maximize therapeutic effects of Pilates for pwMS.
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11
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Torkhani E, Dematte E, Slawinski J, Csillik A, Gay MC, Bensmaïl D, Heinzlef O, de Marco G. Improving Health of People With Multiple Sclerosis From a Multicenter Randomized Controlled Study in Parallel Groups: Preliminary Results on the Efficacy of a Mindfulness Intervention and Intention Implementation Associated With a Physical Activity Program. Front Psychol 2022; 12:767784. [PMID: 35002857 PMCID: PMC8740326 DOI: 10.3389/fpsyg.2021.767784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objective of this study is to investigate the efficacy of psychological Interventions – Mindfulness or Implementation Intention – associated with a Physical Activity program, delivered via internet, in reducing Multiple Sclerosis symptoms. Method: Thirty-five adults were randomly assigned to one of the three groups: a Mindfulness-Based Intervention group (N = 12), Implementation Intention group (N = 11), and a Control Group (N = 12). All the groups received the same Physical Activity program. The Mindfulness condition group received daily training in the form of pre-recorded sessions while the Implementation group elaborated their specific plans once a week. Mobility, fatigue, and the impact of the disease on the patient’s life were measured. Two measurement times are carried out in pre-post intervention, at baseline and after eight weeks. Results: Overall, after 8 weeks intervention, results show that there was a significant increase in Walking distance in the three groups. In addition, the within-group analysis showed a statistically significant improvement between pre and post intervention on the physical component of the Disease Impact scale in the Implementation Intention group (p = 0.023) with large effect size, in the Mindfulness-Based Intervention group (p = 0.008) with a medium effect size and in the control group (p = 0.028) with small effect size. In the Implementation Intention group, all physical, psychosocial and cognitive Fatigue Impact subscales scores decreased significantly (p = 0.022, p = 0.023, and p = 0.012, respectively) and the physical component was statistically and negatively correlated (r = −0.745; p = 0.008) when Implementation Intention group practice a mild to moderate physical activity. In the Mindfulness-Based Intervention group, the physical component (MFIS) showed a statistically significant improvement (p = 0.028) but no correlation with moderate-to-vigorous physical activity (MVPA); the control group outcomes did not reveal any significant change. Conclusion: The results of this study are very encouraging and show the feasibility of Mindfulness interventions associated with physical activity to improve the health of people with MS. Further study should assess Mindfulness interventions tailored to MS condition and using both hedonic and eudemonic measures of happiness.
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Affiliation(s)
- Eya Torkhani
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Emilie Dematte
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Jean Slawinski
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,French National Institute of Sport, Expertise and Performance, Sport, Expertise and Performance Laboratory, Paris, France
| | - Antonia Csillik
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Marie-Claire Gay
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Djamel Bensmaïl
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital - APHP Paris Saclay, Garches, France.,UMR 1179 INSERM-UVSQ, Neuromuscular Handicap - University of Versailles, Montigny-le-Bretonneux, France
| | - Olivier Heinzlef
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,CHI de Poissy-St Germain, Conflans-Sainte-Honorine, France
| | - Giovanni de Marco
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France
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12
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Razi O, Tartibian B, Teixeira AM, Zamani N, Govindasamy K, Suzuki K, Laher I, Zouhal H. Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential therapeutic role of exercise. Mult Scler Relat Disord 2022; 59:103557. [PMID: 35092946 PMCID: PMC8785368 DOI: 10.1016/j.msard.2022.103557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 12/15/2022]
Abstract
Thermoregulation is a homeostatic mechanism that is disrupted in some neurological diseases. Patients with multiple sclerosis (MS) are susceptible to increases in body temperature, especially with more severe neurological signs. This condition can become intolerable when these patients suffer febrile infections such as coronavirus disease-2019 (COVID-19). We review the mechanisms of hyperthermia in patients with MS, and they may encounter when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Finally, the thermoregulatory role and relevant adaptation to regular physical exercise are summarized.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ana Maria Teixeira
- University of Coimbra, Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan.
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé) - EA 1274, Rennes F-35000, France; Institut International des Sciences du Sport (2I2S), Irodouer 35850, France.
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13
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Gopal A, Sydow R, Block V, Allen DD. Effectiveness of Physical Therapy in Addressing Sexual Dysfunction in Individuals with Multiple Sclerosis: A Systematic Review and Meta-analysis. Int J MS Care 2021; 23:213-222. [PMID: 34720761 PMCID: PMC8550487 DOI: 10.7224/1537-2073.2020-039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) frequently report sexual dysfunction, a condition that may result in low sexual satisfaction and decreased quality of life. Although sexual dysfunction is usually treated pharmacologically, physical therapists, especially those trained in pelvic floor physical therapy (PT), are well-equipped to address a variety of impairments that contribute to poor sexual function. The current evidence for effectiveness of PT interventions in improving sexual dysfunction, sexual satisfaction, and the emotional well-being aspect of quality of life was analyzed. METHODS The PubMed, CINAHL, and PEDro databases were searched through December 2019. Articles were included if participants had a clinical diagnosis of MS, reported sexual dysfunction or pain with intercourse, and had an intervention within the PT scope that addressed sexual dysfunction. Means and SDs were extracted from each study independently by two authors. Effect sizes (d) and 95% CIs were calculated within and across studies. RESULTS Eight studies met the inclusion criteria. Combined effects were significant and large across six studies for sexual function (d = 0.82, 95% CI, 0.57-1.06), moderate across seven studies for sexual satisfaction (d = 0.65, 95% CI, 0.43-0.87), and moderately large across two studies for emotional well-being (d = 0.78, 95% CI, 0.17-1.40). Between-group differences reached significance for sexual satisfaction (d = 0.29, 95% CI, 0.03-0.55). CONCLUSIONS Sexual function, sexual satisfaction, and emotional well-being can all be effectively addressed with various PT interventions. Highly effective interventions included pelvic floor muscle training and mindfulness. Future research should compare PT interventions with non-PT controls to determine best practice in this population.
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Affiliation(s)
- Arpita Gopal
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
| | - Rebecca Sydow
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
| | - Valerie Block
- Weill Institute for Neurosciences, Department of Neurology (VB), University of California, San Francisco, CA, USA
| | - Diane D. Allen
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
- Department of Physical Therapy, San Francisco State University, San Francisco, CA, USA (DDA)
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14
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Homayuni A, Abedini S, Hosseini Z, Etemadifar M, Ghanbarnejad A. Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study. BMC Neurol 2021; 21:193. [PMID: 33975555 PMCID: PMC8111999 DOI: 10.1186/s12883-021-02213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS. Methods This research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management. Results Saturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems). Conclusions Based on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02213-9.
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Affiliation(s)
- Atefeh Homayuni
- Health School, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sedigheh Abedini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Zahra Hosseini
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoud Etemadifar
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ghanbarnejad
- Department of Public Health, School of Health, Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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15
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Mark VW. Retention of Physical Gains in the Community Following Physical Training for Multiple Sclerosis: A Systematic Review and Implications. Semin Neurol 2021; 41:177-188. [PMID: 33690875 DOI: 10.1055/s-0041-1725139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple sclerosis (MS) is a progressive neurological illness whose typically young adult onset results in a nearly entire lifetime of worsening disability. But despite being an unrelenting neurodegenerative disease, numerous clinical trials over the past 40 years for MS have vigorously attempted to improve or at least stabilize declining physical function. Although the vast majority of the studies assessed training effects only within controlled laboratory or clinic settings, in recent years a growing interest has emerged to test whether newer therapies can instead benefit real-life activities in the community. Nonetheless, comparatively little attention has been paid to whether the training gains can be retained for meaningful periods. This review discusses the comparative success of various physical training methods to benefit within-community activities in MS, and whether the gains can be retained long afterward. This review will suggest future research directions toward establishing efficacious treatments that can allow persons with MS to reclaim their physical abilities and maximize functionality for meaningful periods.
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Affiliation(s)
- Victor W Mark
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychology, University of Alabama at Birmingham, Birmingham, Alabama
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16
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Gascoyne C, Karahalios A, Demaneuf T, Marck C. Effect of Exercise Interventions on Anxiety in People with Multiple Sclerosis: A Systematic Review and Meta-analysis. Int J MS Care 2020; 22:103-109. [PMID: 32607071 PMCID: PMC7307872 DOI: 10.7224/1537-2073.2019-009r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence suggests that exercise can alleviate symptoms associated with multiple sclerosis (MS). However, it is unclear whether exercise alleviates symptoms of anxiety, present in one-third of people with MS. This systematic review and meta-analysis investigates whether exercise interventions are effective in reducing anxiety in people with MS. METHODS CINAHL, Embase, MEDLINE, PsycINFO, and the Cochrane Controlled Clinical Trials Register were searched to identify relevant randomized controlled trials (RCTs) published up to March 30, 2018. The primary outcome was postintervention difference in anxiety scores between intervention and control groups. Using a restricted maximum likelihood random-effects model, standardized mean differences were pooled and heterogeneity was estimated. Risk of bias was assessed using an a priori modified Cochrane Risk of Bias 2.0 tool. RESULTS Four RCTs with 133 participants were included. Exercise type included walking, aerobic activities, and cycling. Intervention duration ranged from 8 to 26 weeks. The pooled standardized mean difference in anxiety score was -0.16 (95% CI, -0.50 to 0.19), without heterogeneity. Two studies had high risk of bias, and two had some risk of bias. CONCLUSIONS Based on available RCT data, exercise does not seem to have an effect on anxiety in people with MS. These results should be interpreted with caution because studies had concerns of bias and small sample sizes, and anxiety was not the primary outcome measure. Future studies should exhibit sufficient reporting standards, alongside publishing protocols. There is opportunity to investigate the effect of exercise in people with MS experiencing clinically relevant levels of anxiety rather than in the general MS population.
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17
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Kalb R, Brown TR, Coote S, Costello K, Dalgas U, Garmon E, Giesser B, Halper J, Karpatkin H, Keller J, Ng AV, Pilutti LA, Rohrig A, Van Asch P, Zackowski K, Motl RW. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler 2020; 26:1459-1469. [PMID: 32323606 PMCID: PMC7575303 DOI: 10.1177/1352458520915629] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - Susan Coote
- School of Allied Health and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Ulrik Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Eric Garmon
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - June Halper
- Consortium of Multiple Sclerosis Centers and International Organization of MS Nurses, Hackensack, NJ, USA
| | - Herb Karpatkin
- Program in Physical Therapy, Hunter College, New York, NY, USA
| | - Jennifer Keller
- Motion Analysis Lab, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alexander V Ng
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Paul Van Asch
- Fit Up Neurological and Sport Physiotherapy, Antwerp, Belgium
| | | | - Robert W Motl
- UAB/Lakeshore Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Razazian N, Kazeminia M, Moayedi H, Daneshkhah A, Shohaimi S, Mohammadi M, Jalali R, Salari N. The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol 2020; 20:93. [PMID: 32169035 PMCID: PMC7068865 DOI: 10.1186/s12883-020-01654-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite many benefits of the physical activity on physical and mental health of patients with Multiple Sclerosis (MS), the activity level in these patients is still very limited, and they continue to suffer from impairment in functioning ability. The main aim of this study is thus to closely examine exercise's effect on fatigue of patients with MS worldwide, with particular interest on Iran based on a comprehensive systematic review and meta-analysis. METHODS The studies used in this systematic review were selected from the articles published from 1996 to 2019, in national and international databases including SID, Magiran, Iranmedex, Irandoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (ISI). These databases were thoroughly searched, and the relevant ones were selected based on some plausible keywords to the aim of this study. Heterogeneity index between studies was determined using Cochran's test and I2. Due to heterogeneity in studies, the random effects model was used to estimate standardized mean difference. RESULTS From the systematic review, a meta-analysis was performed on 31 articles which were fulfilled the inclusion criteria. The sample including of 714 subjects was selected from the intervention group, and almost the same sample size of 720 individuals were selected in the control group. Based on the results derived from this meta-analysis, the standardized mean difference between the intervention group before and after the intervention was respectively estimated to be 23.8 ± 6.2 and 16.9 ± 3.2, which indicates that the physical exercise reduces fatigue in patients with MS. CONCLUSION The results of this study extracted from a detailed meta-analysis reveal and confirm that physical exercise significantly reduces fatigue in patients with MS. As a results, a regular exercise program is strongly recommended to be part of a rehabilitation program for these patients.
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Affiliation(s)
- Nazanin Razazian
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Moayedi
- Institute of Research and Development, Ton Duc Thang University, Da Nang, 550000 Viet Nam
| | - Alireza Daneshkhah
- School of Computing, Electronics and Maths, Coventry University, London, UK
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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19
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Lane M, Yadav V. Multiple Sclerosis. TEXTBOOK OF NATURAL MEDICINE 2020. [PMCID: PMC7348625 DOI: 10.1016/b978-0-323-43044-9.00199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Torres-Pareja M, Sánchez-Lastra MA, Iglesias L, Suárez-Iglesias D, Mendoza N, Ayán C. Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55110726. [PMID: 31684026 PMCID: PMC6915647 DOI: 10.3390/medicina55110726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: People with multiple sclerosis (MS) often experience limitations in joint range of motion, which is linked to spasticity and continued inactivity. Low flexibility levels in this population have been linked to postural problems and muscular pain. Therefore, the purpose of this study was to conduct a systematic review and a meta-analysis aimed at identifying the characteristics and methodological quality of investigations studying the effects of exercise interventions on the flexibility levels of people with MS. Materials and Methods: Three electronic databases (MEDLINE/PubMed, SPORTDiscus and Scopus) were systematically searched up to May 2019 for intervention studies focused on the effects of exercise on the flexibility levels of people with MS. A meta-analysis, including randomized controlled trials (RCT), which reported information regarding the effects of exercise on flexibility, was also conducted. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database, and the Quality Assessment Tool for Before–After Studies, with no control group. The quality of the information reported, regarding the programs conducted, was assessed by means of the Consensus on Exercise Reporting Template (CERT) scale. Results: Seven studies, four RCTs and three uncontrolled investigations were finally selected. The methodological quality of the RCTs was considered “poor” in one study, and “good” and “excellent” in two studies and one investigation, respectively. The three uncontrolled studies showed a methodological quality between “fair” and “poor”. Following the CERT scale, four studies were graded as “high” and three as “low”. Findings from the meta-analysis indicated no significant effects on hamstring flexibility, or the range of motion in the hips, knees or ankles. Conclusions: There is preliminary evidence from individual studies which indicates that people with MS can improve their lower limb flexibility following participation in physical exercise programs, but the meta-analysis did not confirm these findings.
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Affiliation(s)
- Marta Torres-Pareja
- Research Group DEPORSALUD (Physical Activity and Health, Studies in Sports Performance, Disability and Gender), Faculty of Sports Sciences, University of Castilla La-Mancha, A Carlos III s/n, E-45071 Toledo, Spain.
| | - Miguel A Sánchez-Lastra
- HealthyFit Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain.
| | - Laura Iglesias
- Faculty of Education and Sport Science, University of Vigo, E-36005 Pontevedra, Spain.
| | - David Suárez-Iglesias
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports Sciences, University of León, 24071 León, Spain.
| | - Nuria Mendoza
- University of Francisco de Vitoria (UFV), Faculty of Healthy Sciences, Ctra Pozuelo a Majadahonda 11-515 KM 1.800, 28223 Pozuelo de Alarcón, Madrid, Spain.
| | - Carlos Ayán
- Well-Move Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain.
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21
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Allen DR, Huang MU, Morris NB, Chaseling GK, Frohman EM, Jay O, Davis SL. Impaired Thermoregulatory Function during Dynamic Exercise in Multiple Sclerosis. Med Sci Sports Exerc 2019; 51:395-404. [PMID: 30779715 DOI: 10.1249/mss.0000000000001821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared with healthy controls (CON) exercising at similar rates of metabolic heat production. METHODS Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass-, and BSA-matched CON during a single bout of cycling exercise (rate of metabolic heat production: ∼4.5 W·kg) for 60 min in a climate-controlled room (25°C, 30% RH). RESULTS Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS, 72 ± 51 g; CON, 104 ± 37 g; P = 0.04) and 60 min (MS, 209 ± 94 g; CON, 285 ± 62 g; P = 0.02), as well as lower sweating thermosensitivity (MS, 0.49 ± 0.26 mg·cm·min·°C; CON, 0.86 ± 0.30 mg·cm·min·°C; P = 0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30- or 60-min time points (P > 0.05). Cutaneous vasculature responses were also not different in MS compared with CON (P > 0.05). CONCLUSION Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions.
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Affiliation(s)
- Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Department of Health Sciences, Boston University, Boston, MA
| | - M U Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Georgia K Chaseling
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Elliot M Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, AUSTRALIA
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
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22
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Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH, Motl RW. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis. Am J Phys Med Rehabil 2019; 98:613-621. [PMID: 30844920 PMCID: PMC6586489 DOI: 10.1097/phm.0000000000001174] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The translation of knowledge from exercise training research into the clinical management of multiple sclerosis, stroke, and Parkinson disease requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients. This article synthesized resources that reported aerobic and resistance training guidelines for people with multiple sclerosis, stroke, and Parkinson disease. Systematic searches yielded 25 eligible resources from electronic databases and Web sites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into three sets of recommendations. Exercise guidelines for multiple sclerosis consistently recommended 2-3 d/wk of aerobic training (10-30 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets between 8 and 15 repetition maximum). Exercise guidelines for stroke recommended 3-5 d/wk of aerobic training (20-40 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-15 repetitions between 30% and 50% 1 repetition maximum). Exercise guidelines for Parkinson disease recommended 3-5 d/wk of aerobic training (20-60 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-12 repetitions between 40% and 50% of 1 repetition maximum). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with multiple sclerosis, stroke, and Parkinson disease regarding exercise programming.
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Affiliation(s)
- Yumi Kim
- Rehabilitation Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Byron Lai
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | | | - James H. Rimmer
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, USA
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23
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Mayo CD, Miksche K, Attwell-Pope K, Gawryluk JR. The relationship between physical activity and symptoms of fatigue, mood, and perceived cognitive impairment in adults with multiple sclerosis. J Clin Exp Neuropsychol 2019; 41:715-722. [PMID: 31096850 DOI: 10.1080/13803395.2019.1614535] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Multiple Sclerosis (MS) is achronic neurological condition that requires costly treatment for aconstellation of motor and sensory symptoms, as well as fatigue, depression, and cognitive problems. Given that this pharmacological treatment often results in side effects, there is acrucial need for low-costbehavioral treatments that are effective in further reducing MS symptoms. It has been hypothesized that physical activity may slow the neurodegenerative progression of MS. The aim of the current study was to investigate the relationship between physical activity and commonly reported MS symptoms, including fatigue, depression, and perceived cognitive impairment. Method: 86 individuals with MS responded to amail-outquestionnaire. Physical activity, fatigue, mood, and perceived cognitive impairment were assessed using the following measures: Godin Leisure-TimeExercise Questionnaire (GLTEQ), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire (PHQ-9), and Patient Deficit Questionnaire (PDQ). Descriptive and correlational statistics were calculated to investigate the relationship between scores on the GLTEQ and scores on the MFIS, PHQ-9, and PDQ. Results: Overall, there was asignificant negative relationship between physical activity (GLTEQ) and fatigue (MFIS; r= -.34, p= .002) and depression (PHQ-9; r= -.23, p= .034) in individuals with MS. There was not asignificant relationship between physical activity and overall perceived cognitive dysfunction (PDQ; r= -.19, p= .08), but when the PDQ subscales were examined, there was asignificant relationship with perceived retrospective (r = 0.24, p= .03) and prospective memory abilities (r = -.22, p= .04). When the RRMS and progressive subtypes were examined separately, we observed asimilar pattern of results for the RRMS group, but the progressive MS group did not reach significance. Conclusions: Individuals with MS who reported more strenuous and/or frequent physical activity, reported fewer problems with fatigue, depression, and perceived memory abilities.
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Affiliation(s)
- Chantel D Mayo
- a Department of Psychology , University of Victoria , Victoria , Canada
| | - Kelly Miksche
- a Department of Psychology , University of Victoria , Victoria , Canada
| | | | - Jodie R Gawryluk
- a Department of Psychology , University of Victoria , Victoria , Canada
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24
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Manca A, Dvir Z, Deriu F. Meta-analytic and Scoping Study on Strength Training in People With Multiple Sclerosis. J Strength Cond Res 2019; 33:874-889. [DOI: 10.1519/jsc.0000000000002381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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25
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Mark VW, Taub E, Uswatte G, Morris DM, Cutter GR, Adams TL, Bowman MH, McKay S. Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function. Neurorehabil Neural Repair 2019; 32:223-232. [PMID: 29668399 DOI: 10.1177/1545968318761050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Constraint-Induced Movement therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cerebral palsy). OBJECTIVE This study sought to determine whether this therapy can produce comparable results with a progressive disorder such as multiple sclerosis (MS). We conducted a preliminary phase II randomized controlled trial of CIMT versus a program of complementary and alternative medicine (CAM) treatments for persons with MS, to evaluate their effect on real-world disability. METHODS Twenty adults with hemiparetic MS underwent 35 hours of either CIMT or CAM over 10 consecutive weekdays. The primary clinical outcome was change from pretreatment on the Motor Activity Log (MAL). RESULTS The CIMT group improved more on the MAL (2.7 points, 95% confidence interval 2.2-3.2) than did the CAM group (0.5 points, 95% confidence interval -0.1 to 1.1; P < .001). These results did not change at 1-year follow-up, indicating long-term retention of functional benefit for CIMT. The treatments were well tolerated and without adverse events. CONCLUSION These results suggest that CIMT can increase real-world use of the more-affected arm in patients with MS for at least 1 year. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01081275.
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Affiliation(s)
- Victor W Mark
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Taub
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - David M Morris
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary R Cutter
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Terrie L Adams
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary H Bowman
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Staci McKay
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Keytsman C, Van Noten P, Spaas J, Nieste I, Van Asch P, Eijnde BO. Periodized home-based training: A new strategy to improve high intensity exercise therapy adherence in mildly affected patients with Multiple Sclerosis. Mult Scler Relat Disord 2019; 28:91-97. [DOI: 10.1016/j.msard.2018.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/25/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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27
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Fjeldstad-Pardo C, Thiessen A, Pardo G. Telerehabilitation in Multiple Sclerosis: Results of a Randomized Feasibility and Efficacy Pilot Study. Int J Telerehabil 2018; 10:55-64. [PMID: 30588276 PMCID: PMC6296802 DOI: 10.5195/ijt.2018.6256] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.
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Affiliation(s)
- Cecilie Fjeldstad-Pardo
- OKLAHOMA MEDICAL RESEARCH FOUNDATION, MULTIPLE SCLEROSIS CENTER OF EXCELLENCE, OKLAHOMA CITY, OKLAHOMA, USA
| | - Amy Thiessen
- OKLAHOMA MEDICAL RESEARCH FOUNDATION, MULTIPLE SCLEROSIS CENTER OF EXCELLENCE, OKLAHOMA CITY, OKLAHOMA, USA
| | - Gabriel Pardo
- OKLAHOMA MEDICAL RESEARCH FOUNDATION, MULTIPLE SCLEROSIS CENTER OF EXCELLENCE, OKLAHOMA CITY, OKLAHOMA, USA
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28
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Kaltsatou A, Flouris AD. Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic review. Mult Scler Relat Disord 2018; 27:419-423. [PMID: 30544086 DOI: 10.1016/j.msard.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 10/04/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Patients with multiple sclerosis experience many complications that gradually lead them to comorbidity and disability. Exercise could prevent and ameliorate the symptoms that comorbidity or inactivity generate. However, until recently it was suggested that multiple sclerosis patients should not participate in exercise training programs because these patients are characterized by thermoregulatory failure and the heat stress due to physical work could exacerbate the disease symptoms. Furthermore, taken into account that 60-80% of the multiple sclerosis patients present adverse clinical symptoms when their body temperature is increased (not only due to physical working but even when immerse in hot water or by exposure to infrared lamps or to the sun), the need for the development of treatment strategies to overcome the thermoregulatory problem in these patients is crucial. Given that pre-cooling has been proposed as an effective method, the aim of this systematic review is to discuss the current knowledge for the effects of cooling therapy on the functional capacity of multiple sclerosis patients. The relevant literature includes many articles, but only a handful of studies published thus far have used a cooling intervention in multiple sclerosis patients and have examined the effects of pre-cooling on functional capacity. These studies used active cooling methods, namely garments or other material that are cooled by circulating liquid through a tube, as well as passive, cooling methods. Passive cooling methods include passive cooling garments or other material namely garments that have ice or gel packs inside them. Overall, the results of all the studies analysed in this review demonstrated that pre-cooling therapy can prevent the symptom worsening due to increased body temperature in multiple sclerosis patients without causing adverse effects. Therefore, such strategies could serve as a complimentary therapeutic approach in multiple sclerosis patients.
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Affiliation(s)
- Antonia Kaltsatou
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Karies 42100, Greece
| | - Andreas D Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Karies 42100, Greece.
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29
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Coulter EH, Bond S, Dalgas U, Paul L. The effectiveness of interventions targeting physical activity and/or sedentary behaviour in people with Multiple Sclerosis: a systematic review. Disabil Rehabil 2018; 42:594-612. [PMID: 30290702 DOI: 10.1080/09638288.2018.1503737] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Remaining physically active is important to maintain functional ability and reduce the incidence of co-morbidities in people with Multiple Sclerosis. The aim of this review was to evaluate the effectiveness of interventions on physical activity or sedentary behaviour in people with Multiple Sclerosis.Methods: A systematic search was conducted in May 2018 of the following databases: Web of Science Core Collections, Embase and Medline. Included studies were randomised controlled trials involving people with Multiple Sclerosis who completed an intervention, compared to any comparator. Outcomes included subjective or objective measures of physical activity or sedentary behaviour. Quality assessment was performed using the Physiotherapy Evidence Database scale.Results: Twenty-five trials were included covering 1697 participants, the majority of which had mild-moderate disability (average Physiotherapy Evidence Database score 6.2 ± 1.5). Experimental interventions included exercise prescription (n = 5), behaviour change interventions (n = 10), combined exercise, and behaviour change techniques (n = 7) and education (n = 3). Generally, subjective but not objective physical activity improved in those with mild-moderate disability. Insufficient data existed on the effectiveness on sedentary behaviour.Conclusions: A discrepancy seems to exists between the effectiveness of physical activity interventions in people with Multiple Sclerosis depending on whether physical activity was assessed objectively or subjectively, with the latter indicating effects. Effects on sedentary behaviour remain to be elucidated.Implications for RehabilitationRemaining physically active is important to maintain functional ability, independence, quality of life, and to reduce the incidence of co-morbidity.Exercise prescription, behaviour change interventions, combined exercise and behaviour change interventions, and health promotion education appear to subjectively improve physical activity in people with Multiple Sclerosis with mild-moderate disability, yet this is often not the case when measured objectively.There is a lack of evidence to support the effectiveness of these interventions on sedentary behaviour.
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Affiliation(s)
- Elaine H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sarah Bond
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Ulrik Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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30
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Melendez-Torres GJ, Auguste P, Armoiry X, Maheswaran H, Court R, Madan J, Kan A, Lin S, Counsell C, Patterson J, Rodrigues J, Ciccarelli O, Fraser H, Clarke A. Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-352. [PMID: 28914229 DOI: 10.3310/hta21520] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND At the time of publication of the most recent National Institute for Health and Care Excellence (NICE) guidance [technology appraisal (TA) 32] in 2002 on beta-interferon (IFN-β) and glatiramer acetate (GA) for multiple sclerosis, there was insufficient evidence of their clinical effectiveness and cost-effectiveness. OBJECTIVES To undertake (1) systematic reviews of the clinical effectiveness and cost-effectiveness of IFN-β and GA in relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and clinically isolated syndrome (CIS) compared with best supportive care (BSC) and each other, investigating annualised relapse rate (ARR) and time to disability progression confirmed at 3 months and 6 months and (2) cost-effectiveness assessments of disease-modifying therapies (DMTs) for CIS and RRMS compared with BSC and each other. REVIEW METHODS Searches were undertaken in January and February 2016 in databases including The Cochrane Library, MEDLINE and the Science Citation Index. We limited some database searches to specific start dates based on previous, relevant systematic reviews. Two reviewers screened titles and abstracts with recourse to a third when needed. The Cochrane tool and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Philips checklists were used for appraisal. Narrative synthesis and, when possible, random-effects meta-analysis and network meta-analysis (NMA) were performed. Cost-effectiveness analysis used published literature, findings from the Department of Health's risk-sharing scheme (RSS) and expert opinion. A de novo economic model was built for CIS. The base case used updated RSS data, a NHS and Personal Social Services perspective, a 50-year time horizon, 2014/15 prices and a discount rate of 3.5%. Outcomes are reported as incremental cost-effectiveness ratios (ICERs). We undertook probabilistic sensitivity analysis. RESULTS In total, 6420 publications were identified, of which 63 relating to 35 randomised controlled trials (RCTs) were included. In total, 86% had a high risk of bias. There was very little difference between drugs in reducing moderate or severe relapse rates in RRMS. All were beneficial compared with BSC, giving a pooled rate ratio of 0.65 [95% confidence interval (CI) 0.56 to 0.76] for ARR and a hazard ratio of 0.70 (95% CI, 0.55 to 0.87) for time to disability progression confirmed at 3 months. NMA suggested that 20 mg of GA given subcutaneously had the highest probability of being the best at reducing ARR. Three separate cost-effectiveness searches identified > 2500 publications, with 26 included studies informing the narrative synthesis and model inputs. In the base case using a modified RSS the mean incremental cost was £31,900 for pooled DMTs compared with BSC and the mean incremental quality-adjusted life-years (QALYs) were 0.943, giving an ICER of £33,800 per QALY gained for people with RRMS. In probabilistic sensitivity analysis the ICER was £34,000 per QALY gained. In sensitivity analysis, using the assessment group inputs gave an ICER of £12,800 per QALY gained for pooled DMTs compared with BSC. Pegylated IFN-β-1 (125 µg) was the most cost-effective option of the individual DMTs compared with BSC (ICER £7000 per QALY gained); GA (20 mg) was the most cost-effective treatment for CIS (ICER £16,500 per QALY gained). LIMITATIONS Although we built a de novo model for CIS that incorporated evidence from our systematic review of clinical effectiveness, our findings relied on a population diagnosed with CIS before implementation of the revised 2010 McDonald criteria. CONCLUSIONS DMTs were clinically effective for RRMS and CIS but cost-effective only for CIS. Both RCT evidence and RSS data are at high risk of bias. Research priorities include comparative studies with longer follow-up and systematic review and meta-synthesis of qualitative studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42016043278. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- G J Melendez-Torres
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Xavier Armoiry
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hendramoorthy Maheswaran
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alan Kan
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephanie Lin
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carl Counsell
- Divison of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Jeremy Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Institute of Neurology, University College London, London, UK
| | - Hannah Fraser
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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31
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Kara B, Küçük F, Poyraz EC, Tomruk MS, İdıman E. Different types of exercise in Multiple Sclerosis: Aerobic exercise or Pilates, a single-blind clinical study. J Back Musculoskelet Rehabil 2018; 30:565-573. [PMID: 27911284 DOI: 10.3233/bmr-150515] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKROUND The aim of our study is to examine effects of aerobic and Pilates exercises on disability, cognition, physical performance, balance, depression and fatigue in relapsing-remitting Multiple Sclerosis (MS) patients as compared to healthy controls. METHODS The subjects were divided as aerobic exercise (n = 26), Pilates (n = 9), and the healthy control group (n = 21). We used MSFC, physical performance, Berg balance scale, Beck depression scale, fatigue impact scale. All evaluations were performed before and after exercise training. RESULTS There are statistically meaningful differences between Nine hole testing, PASAT 3, physical performance and fatique impact scale before and after aerobic exercise. Also we found significant difference for physical performance in the Pilates group. There are no significant differences in measures of fatique impact scale and depression between aerobic exercise group and the healthy controls after exercise. We found significant differences between Pilates and control group's after measurements except depression. There were significant differences between the Pilates and aerobic group for cognitive tests in favor of the Pilates group. CONCLUSION Aerobic exercise and clinical Pilates exercises revealed moderate changes in levels of cognitive, physical performance, balance, depression, fatigue in MS patients.
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Affiliation(s)
- Bilge Kara
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Dokuz Eylül University, İnciraltı, İzmir, Turkey
| | - Fadime Küçük
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | | | - Melda Soysal Tomruk
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Dokuz Eylül University, İnciraltı, İzmir, Turkey
| | - Egemen İdıman
- Department of Neurology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
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32
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Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:701-714. [PMID: 30459034 DOI: 10.1016/b978-0-444-64074-1.00042-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is a progressive neurologic disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff's phenomenon). This heat intolerance in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. Isolating and interpreting mechanisms responsible for autonomic dysfunction due to MS can be difficult as it may involve sensory impairments, altered neural integration within the central nervous system, impaired effector responses, or combinations of all of these factors. MS lesions occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacologic) for the MS patient to preserve function and decrease symptom worsening during heat stress. This review focuses on four main themes influencing current understanding of thermoregulatory dysfunction in MS: (1) heat intolerance; (2) central regulation of body temperature; (3) thermoregulatory effector responses; and (4) countermeasures to improve or maintain function during thermal stress.
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Affiliation(s)
- Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, United States.
| | - Ollie Jay
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Thad E Wilson
- Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
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33
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Steimer J, Weissert R. Effects of Sport Climbing on Multiple Sclerosis. Front Physiol 2017; 8:1021. [PMID: 29311957 PMCID: PMC5742106 DOI: 10.3389/fphys.2017.01021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/27/2017] [Indexed: 11/20/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system (CNS) with different types of disease courses (relapsing-remitting, secondary-progressive, primary progressive) that leads to physical as well as mental disability. The symptoms comprise paresis or/and paralysis, ataxia, bladder dysfunction, visual problems as well as effects on cognition. There is limited data regarding the possible effects of sport climbing respectively therapeutic climbing on patients with MS. Sport climbing offers many potentially beneficial effects for patients with MS since there are effects on coordination, muscular strength, and cognition to name the most relevant ones. Also, disease models in rodents point toward such positive outcomes of climbing. Therefore, we assessed the currently available research literature on general effects of physical exercise, impact of climbing on body and mind and therapeutic climbing for prevention or therapy for the treatment of MS. The sparse published controlled trials that investigated this sport activity on different groups of patients with neurological or geriatric diseases grossly differ in study design and outcome parameters. Nevertheless, it appears that climbing offers the opportunity to improve some of the symptoms of patients with MS and can contribute to an enhanced quality of life.
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Affiliation(s)
- Julia Steimer
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
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34
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Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol 2017; 17:185. [PMID: 28915856 PMCID: PMC5602953 DOI: 10.1186/s12883-017-0960-9] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/04/2017] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) can result in significant mental and physical symptoms, specially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression. Patients with MS frequently decrease physical activity due to the fear from worsening the symptoms and this can result in reconditioning. Physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental symptoms without any concern about triggering the onset or exacerbation of disease symptoms or relapse. MAIN BODY Appropriate exercise can cause noteworthy and important improvements in different areas of cardio respiratory fitness (Aerobic fitness), muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function in MS patients. Aerobic exercise training with low to moderate intensity can result in the improvement of aerobic fitness and reduction of fatigue in MS patients affected by mild or moderate disability. MS patients can positively adapt to resistance training which may result in improved fatigue and ambulation. Flexibility exercises such as stretching the muscles may diminish spasticity and prevent future painful contractions. Balance exercises have beneficial effects on fall rates and better balance. Some general guidelines exist for exercise recommendation in the MS population. The individualized exercise program should be designed to address a patient's chief complaint, improve strength, endurance, balance, coordination, fatigue and so on. An exercise staircase model has been proposed for exercise prescription and progression for a broad spectrum of MS patients. CONCLUSION Exercise should be considered as a safe and effective means of rehabilitation in MS patients. Existing evidence shows that a supervised and individualized exercise program may improve fitness, functional capacity and quality of life as well as modifiable impairments in MS patients.
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Affiliation(s)
- Farzin Halabchi
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Neurology, MS fellowship, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports and Exercise Medicine, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sports and Exercise medicine, Sina MS Research Center, Department of Sports Medicine, Sina Hospital, Hassan Abad Square, Tehran, Iran
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Donze C, Massot C, Hautecoeur P, Cattoir-Vue H, Guyot MA. The Practice of Sport in Multiple Sclerosis: Update. Curr Sports Med Rep 2017; 16:274-279. [PMID: 28696991 DOI: 10.1249/jsr.0000000000000374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The practice of sport by multiple sclerosis patients has long been controversial. Recent studies, however, show that both sport and physical activity are essential for these patients. Indeed, they help to cope with the effects of multiple sclerosis, such as fatigue, reduced endurance, loss of muscle mass, and reduction of muscle strength. The beneficial effects of physical activity on these patients have been underlined in several studies, whereas those of practicing sport have been the subject of fewer evaluations and assessments. The aim of this update is to report on the effects of sport on multiple sclerosis patients. The benefits of sport have been demonstrated in several studies. It helps multiple sclerosis patients to increase their balance, resistance to fatigue, mobility and quality of life. Several biases in these studies do not enable us to recommend the practice of some of these sports on a routine basis.
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Affiliation(s)
- Cecile Donze
- 1Department of Physical and Rehabilitation Medicine, Saint Philibert Hospital, Lomme, FRANCE; and 2Department of Neurology, Saint Philibert Hospital, Lomme, FRANCE
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Resistance Training for Muscle Weakness in Multiple Sclerosis: Direct Versus Contralateral Approach in Individuals With Ankle Dorsiflexors' Disparity in Strength. Arch Phys Med Rehabil 2017; 98:1348-1356.e1. [DOI: 10.1016/j.apmr.2017.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 02/21/2017] [Indexed: 12/16/2022]
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Manca A, Dvir Z, Dragone D, Mureddu G, Bua G, Deriu F. Time course of strength adaptations following high-intensity resistance training in individuals with multiple sclerosis. Eur J Appl Physiol 2017; 117:731-743. [DOI: 10.1007/s00421-017-3534-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
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Tai chi for health benefits in patients with multiple sclerosis: A systematic review. PLoS One 2017; 12:e0170212. [PMID: 28182629 PMCID: PMC5300172 DOI: 10.1371/journal.pone.0170212] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS). After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL) and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients.
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Learmonth YC, Ensari I, Motl RW. Physiotherapy and walking outcomes in adults with multiple sclerosis: systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2016.1263415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yvonne C. Learmonth
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ipek Ensari
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Magnani S, Olla S, Pau M, Palazzolo G, Tocco F, Doneddu A, Marcelli M, Loi A, Corona F, Corona F, Coghe G, Marrosu MG, Concu A, Cocco E, Marongiu E, Crisafulli A. Effects of Six Months Training on Physical Capacity and Metaboreflex Activity in Patients with Multiple Sclerosis. Front Physiol 2016; 7:531. [PMID: 27895592 PMCID: PMC5108173 DOI: 10.3389/fphys.2016.00531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with multiple sclerosis (MS) have an increased systemic vascular resistance (SVR) response during the metaboreflex. It has been hypothesized that this is the consequence of a sedentary lifestyle secondary to MS. The purpose of this study was to discover whether a 6-month training program could reverse this hemodynamic dysregulation. Patients were randomly assigned to one of the following two groups: the intervention group (MSIT, n = 11), who followed an adapted training program; and the control group (MSCTL, n = 10), who continued with their sedentary lifestyle. Cardiovascular response during the metaboreflex was evaluated using the post-exercise muscle ischemia (PEMI) method and during a control exercise recovery (CER) test. The difference in hemodynamic variables such as stroke volume (SV), cardiac output (CO), and SVR between the PEMI and the CER tests was calculated to assess the metaboreflex response. Moreover, physical capacity was measured during a cardiopulmonary test till exhaustion. All tests were repeated after 3 and 6 months (T3 and T6, respectively) from the beginning of the study. The main result was that the MSIT group substantially improved parameters related to physical capacity (+5.31 ± 5.12 ml·min−1/kg in maximal oxygen uptake at T6) in comparison with the MSCTL group (−0.97 ± 4.89 ml·min−1/kg at T6; group effect: p = 0.0004). However, none of the hemodynamic variables changed in response to the metaboreflex activation. It was concluded that a 6-month period of adapted physical training was unable to reverse the hemodynamic dys-regulation in response to metaboreflex activation in these patients.
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Affiliation(s)
- Sara Magnani
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Sergio Olla
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari Cagliari, Italy
| | - Girolamo Palazzolo
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Filippo Tocco
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Azzurra Doneddu
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Maura Marcelli
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Andrea Loi
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Federica Corona
- Department of Mechanical, Chemical and Materials Engineering, University of CagliariCagliari, Italy; Department of Public Health, Clinical and Molecular Medicine, University of CagliariCagliari, Italy
| | - Francesco Corona
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Giancarlo Coghe
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari Cagliari, Italy
| | - Maria G Marrosu
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Alberto Concu
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Eleonora Cocco
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari Cagliari, Italy
| | - Elisabetta Marongiu
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Lab, Department of Medical Sciences, University of Cagliari Cagliari, Italy
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Ebrahimi A, Eftekhari E, Etemadifar M. Effects of whole body vibration on hormonal & functional indices in patients with multiple sclerosis. Indian J Med Res 2016; 142:450-8. [PMID: 26609037 PMCID: PMC4683830 DOI: 10.4103/0971-5916.169210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background & objectives: Multiple sclerosis (MS) is a neurodegenerative disease, which affects the patients’ mobility, and exercise training is considered to be beneficial for these patients. The aim of this study was to determine the effects of 10 wk of low intensity exercise and whole body vibration (WBV) training on fatigue, quality of life, functional and physical indices, and serum levels of ghrelin, leptin, and testosterone in MS patients. Methods: Thirty four MS patients with mild to moderate disability were recruited and randomly divided into two groups, the training group (n=17) and control group (n=17). Patients in the training group did low intensity exercise and WBV training programme three times a week for 10 wk. The control group continued their routine life. Intended variables like expanded disability status scale (EDSS), fatigue, quality of life, functional and physical indices consisted of balance, walking speed, functional mobility, functional muscle endurance, and walking endurance, and serum levels of ghrelin, leptin, and testosterone were measured before and after the protocol. Results: Thirty subjects completed the study (23 females, 7 males; mean age =38.80 ± 9.50 yr). Statistical analysis demonstrated that EDSS in the WBV training group was significantly decreased (P=0.01), balance (P=0.01), and walking endurance significantly increased (P=0.01) in MS patients (P<0.05). Interpretation & conclusions: The results suggest that low intensity exercise and WBV training have some beneficial impact on functional and physical indices of MS patients.
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Affiliation(s)
| | - Elham Eftekhari
- Department of Physical Education & Sport Sciences, Najafabad Branch, Islamic Azad University, Isfahan, Iran
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Wens I, Eijnde BO, Hansen D. Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review. J Neurol Sci 2016; 367:107-21. [DOI: 10.1016/j.jns.2016.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 01/03/2023]
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Mostert S, Kesselring J. Effect of pulsed magnetic field therapy on the level of fatigue in patients with multiple sclerosis - a randomized controlled trial. Mult Scler 2016; 11:302-5. [PMID: 15957511 DOI: 10.1191/1352458505ms1156oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twenty-five multiple sclerosis patients, taking part in a rehabilitation program, were randomly assigned to treatment with pulsed magnetic field therapy (PMFT) or to sham therapy in order to study the additional effect of PMFTas part of a multimodal neurological rehabilitation program on fatigue. Patients demographic and disease specific characteristics were recorded. Level of fatigue was measured by fatigue sverity scale (FSS) at entrance and discharge and with a visual analog scale (VAS) immediate before and after a single treatment session. The ‘Magnetic Cell Regeneration’ system by Santerra was used for PMFT. A single treatment lasted 16 minutes twice daily over 3-4 weeks and consisted of relaxed lying on a PMF mattress. Sham intervention was conducted in an identical manner with the PMF-device off. Patients and statistics were blinded. Level of fatigue measured by FSS was high at entrance in both treatment group (TG) and control group (CG) (5.6 versus 5.5). Over time of rehabilitation fatigue was reduced by 18% in TG and 7% in CG which was statistically not significant. There was a statistically significant immediate effect of the single treatment session witch 18% reduction of fatigue measured by VAS in TG versus 11% in CG. Because of a high ‘placebo effect’ of simple bed rest, a only small and short lasting additional effect of PMFT and high costs of a PMF-device, we cannot recommend PMFTas an additional feature of a multimodal neurological rehabilitation program in order to reduce fatigue level of MS-patients.
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Affiliation(s)
- Stefan Mostert
- Department of Neurology, Rehabilitation Centre, CH 7317 Valens, Switzerland
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Abstract
Using meta-analytic procedures, this study involved a quantitative synthesis of the difference in physical activity among individuals with multiple sclerosis (MS) compared with nondiseased and diseased populations and then examined factors (i.e., moderators) that explain variation in the overall difference in physical activity. We searched MEDLINE, PsycINFO and Current Contents Plus using the key words physical activity, exercise and physical fitness in conjunction with multiple sclerosis; conducted a manual search of bibliographies of the retrieved papers; and contacted study authors about additional studies. Overall, 53 effects were retrieved from 13 studies with 2360 MS participants and yielded a weighted mean effect size (ES) of -0.60 (95% CI= -0.44,-0.77). The weighted mean ES was heterogenous, Q=1164.11, df=52, p<0.0001. There were larger effects with objective versus self-report measures of physical activity, nondiseased versus diseased populations and primary progressive versus relapsing-remitting MS. The cumulative evidence suggests that individuals with MS are less physically active than nondiseased, but not diseased, populations.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology, University of Illinois, 332 Freer Hall, Urbana, IL 61801, USA.
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Surakka J, Romberg A, Ruutiainen J, Aunola S, Virtanen A, Karppi SL, Mäentaka K. Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis: a randomized controlled trial. Clin Rehabil 2016; 18:737-46. [PMID: 15573829 DOI: 10.1191/0269215504cr780oa] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in subjects with multiple sclerosis (MS). Design: A randomized controlled trial. Setting: At Masku Neurological Rehabilitation Centre, Masku, and the Social Insurance Institution, Research Department, Turku, Finland. Subjects: Ninety-five MS patients with mild to moderate disability were randomized into exercise group (n = 47) and a control group (n = 48). Intervention: Participants in the exercise group attended in a supervised exercise period of three weeks, which was followed by a home exercise programme lasting for 23 weeks. Patients in the control group continued with their normal living. Outcome measures: Motor fatigue of knee flexor and extensor muscles was measured during a static 30-s maximal sustained muscle contraction. The decline in force (Nm) during the 30 s was recorded, and a fatigue index (FI) was calculated. Subjective fatigue was measured by using the Fatigue Severity Scale (FSS). The Ambulatory Fatigue Index (AFI) was calculated on the basis of a 500-m walking test. Assessment took place at baseline, at the third week (not for the control group) and at the 26th week. All outcome variables were analysed, men and women together, and some interesting contrasts were analysed by gender. Results: Associations were observed with changes in extension FI and Expanded Disability Status Scale (EDSS) score and mean extension torque (Nm), but not with changes in FI and aerobic or strength exercise activity, mean AFI, mean FSS or in mean knee flexion torque. AFI was decreased in all subject groups (p = 0.007). Motor fatigue was reduced in knee flexion (p = 0.0014) and extension (ns) among female but not in male exercisers after six months of exercise. The exercise activity of women was 25% higher than that of the men. Conclusions: Six months of exercise reduced motor fatigue in women, but not in men.
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Affiliation(s)
- Jukka Surakka
- National Public Health Institute, Department of Health and Functional Capacity, Turku, Finland.
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Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports Med 2016; 45:905-23. [PMID: 25739555 DOI: 10.1007/s40279-015-0307-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS. OBJECTIVES The objectives of this study were to (1) systematically review the psychometric properties of the VO2max test; (2) systematically review the literature on VO2max compared with healthy populations; (3) summarize correlates of VO2max; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO2max in PwMS. DATA SOURCES AND STUDY SELECTION A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity (VO2max) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. STUDY APPRAISAL AND SYNTHESIS METHODS The psychometric properties of the VO2max test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO2max. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. RESULTS A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO2max testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having low-to-mild disability, and an ∼10% change between two tests performed on separate days can be considered the smallest reliable change (with 95% certainty) in VO2max in PwMS. The average body-weight-adjusted VO2max was significantly lower in PwMS (25.5 ± 5.2 mL·kg(-1)·min(-1)) compared with healthy controls (30.9 ± 5.4 mL·kg(-1)·min(-1)). The analysis of VO2max correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO2max by as much as 3.5 mL·kg(-1)·min(-1). CONCLUSIONS A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits.
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Fjeldstad C, Fjeldstad AS, Pardo G. Use of Accelerometers to Measure Real-Life Physical Activity in Ambulatory Individuals with Multiple Sclerosis: A Pilot Study. Int J MS Care 2015; 17:215-20. [PMID: 26472942 DOI: 10.7224/1537-2073.2014-037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) may negatively affect individuals' participation in physical activity (PA). We used accelerometers to determine PA level in individuals with MS with varying degrees of disability as measured by the Expanded Disability Status Scale (EDSS) during regular daily activities. METHODS Participants wore an accelerometer from 8 a.m. to 9 p.m. for 7 consecutive days. Activity counts recorded during this period were analyzed in 1-minute epochs and categorized into one of four PA levels: light, moderate, hard, and very hard. RESULTS The study cohort comprised 13 patients with MS and 12 controls. There were significant negative correlations for minutes spent in PA and EDSS measures on weekdays (r = -0.61), weekend (r = -0.64), and full week (r = -0.61) and number of steps taken on weekdays (r = -0.56), weekend (r = -0.80), and full-week average (r = -0.68). Significant positive correlations were found for minutes spent in light PA and EDSS score (r = 0.69). Significant negative correlations were found for minutes spent in moderate and hard PA and EDSS score. No significant difference was seen between the MS group and controls on any parameters (P > .05). CONCLUSIONS This study showed that accelerometers can be used to objectively quantify PA levels in individuals with MS with different disability levels. This cohort demonstrated that the amount of PA is inversely proportional to the degree of physical disability. Collected data revealed not only the amount but also the intensity of PA performed in real-life circumstances.
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Affiliation(s)
- Cecilie Fjeldstad
- Oklahoma Medical Research Foundation, Multiple Sclerosis Center of Excellence, Oklahoma City, OK, USA (CF, GP); and Department of Neurology, University of Utah, Salt Lake City, UT, USA (ASF)
| | - Anette S Fjeldstad
- Oklahoma Medical Research Foundation, Multiple Sclerosis Center of Excellence, Oklahoma City, OK, USA (CF, GP); and Department of Neurology, University of Utah, Salt Lake City, UT, USA (ASF)
| | - Gabriel Pardo
- Oklahoma Medical Research Foundation, Multiple Sclerosis Center of Excellence, Oklahoma City, OK, USA (CF, GP); and Department of Neurology, University of Utah, Salt Lake City, UT, USA (ASF)
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Horton S, MacDonald DJ, Erickson K, Dionigi RA. A qualitative investigation of exercising with MS and the impact on the spousal relationship. Eur Rev Aging Phys Act 2015; 12:3. [PMID: 26865867 PMCID: PMC4743858 DOI: 10.1186/s11556-015-0148-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Multiple Sclerosis is an autoimmune disease that affects more than 2.3 million people around the world. Symptoms are numerous and varied, often having a profound effect on activities of daily living. While for many years individuals with MS were told to avoid exercise for fear of worsening their symptoms, recent research has emphasized the multi-faceted benefits associated with regular physical activity. Given the strain that MS can put on family and interpersonal relationships, the intention of this study was to investigate the exercise experiences of individuals with MS and the extent to which these experiences affect, or are affected by, their spousal relationship. Methods In-depth qualitative interviews were conducted with 10 individuals, five with MS, along with each of their spouses, in order to gain a comprehensive understanding of living and exercising with the disease. An inductive approach was used to analyze the interview data. Results The results displayed the important physical, psychological, and social benefits of involvement in an exercise program. Spouses help to counteract barriers and facilitate exercise, and are well aware of the integral role they play in their partner’s health and well-being. Spouses also valued the increased independence they gained, in the form of reduced care-giving responsibilities and enhanced social opportunities, as a result of the improved physical function of their partner. These findings contrast the severe strain on spousal relationships that is often reported in studies on people living with MS. Conclusions Rather than an inexorable downward decline in physical ability that is common with MS, participants spoke of a positive reversal in physical function, which has had far-reaching implications for multiple aspects of their lives, including their psychological outlook, their sense of independence, overcoming isolation, and their relationship with their spouse, all of which are identified in the literature as notable aspects of life affected by the disease.
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Affiliation(s)
- Sean Horton
- Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, N9B 3P4 Canada
| | - Dany J MacDonald
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - Karl Erickson
- Michigan State University, 308 West Circle Dr., East Lansing, MI 48824 USA
| | - Rylee A Dionigi
- School of Human Movement Studies, Faculty of Science, Charles Sturt University, Panorama Avenue, Bathurst, NSW, 2795 Australia
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Pearson M, Dieberg G, Smart N. Exercise as a Therapy for Improvement of Walking Ability in Adults With Multiple Sclerosis: A Meta-Analysis. Arch Phys Med Rehabil 2015; 96:1339-1348.e7. [DOI: 10.1016/j.apmr.2015.02.011] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/28/2015] [Accepted: 02/06/2015] [Indexed: 01/03/2023]
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50
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Wens I, Dalgas U, Verboven K, Kosten L, Stevens A, Hens N, Eijnde BO. Impact of high intensity exercise on muscle morphology in EAE rats. Physiol Res 2015; 64:907-23. [PMID: 26047382 DOI: 10.33549/physiolres.932824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The impact of high-intensity exercise on disease progression and muscle contractile properties in experimental autoimmune encephalomyelitis (EAE) remains unclear. Control (CON) and EAE rats were divided into sedentary and exercise groups. Before onset (experiment 1, n=40) and after hindquarter paralysis (experiment 2, n=40), isokinetic foot extensor strength, cross sectional area (CSA) of tibialis anterior (TA), extensor digitorum longus (EDL) and soleus (SOL) and brain-derived neurotrophic factor (BDNF) levels were assessed. EAE reduced muscle fiber CSA of TA, EDL and SOL. In general, exercise was not able to affect CSA, whereas it delayed hindquarter paralysis peak. CON muscle work peaked and declined, while it remained stable in EAE. BDNF-responses were not affected by EAE or exercise. In conclusion, EAE affected CSA-properties of TA, EDL and SOL, which could, partly, explain the absence of peak work during isokinetic muscle performance in EAE-animals. However, exercise was not able to prevent muscle fiber atrophy.
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Affiliation(s)
- I Wens
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
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