Outcomes of an aquatic exercise program including aerobic capacity, lactate threshold, and fatigue in two individuals with multiple sclerosis

A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis

OBJECTIVE

In this systematic review and meta-analysis, we aimed to evaluate the impact of long-term aquatic exercise training on balance, fatigue, and motor function.

METHODS

Scopus, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing, and Allied Health Literature were searched on April 19, 2021. The search included randomized and non-randomized controlled trials, case-control studies, case series, and case reports. Two independent reviewers reviewed titles and abstracts to determine which studies satisfied the eligibility criteria. Two reviewers independently surveyed the full texts and conducted the study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from included studies. Meta-analysis was performed using RevMan 5.

RESULTS

From 170 studies that were identified in the initial search, 16 trials (794 participants) satisfied the eligibility criteria. Aquatic therapy had a positive effect on fatigue compared to control group based on Modified Fatigue Impact Scale (MFIS) in physical (SMD, -1.29; 95% CI, [(-1.65) - (-0.93)]; I²=88%) cognitive (SMD, -0.75; 95% CI, [(-1.08)-(- 0.43)]; I²=78%), and psychological (SMD, -1.25; 95% CI, [(-1.59) - (-0.90)]; I²=79%) domains, and Fatigue Severity Scale (FSS) (SMD, -0.53; 95% CI, [(-0.86) - (-0.20)]; I²=57%). In addition, aquatic therapy improved balance based on the Berg Balance Scale (BBS) compared to the control group (SMD, 1.19; 95% CI, [(0.62)-(1.76)]; I²=11%) CONCLUSIONS: Aquatic therapy has positive effects on fatigue and balance. Further research is needed to confirm the clinical utility of aquatic therapy for multiple sclerosis patients in the long term.

Assessing the effects of exercise on post-partum fatigue symptoms: A systematic review and meta-analysis

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.

The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis

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.

The effectiveness of physical factors used in the treatment of patients with Multiple Sclerosis. Literature review

Introduction: Multiple Sclerosis (MS) is a chronic progressive disease of the nervous system which etiology is still unknown. Environmental factors, genetic predisposition and complex autoimmune reactions play a significant role in its pathogenesis. MS is not a fatal disease, but patients often require constant medical care and complex social welfare. Physiotherapy conducted at every stage of the disease depends on the current state of a patient and their functional capability and gradually occurring disorders and dysfunctions. Physical therapy is an important element of the therapy.

Aim: To evaluate the usefulness of physical treatments used in the treatment of the MS patients.

Material and methods: An analysis of domestic and foreign literature published between 2004 and 2014. The following databases were searched: PubMed, Science Direct, Termedia, Polish Medical Bibliography, Cochrane. The papers concerning the use of physical treatment as monotherapy and combination therapy were included.

Summary and conclusions: Numerous research confirm both safety and efficacy of physical methods used in treatment of the MS patients. The implementation of research on the mechanism of action and effectiveness of physical factors, which are well-designed in terms of methodology, allows for the selection of the optimal physical procedure. Modern equipment and current methods of physiotherapy change views on the previously used treatments, their methodology and application.

Difference in Motor Fatigue between Patients with Stroke and Patients with Multiple Sclerosis: A Pilot Study

Fatigue is often reported in stroke patients. However, it is still unclear if fatigue in stroke patients is more prominent, more frequent or more "typical" than in patients with multiple sclerosis (MS) and if the pathophysiology differs between these two populations. The purpose of this study was to compare motor fatigue and fatigue-induced changes in kinematic gait parameters between stroke patients, MS patients, and healthy persons. Gait parameters at the beginning and end of a treadmill walking test were assessed in 10 stroke patients, 40 MS patients, and 20 healthy subjects. The recently developed Fatigue index Kliniken Schmieder (FKS) based on change of the movement's attractor and its variability was used to measure motor fatigue. Six stroke patients had a pathological FKS. The FKS (indicating the level of motor fatigue) in stroke patients was similar compared to MS patients. Stroke patients had smaller step length, step height and greater step width, circumduction with the right and left leg, and greater sway compared to the other groups at the beginning and at the end of test. A severe walking impairment in stroke patients does not necessarily cause a pathological FKS indicating motor fatigue. Moreover, the FKS can be used as a measure of motor fatigue in stroke and MS and may also be applicable to other diseases.

Management of fatigue in persons with multiple sclerosis

Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.

Barriers and facilitators related to participation in aquafitness programs for people with multiple sclerosis: a pilot study

Exercise and leisure activities provide physical and psychosocial benefits to people with multiple sclerosis (MS) and can enhance their quality of life. In Winnipeg, Manitoba, Canada, people with MS have reported barriers to their participation in local MS-specific aquafitness (AF) programs. Therefore, a formal exploration of the accessibility of local AF programs for people with MS was undertaken. The purpose of this phenomenological study was to identify factors that facilitate or impede participation in AF programs by individuals with MS living in Winnipeg. Qualitative data were collected from a total of eight participants through one focus group (n = 7) and one in-depth interview (n = 1). The sample consisted of individuals with MS who were currently participating in AF programming as well as those who were not. Data were audio-recorded and transcribed verbatim, and thematic analysis was completed. Seven themes emerged regarding factors affecting participation in local AF programs. Barriers to participation included inadequate transportation, lack of one-on-one support, environmental inaccessibility, and fears associated with participation in the programs. Facilitators of participation included a knowledgeable instructor and experiencing physical and psychosocial benefits from the program. Information from this study was used locally to advocate for people with MS in order to increase participation in local AF programming.

The metabolic response to treadmill graded exercise: traditional vs. underwater

The purpose of this study was to determine the metabolic effect(s) of four graded exercise tests (GXT) performed on the underwater treadmill (UWT), and compare them to the results from performing the standard Bruce protocol on a traditional land treadmill (LT). Twelve male Division I college athletes performed the stand Bruce protocol on a LT and 4 different GXT protocols on the UWT. Each test was performed to volitional max. oxygen consumption (VO2), heart rate (HR), respiratory exchange ratio (RER) and blood lactate (BL), which were measured at regular intervals throughout each of the GXTs. A two-way ANOVA with repeated measures was used to determine any main effect among the variables within the protocols and within the stages. Established effects were identified further using Tukey's post-hoc analysis. VO2and HR were positively correlated in all the GXTs, (r=0.992−0.999). When comparing the UWT GXTs to the Bruce, significant (P≤0.001) differences were found within certain stages for each of the dependent variables. While the Bruce resulted in attainment of VO2max, (mean = 55.72±5.92 ml/kg/min), only one of the UWT GXTs resulted in the same level of metabolic stress. At maximum speed and water velocity, the UWT produced a mean VO2of 53.9±3.68 ml/kg/min. HR and RER both increased by stage in all the GXTs as did BL. The onset of blood lactate accumulation (OBLA) was identified in all of the GXTs with the exception of one of the UWTs. Mean BL at OBLA ranged from, 3.12+1.31 to 5.98+4.24 mmol/dl. Our results suggest that an UWT GXT protocol can be developed that would produce metabolic results similar to the Bruce through stage 5. Buoyancy and variation in biomechanics need to be studied further for their effects on energy metabolism while performing work on the UWT. However, this study provides a better understanding of the metabolic demands at different treadmill speeds and water jet settings with the UWT.

Endurance exercise improves walking distance in MS patients with fatigue

OBJECTIVES

Effects of endurance training in multiple sclerosis (MS) patients complaining of motor fatigue.

MATERIALS AND METHODS

Thirty MS patients complaining of fatigue with low to moderate disabilities randomly allocated to the intervention (thrice weekly 45-min intervals of endurance exercise) or control treatment (three 45-min episodes of stretching, balance training and coordination), both as 'add-on' therapy for 3 weeks during inpatient rehabilitation.

RESULTS

Maximal walking distance before intervention averaged 1043 +/- 568 and 1163 +/- 750 m in the two groups. The intervention group increased its maximal walking distance by 650 +/- 474 m. The control group extended its walking distance by 96 +/- 70 m.

CONCLUSIONS

The present data confirm a strong effect of endurance exercise on maximal walking distance. Remarkably, there were no parallel improvements on the Modified Fatigue Impact Scale, the Beck Depression Inventory and the Hamburg Quality of Life Questionnaire for MS.

Hypoxia-ischemia causes persistent movement deficits in a perinatal rabbit model of cerebral palsy: assessed by a new swim test

The relationship of movement between different muscle groups has not been quantified before in the newborn period. Cerebral palsy (CP), which often occurs as a result of perinatal hypoxia-ischemia (H-I), is categorized depending on clinical presentation, brain region involvement and extent of involvement. In order to test different brain region involvement, this study investigates individual and multi-joint involvement in a rabbit model of CP. Pregnant rabbits at 70% gestation were subjected to 40-min uterine ischemia. Newborn rabbit kits were subjected to a swim test at 5 time points over the first 11 days of life. H-I kits were divided into hypertonic and non-hypertonic groups based on muscle tone at birth. The ranges and velocity of angular movement of the forelimb and hind limb joints (wrist, elbow, shoulder, ankle, knee and hip) during supported swimming were determined. Severely impaired (hypertonic) animals have significantly reduced range and angular velocity of joint motion, which do not improve over time. The non-hypertonic group showed deficits in wrist and hind limb movements that were not evident on prolonged observation. Preventive treatment with an inhibitor of neuronal nitric oxide synthase decreased the incidence of severely impaired kits; the non-hypertonic kits showed a different pattern of swimming. Supported swimming allows quantification of limb and joint motion in the principal plane of movement in the absence of weight bearing and decreases the need for balance control. Identification and quantification of milder deficits allows mechanistic studies in the causation of H-I injury as well as estimation of recovery with therapeutic agents.

Metabolic testing in the office

The three most commonly used metabolic tests are the Resting Metabolic Rate, Anaerobic Threshold Testing, and V.O2max. For several decades, these metabolic tests have been confined to the setting of university-based physiology laboratories and cardiopulmonary environments, i.e., metabolic carts in the intensive care units. The information gathered is used as a research and clinical tool in evaluating metabolic activity in a variety of physiological states from a body at rest, to exercise (aerobic and anaerobic), in certain medical states like illness, fed/starvation, and medicinal or supplementation affective states. Over the last decade, as technology has improved, so have the metabolic testing carts. They have become widely available for mainstream use by a variety of health care professionals. The purpose of this article is to review these three tests and how they may be useful in a medical practice.