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Rinaldo N, Pasini A, Straudi S, Piva G, Crepaldi A, Baroni A, Caruso L, Manfredini F, Lamberti N. Effects of Exercise, Rehabilitation, and Nutritional Approaches on Body Composition and Bone Density in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol 2023; 8:132. [PMID: 37754965 PMCID: PMC10532597 DOI: 10.3390/jfmk8030132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
People with multiple sclerosis (pwMS) are affected by a wide range of disabilities, including a decrease in bone mineral density (BMD) and a worsening of body composition (BC), which negatively impact their quality of life quality. This study aims to analyze the effects of nonpharmacological interventions-in particular, physical activity, nutritional approaches, and rehabilitation-on BC and BMD in pwMS. This systematic review and meta-analysis was performed following the updated version of the PRISMA guidelines. In July 2022, five databases (MEDLINE, Embase, The Cochrane Library, Google Scholar, Web of Science) and gray literature were screened. Relevant articles published between 1 January 1990 and 1 September 2022 in any language were included. Outcomes of interest were anthropometric, BC measures, and BMD. The RoB 2.0 tool was used to assess the risk of bias. After duplicates elimination, 1120 records were screened, and 36 studies were included. A total of 25 articles were focused on physical activity and rehabilitation, 10 on nutrition, and 1 on multimodal intervention. One-third of the studies were judged to be at high risk of bias. The meta-analysis showed a high degree of heterogeneity due to the high variability in disease severity and intervention duration, intensity, frequency, and type. In general, no intervention showed consistent positive effects on BC. However, the most promising interventions seemed to be high-intensity training and ketogenic diets. Only a few studies considered BMD, and the results are inconsistent. Nevertheless, more studies are needed in order to confirm these results.
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Affiliation(s)
- Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Alba Pasini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Giovanni Piva
- Doctoral Program in Environmental Sustainability and Wellbeing, Department of Humanities, University of Ferrara, 44121 Ferrara, Italy;
| | - Anna Crepaldi
- Unit of Nephrology, University Hospital of Ferrara, 44124 Ferrara, Italy;
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Lorenzo Caruso
- Department of Environment and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
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Buehler RA, Yang F. Preliminary race-ethnicity-based analyses of fall risk among people with multiple sclerosis. Mult Scler Relat Disord 2023; 77:104857. [PMID: 37390677 DOI: 10.1016/j.msard.2023.104857] [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: 04/04/2023] [Revised: 06/02/2023] [Accepted: 06/24/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Mounting evidence suggests differences in the disease characteristics of multiple sclerosis (MS) across ethnic and racial groups. Although it is widely recognized that falls are a significant concern for people with MS (PwMS), no study has explored if the fall risk is related to race/ethnicity in PwMS. The primary purpose of this pilot study was to examine whether the risk of falls is different between age-matched White, Black, and Latinx PwMS. METHODS Fifteen White, 16 Black, and 22 Latinx, age-matched ambulatory PwMS were selected from previous studies. Demographic and disease information, the fall risk (annual fall prevalence, proportion of recurrent fallers, and the number of falls) in the preceding year, and a battery of fall risk factors (including the disability level, gait speed, and cognition) were compared between race/ethnicity groups. The fall history was gathered using the valid fall questionnaire. The disability level was assessed by the Patient Determined Disease Steps score. Gait speed was measured using the Timed 25-Foot Walk test. The short Blessed Orientation-Memory-Concentration test evaluates participants' cognitive function. SPSS 28.0 was used for all statistical analyses and a significance level of 0.05 was applied. RESULTS Among the demographic measurements, age (p = 0.052), sex (p = 0.17), body mass (p = 0.338), age at diagnosis (p = 0.623), and disease duration (p = 0.280) were comparable across groups while the body height was significantly different between racial groups (p < 0.001). Binary logistic regression analysis did not detect a significant relationship between the faller status and racial/ethnic group (p = 0.571) after controlling the body height and age. Similarly, the recurrent faller status was not associated with our participants' race/ethnicity (p = 0.519). There was no difference in the number of falls in the past year between racial groups (p = 0.477). The fall risk factors of disability level (p = 0.931) and gait speed (p = 0.252) were similar among the groups. However, the White group had a significantly better Blessed Orientation-Memory-Concentration score than the Black (p = 0.037) and Latinx (p = 0.036) groups. No significant difference in the Blessed Orientation-Memory-Concentration score was observed between the Black and Latinx groups (p = 0.857). CONCLUSION As the initial attempt, our preliminary study suggests that the annual risk of being a faller or recurrent faller may not be affected by PwMS' race/ethnicity. Similarly, the physical functions (quantified by the Patient Determined Disease Steps and the gait speed) are comparable between racial/ethnic groups. However, the cognitive function may differ among age-matched racial groups of PwMS. Given the small sample size, caution is warranted when interpreting our findings. Despite the limitations, our study provides pilot knowledge about how race/ethnicity affects the fall risk in PwMS. Due to the limited sample size, it is too soon to definitively conclude that race/ethnicity has ignorable impacts on fall risk in PwMS. Further studies with larger sample sizes and more fall risk metrics are needed to clarify the effects of race/ethnicity on fall risk in this population.
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Affiliation(s)
- Rebekah A Buehler
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, 30303, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, 30303, USA.
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Safder SNUH, Akram MU, Dar MN, Khan AA, Khawaja SG, Subhani AR, Niazi IK, Gul S. Analysis of EEG signals using deep learning to highlight effects of vibration-based therapy on brain. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Vibration training reducing falls in community-living older adults: a pilot randomized controlled trial. Aging Clin Exp Res 2023; 35:803-814. [PMID: 36781617 PMCID: PMC9924854 DOI: 10.1007/s40520-023-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although vibration training has been applied in older adults, it remains unclear if it can reduce falls. AIMS This pilot randomized-controlled trial aimed to test the effects of an 8-week vibration training program on reducing falls among community-dwelling adults. METHODS Forty-eight older adults were randomized to two groups: training and control. The training group received three weekly training sessions over eight weeks while the control group maintained their normal lifestyle over the 8-week period. Immediately before (or baseline), following (post-training), and three months after (retest) the 8-week training course, a group of fall risk factors were assessed for all participants. Each participant was also exposed to an unexpected gait-slip on a treadmill during post-training and retest sessions. Their daily-living fall incidence was collected for 12 months after the baseline test. The slip fall was the primary outcome, prospective all-cause falls were the secondary outcome, and fall risk factors acted as the tertiary ones. RESULTS The vibration training program significantly reduced the risk of slip-falls and improved all fall risk factors immediately after the training course. The training effect may be carried over for three months. The 8-week training program could also lower the number of falls between the baseline test and retest and reduce the recurrent faller rate across the 12 months after the baseline test. DISCUSSION This study indicates that vibration training might have some effects on fall-related measures in older adults. CONCLUSIONS An 8-week vibration training program could be effective to reduce falls in older adults. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02694666.
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Buehler R, Simpkins C, Yang F. Effects of vibration training on quality of life in older adults: a preliminary systematic review and meta-analysis. Qual Life Res 2022; 31:3109-3122. [PMID: 35396690 PMCID: PMC8993584 DOI: 10.1007/s11136-022-03135-w] [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] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Older adults experience reduced quality of life (QOL). Vibration training has been applied in older adults. However, it remains inconclusive whether vibration training improves QOL in this population. This review summarized the effects of vibration training in changing eight domains of the Short Form-36 (SF-36) among older adults. METHODS Five randomized controlled trials enrolling 212 participants were included. The mean difference (MD) was calculated as the effect size measurement. Meta-analyses were completed for each of the eight SF-36 domains. RESULTS Relative to control groups, vibration training is more effective in improving five QOL domains: physical function (MD = 15.61, p < 0.001), physical role limitations (MD = 12.71, p = 0.001), general health (MD = 10.59, p < 0.001), social function (MD = 11.60, p < 0.001), and vitality (MD = 6.86, p = 0.002). Vibration training may not lead to greater improvements for the other three domains (MD = 0.13-3.25, p values = 0.21-0.96) than the control groups. Vibration training showed a low attrition rate of 7.1%. CONCLUSION Vibration training programs may significantly improve five of eight SF-36 QOL domains. While three domains did not demonstrate significant improvements, results were slightly in favor of vibration training compared to the control groups. More rigorous studies are necessary to further confirm the effectiveness of vibration training on QOL in older adults.
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Affiliation(s)
- Rebekah Buehler
- Department of Kinesiology and Health, Georgia State University, 125 Decatur St., Suite-137, Atlanta, GA, 30303, USA
| | - Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, 125 Decatur St., Suite-137, Atlanta, GA, 30303, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, 125 Decatur St., Suite-137, Atlanta, GA, 30303, USA.
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Yang F, Wen PS, Bethoux F, Zhao Y. Effects of Vibration Training on Cognition and Quality of Life in People with Multiple Sclerosis. Int J MS Care 2021; 24:132-138. [DOI: 10.7224/1537-2073.2020-095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background: Multiple sclerosis (MS) detrimentally affects cognition and quality of life (QOL). Interventions that can improve cognitive deficit and QOL in people with MS are desired. This pilot study investigated the possible effects of vibration training on improving cognition and QOL in people with MS.
Methods: Eighteen adults with MS were randomized into two groups: training and control. The training group underwent 6 weeks of vibration training, and the control group maintained their normal lifestyle throughout the study. In both groups, before and after the training course, the disability status was evaluated by the Patient-Determined Disease Steps scale and the Multiple Sclerosis Functional Composite (MSFC), cognitive function was assessed by the Behavior Rating Inventory of Executive Function (BRIEF) and the Selective Reminding Test (SRT), and QOL was gauged by the 36-item Short Form Health Survey (SF-36).
Results: The training was well accepted by the participants, and no major adverse event was reported. All participants finished the entire protocol. Compared with the control group, after the training the training group showed greater improvements in MSFC score, Metacognition Index score of the BRIEF, SRT score, and physical domain score of the SF-36.
Conclusions: These results suggest that vibration training could be an effective alternative training paradigm to enhance cognition and QOL in people with MS, and they provide an encouraging base to conduct a large-scale clinical trial.
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Affiliation(s)
- Feng Yang
- From the Department of Kinesiology and Health (FY), Georgia State University, Atlanta, GA, USA
| | - Pey-Shan Wen
- Department of Occupational Therapy (P-SW), Georgia State University, Atlanta, GA, USA
| | - Francois Bethoux
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH, USA (FB)
| | - Yichuan Zhao
- Department of Mathematics and Statistics (YZ), Georgia State University, Atlanta, GA, USA
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Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials. Gait Posture 2021; 84:377-388. [PMID: 33476831 DOI: 10.1016/j.gaitpost.2020.12.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/22/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke. RESEARCH QUESTIONS 1) Are there effective interventions to prevent falls among people in the post-acute and chronic stages of stroke? and 2) How do fall prevention interventions change three key fall risk factors in this population: balance, mobility, and lower limb strength? METHODS Eleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot. RESULTS Thirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = -0.01 to 0.06 and p-value = 0.38-0.86), except one (the combined treadmill and overground walking) which significantly improved mobility. SIGNIFICANCE Currently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.
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Scholz M, Haase R, Trentzsch K, Weidemann ML, Ziemssen T. Fear of falling and falls in people with multiple sclerosis: A literature review. Mult Scler Relat Disord 2020; 47:102609. [PMID: 33189021 DOI: 10.1016/j.msard.2020.102609] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Fear of falling (FOF) is a widespread problem affecting about 60% of people with multiple sclerosis (pwMS). Inflammatory lesions in the brain that are caused by the disease result in gait deficits and increase the risk of fall. Falls induce fear of falling and trigger a vicious circle, which in turn increases the likelihood of falling. Objective of this review was to provide an overview of existing research on the effects of FOF and therapy options in multiple sclerosis. METHODS A systematic search at Web of Science and PubMed was conducted. The search included the terms (fear of falling) OR (concern about falling) OR (fall anxiety) AND (multiple sclerosis). RESULTS In included studies, FOF was measured by different instruments. The Falls Efficacy Scale-International (FES-I) was the most frequently used instrument for pwMS. Patients with a higher FOF score fell more frequently, had lower walking speed, shorter stride length, larger ellipse sway area and a more severe disability. At present, therapeutic offers exist mainly in the field of physiotherapy. For reducing FOF, assisted vibration (dz = 0.68), VR (dz =0.87) and bicycle training (dz = 1.23) were the most effective methods. CONCLUSION It is advisable to develop therapies that incorporate both physical and psychological aspects in neurorehabilitation, like in a cognitive behavioral therapy. Moreover, FOF monitoring should be integrated into the clinical routine.
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Affiliation(s)
- Maria Scholz
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Rocco Haase
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Katrin Trentzsch
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Marie Luise Weidemann
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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Andreu-Caravaca L, Chung LH, Ramos-Campo DJ, Marín-Cascales E, Encarnación-Martínez A, Rubio-Arias JÁ. Neuromuscular and Mobility Responses to a Vibration Session in Hypoxia in Multiple Sclerosis. Int J Sports Med 2020; 42:307-313. [PMID: 33075829 DOI: 10.1055/a-1273-8304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the acute effects of vibration training (WBVT) under hypoxic and normoxic conditions on the voluntary rate of force development (RFD), balance and muscle oxygen saturation (SMO2) in persons with Multiple Sclerosis (MS). 10 participants completed the study (30% males, 44.4±7.7 years, 164.3±8.9 cm, 65.2±11.1 kg, 2.5±1.3 Expanded Disability Status Scale, 24.1±4.0 kg.m-2 BMI). Maximal force, RFD during isometric knee extension, static balance with eyes open and closed and sit-to-stand test were evaluated before and immediately after one session of WBVT (12 60-s bout of vibration; frequency 35 Hz; amplitude 4 mm; 1-min rest intervals) under both normoxic and hypoxic conditions. In addition, SMO2 of the gastrocnemius lateralis was assessed during each condition. No changes were found in force, static balance and sit-to-stand test. Time-to-peak RFD increased in the left leg (p=0.02) and tended to increase in the right leg (p=0.06) after the hypoxic session. SMO2 resulted in significant increases from the initial to final intervals of the WBVT under both hypoxic and normoxic conditions (p<0.05). Increases in SMO2 during WBVT demonstrates muscle work that may contribute to the observed muscle adaptations in long-term WBVT programs without inducing decreases in neuromuscular activation, physical function and balance within a session.
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Affiliation(s)
- Luis Andreu-Caravaca
- International Chair of Sports Medicine, Universidad Católica San Antonio de Murcia, Murcia.,Faculty of Sport, Universidad Católica San Antonio de Murcia, Murcia
| | - Linda H Chung
- UCAM Research Center for High Performance Sport, Universidad Católica San Antonio de Murcia, Murcia
| | | | - Elena Marín-Cascales
- UCAM Research Center for High Performance Sport, Universidad Católica San Antonio de Murcia, Murcia
| | - Alberto Encarnación-Martínez
- Department of Physical Education and Sports, Research Group in Sport Biomechanics (GIBD), University of Valencia, Valencia
| | - Jacobo Á Rubio-Arias
- LFE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, Madrid
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Lin MW, Liu W, Yang F. Influence of multiple sclerosis on dynamic gait stability. J Biomech 2020; 106:109827. [PMID: 32517976 DOI: 10.1016/j.jbiomech.2020.109827] [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] [Received: 12/30/2019] [Revised: 04/10/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Falls are a serious health threat for people with multiple sclerosis (MS). Dynamic gait stability has been identified as a key risk factor of falls. The development of effective interventions for preventing falls requires a sound understanding of how MS affects dynamic gait stability. The purpose of the study was to compare dynamic gait stability within the framework of Feasible Stability Region between people with and without MS during level walking at a self-selected speed. Twenty adults with MS and 25 age- and sex-matched healthy individuals were recruited. Dynamic gait stability at touchdown and liftoff on both the strong and weak sides was assessed as the primary outcome measurement. Spatiotemporal gait parameters, including step times, step length, step frequency, and foot landing angle, were determined as explanatory variables. People with MS exhibited lower stability at both gait events bilaterally than their healthy counterparts. The lower stability was mainly attributable to the slower gait speed in MS than in the healthy control. To compensate for the dynamic gait stability deficit resulting from the slow gait speed, individuals with MS adopted a short step length to shift the center of mass motion state closer to the feasible stability region. For people with MS, the stability value was higher on the weak side than on the strong side at touchdown, but not liftoff. The findings from this study could provide insight into the impact of MS on the control of dynamic gait stability.
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Affiliation(s)
- Meng-Wei Lin
- Department of Kinesiology and Health, Georgia State University, Atlanta, USA
| | - Wei Liu
- Division of Osteopathic Rehabilitation, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, USA.
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Yang F, Butler AJ. Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis. Neurorehabil Neural Repair 2020; 34:275-288. [PMID: 32106762 DOI: 10.1177/1545968320907073] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Controlled whole-body vibration (CWBV) training has been applied to people with stroke. However, it remains inconclusive if CWBV reduces fall risk in this population. Objective. To (1) assess the immediate and retention effects of CWBV training on fall risk factors in people at postacute and chronic stages of stroke and (2) examine if CWBV dosage is correlated with the effect size (ES) for 3 fall risk factors: body balance, functional mobility, and knee strength. Methods. Twelve randomized controlled trials were included. ES was calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model. Results. CWBV training may lead to improved balance and mobility immediately after training (ES = 0.27, P = .03 for balance; ES = 0.34, P = .02 for mobility) but not at the 3-month follow-up test (ES = 0.02, P = .89 for balance; ES = 0.70, P = .11 for mobility). CWBV affects knee strength capacity with mild ES (ES = 0.08 and 0.11, respectively, for immediate and retention effect; P ≥ .68 for both). Metaregression indicated that the immediate ES is strongly correlated with training dosage for balance (r = 0.649; P = .029) and mobility (r = 0.785; P = .036). Conclusions. CWBV training may benefit balance and mobility immediately, but the training effect may not persist among people with stroke. Additionally, the CWBV dosage correlates with the ES for body balance and mobility. More high-quality studies are needed to determine the retention effects of CWBV training.
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Affiliation(s)
- Feng Yang
- Georgia State University, Atlanta, GA, USA
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Ramari C, Hvid LG, David ACD, Dalgas U. The importance of lower-extremity muscle strength for lower-limb functional capacity in multiple sclerosis: Systematic review. Ann Phys Rehabil Med 2019; 63:123-137. [PMID: 31816449 DOI: 10.1016/j.rehab.2019.11.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle strength) appear to have critical implications for lower-limb functional capacity. However, no review has summarized the current knowledge about the importance of muscle strength for functional tasks in PwMS. Expanding the current knowledge would advance the design of both clinical and research interventions aiming to improve functional capacity in PwMS. OBJECTIVES (1) To identify studies that measured lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS, and (2) to map associations between muscle strength and functional capacity. METHODS This review was based on a literature search (databases: PubMed, Embase). Included studies had to report data on lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS. The associations between muscle strength and functional capacity were analyzed by using the reported correlation coefficients (R) recalculated to the determination coefficient R2. Randomized trials and observational studies were included. RESULTS A total of 59 articles were reviewed; 17 (773 participants) reported associations between muscle strength and functional capacity. Lower-extremity muscle mechanical function explained a significant part of the variance in most lower-limb functional capacity tests (approximately 20-30%). This was particularly evident in muscle strength from the weakest leg. Muscle strength was predominantly tested on knee extensors and knee flexors by using isokinetic dynamometry during maximal isometric (0°/s) and dynamic (30-60°/s) contractions. Walking tests such as the timed 25-Foot Walk Test and 10-Min, 2-Min and 6-Min Walk Test were the most frequently performed functional capacity tests. CONCLUSIONS In PwMS, muscle strength of particularly the weakest limb explains 20% to 30% of the variance across a number of lower-limb functional capacity tests. Thus, exercise programs should focus on increasing lower-extremity muscle mechanical function in PwMS and minimizing strength asymmetry between limbs.
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Affiliation(s)
- Cintia Ramari
- Faculty of Physical Education, University of Brasilia, Brasília, Brazil.
| | - Lars G Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
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Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9234997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Metabolic syndrome (MetS) is related to overweight and obesity, and contributes to clinical limitations. Exercise is used for the management of MetS individuals, who are often not motivated to perform this practice. Whole body vibration exercise (WBVE) produces several biological effects, besides being safe, effective, and feasible for MetS individuals. This pseudo-randomized and cross-over controlled trial study aimed to analyze the effects of WBVE on MetS individuals’ neuromuscular activation using the surface electromyography (sEMG) pattern (root mean square (RMS)) of the vastus lateralis (VL) muscle and on the range of motion (ROM) of the knees. Participants (n = 39) were allocated to two groups: the treatment group (TG), which was exposed to WBVE, and the control group (CG). WBVE interventions were performed twice a week, for a period of 5 weeks. ROM and sEMG were analyzed at baseline, after the first session, and before and after the last session. sEMG (%RMS) significantly increased in the acute effect of the last session of WBVE (108.00 ± 5.07, p < 0.008, right leg; 106.20 ± 3.53, p < 0.02, left leg) compared to the CG. ROM did not significantly change in TG or CG. In conclusion, 5 weeks of WBVE exerted neuromuscular effects capable of increasing VL muscle RMS in individuals with MetS, this effect being potentially useful in the physical rehabilitation of these individuals.
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Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision. Rehabil Res Pract 2018; 2018:8180901. [PMID: 30345117 PMCID: PMC6174747 DOI: 10.1155/2018/8180901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/13/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Stroke is associated with long-term disability and patients experience numerous physical impairments including muscle weakness, particularly in the paretic limbs, balance, and functional mobility. During acute stroke rehabilitation, when individuals are less likely to be functionally independent and rely on rehabilitative care, the efficacy of low skill interventions that can reduce sedentary behaviour should be established. As such, this narrative revision focused on the use of empirical studies of whole-body vibration exercise (WBVE) on different health outcomes in stroke patients. The effects of WBVE on neuromuscular performance (muscular strength and power), mobility, spasticity, and cardiovascular responses have been highlighted. Although some positive results were reported we can conclude that there is no solid evidence confirming the beneficial effects of WBVE among people with stroke compared with either other types of physical activities or sham WBVE. Therefore, further research should be performed in this area, testing the feasibility and efficacy of using WBVE in a more homogeneous sample of stroke patients or comparing different WBVE parameters.
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