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Baroni A, Lamberti N, Gandolfi M, Rimondini M, Bertagnolo V, Grassilli S, Zerbinati L, Manfredini F, Straudi S. Traditional versus progressive robot-assisted gait training in people with multiple sclerosis and severe gait disability: study protocol for the PROGR-EX randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e002039. [PMID: 38779575 PMCID: PMC11110587 DOI: 10.1136/bmjsem-2024-002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Gait disorders are the most frequent symptoms associated to multiple sclerosis (MS). Robot-assisted gait training (RAGT) in people with MS (PwMS) has been proposed as a possible effective treatment option for severe motor disability without significant superiority when compared to intensive overground gait training (OGT). Furthermore, RAGT at high intensity may enhance fatigue and spasticity. This study aims to evaluate the effects of a low-intensity RAGT at progressively increasing intensity compared to conventional RAGT and OGT in PwMS and moderate to severe walking impairment. 24 PwMS will be recruited and assigned to one of the three treatment groups: low-intensity RAGT at progressively increasing intensity, conventional RAGT and OGT. All participants will receive 3-weekly treatment sessions of 3 hours each for 4 weeks. In the first 2 hours of treatment, all participants will receive a rehabilitation programme based on stretching exercises, muscle strengthening and educational interventions. During the last hour, subjects will undergo specific gait training according to the assignment group. Outcomes will be assessed before and after treatment and at 3-month follow-up. The primary outcome is walking speed. Secondary outcomes include mobility and balance, psychological measures, muscle oxygen consumption, electrical and haemodynamic brain activity, urinary biomarkers, usability, and acceptability of robotic devices for motor rehabilitation. The results of this study will provide a safe, affordable and non-operator-dependent, intervention for PwMS. Results in terms of functional, psychological, neurophysiological and biological outcomes will confirm our hypothesis. The study's trial registration number: NCT06381440.
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Affiliation(s)
- Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - Valeria Bertagnolo
- Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Silvia Grassilli
- Department of Environment and Prevention Sciences, Ferrara University, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
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Wanitschek A, Seebacher B, Muehlbacher A, Brenneis C, Ehling R. Comparison of patient-reported outcomes of physical activity and accelerometry in people with multiple sclerosis and ambulatory impairment: A cross-sectional study. Mult Scler Relat Disord 2024; 85:105532. [PMID: 38452648 DOI: 10.1016/j.msard.2024.105532] [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: 07/21/2023] [Revised: 12/29/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Accelerometers and patient-reported outcomes (PRO) are used to assess physical activity (PA) in people with multiple sclerosis (pwMS). So far it is unknown, however, whether these assessments represent mobility limitations in pwMS with mild and moderate to severe disability alike. The primary aim of the study was to assess the correlation between accelerometry and International Physical Activity Questionnaire (IPAQ) scores in pwMS with different degrees of ambulatory impairment. Taken its frequent use into account, the Godin Leisure Time Exercise Questionnaire (GLTEQ) was investigated as additional PRO. METHODS In a prospective cohort of pwMS, correlational analyses were performed between the number of daily steps, time spent in light, moderate to vigorous PA (MVPA) and time spent sitting as assessed using accelerometry (ActiGraph®-GT3X), and the respective IPAQ and GLTEQ scores. Additionally, associations of PA with disease-specific characteristics, aerobic capacity (VO2peak), walking assessments (Timed 25-Foot Walk, T25FW; 2-Minute Walk Test, 2MWT) and walking perception (Multiple Sclerosis Walking Scale-12; MSWS-12) were explored. Patient subgroups with mild (Expanded Disability Status Scale; EDSS score <4.0) and moderate to severe disability (EDSS ≥4.0) were analysed for the impact of ambulatory impairment on PA. Multiple linear regression was used to determine predictors of PA. RESULTS A total of 56 pwMS completed the study, with a mean (standard deviation, SD) age of 48.4 (10.3) years, disease duration of 14.8 (9.6) years and median (interquartile range) EDSS score of 3.5 (2.0 - 4.4). Moderate to weak correlations were found between daily step count and IPAQ total metabolic equivalent (MET) minutes/week (p < 0.001; r = 0.506), MVPA MET-minutes/week (p < 0.01; r = 0.479) and walking MET-minutes/week (p < 0.05; r = 0.372) in the total cohort. Time spent sitting was inversely correlated with total MET-minutes/week and MVPA MET-minutes/week (p < 0.05; r = -0.358 and r = -0.365). Subgroup analysis revealed, that daily step count was significantly correlated with total MET-minutes/week, MVPA MET-minutes/week and walking MET-minutes/week (p < 0.01, r = 0.569; p < 0.01, r = 0.531 and p < 0.05, r = 0.480, respectively) in the "mild disability" subgroup only, whereas time spent sitting was inversely correlated with total MET-minutes/week (p < 0.05; r = -0.582) in the "moderate to severe disability" subgroup. There was no association between objectively assessed PA and GLTEQ scores in any group. In the total cohort, moderate to weak correlations were found between daily step count and walking assessments (T25FW: p < 0.01, ρ = -0.508; 2MWT: p < 0.01, ρ=0.463) and MSWS-12 (p < 0.001; ρ = -0.609). Moderate to weak correlations were also observed between VO2peak and walking assessments (T25FW: p < 0.01; ρ = -0.516; 2MWT: p < 0.01, ρ=0.480). Multiple linear regression analysis identified disability and VO2peak as predictors of PA (p = 0.045; β=0.25 and p < 0.001; β=0.49). CONCLUSION Significant associations of objective PA measurements using accelerometry with IPAQ were found only in pwMS with "mild disability". In pwMS with "moderate to severe disability", IPAQ did not reflect the objectively assessed amount of PA. In our cohort, GLTEQ showed no association with objectively assessed PA. Thus, an MS-specific self-reported questionnaire for assessing PA is warranted.
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Affiliation(s)
- Andreas Wanitschek
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Barbara Seebacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria; Department of Rehabilitation Science, Clinic for Rehabilitation Muenster, Muenster, Austria
| | - Andreas Muehlbacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria.
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Schlagheck ML, Bansi J, Langeskov-Christensen M, Zimmer P, Hvid LG. Cardiorespiratory fitness (V̇O 2peak) across the adult lifespan in persons with multiple sclerosis and matched healthy controls. J Sci Med Sport 2024; 27:10-15. [PMID: 37951825 DOI: 10.1016/j.jsams.2023.10.009] [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: 07/16/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Cardiorespiratory fitness (measured as peak oxygen uptake; V̇O2peak) is a well-established health predictor in the general population and in persons with multiple sclerosis (pwMS). We aimed to investigate differences in V̇O2peak between age groups and the prevalence of V̇O2peak impairments across the adult lifespan in pwMS compared to age- and sex-matched healthy controls (HC). DESIGN Cross-sectional study. METHODS Data from 469 pwMS (EDSS range 1.0-7.0), who carried out graded cardiopulmonary exercise testing during their rehabilitation stay at the Valens clinic from 07/2010 to 10/2022, were retrospectively analyzed. Data from 21,063 HC were extracted from previously published studies containing normative reference values. RESULTS With advanced age (i.e., across age groups), a continuous deterioration of V̇O2peak was observed in both pwMS and HC. Within all age groups, V̇O2peak was reduced in pwMS compared to HC with deficits ranging from 29 % to 40 % for females (p < .05), and from 30 % to 41 % for males (p < .05). However, no age ∗ group interaction was observed in neither males (p = .626) nor females (p = .557). With V̇O2peak impairments defined as values below the 5th percentile of HC, a high prevalence was observed in pwMS, with values ranging from 48 % to 100 % across age groups. CONCLUSIONS The present data provide evidence for a parallel deterioration of V̇O2peak in pwMS and matched controls with advancing age, coinciding with a high prevalence of impairments in V̇O2peak already present in young adulthood in pwMS. Understanding the extent of impairments as well as the age trajectories of cardiorespiratory fitness in pwMS is crucial for designing optimal rehabilitative and preventive interventions.
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Affiliation(s)
- Marit L Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany.
| | - Jens Bansi
- Department of Research and Development, Kliniken Valens, Switzerland; OST - Eastern Swiss University of Applied Sciences, Department of Health, Switzerland
| | - Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; Department of Neurology, Viborg Regional Hospital, Denmark. https://twitter.com/LangekovMartin
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany. https://twitter.com/P_Zimmer
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark. https://twitter.com/HvidLars
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Torres-Costoso A, Martínez-Vizcaíno V, Reina-Gutiérrez S, Álvarez-Bueno C, Guzmán-Pavón MJ, Pozuelo-Carrascosa DP, Fernández-Rodríguez R, Sanchez-López M, Cavero-Redondo I. Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise. Arch Phys Med Rehabil 2021; 103:970-987.e18. [PMID: 34509464 DOI: 10.1016/j.apmr.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. DATA SOURCES MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. STUDY SELECTION Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. DATA EXTRACTION The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. DATA SYNTHESIS A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. CONCLUSIONS Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.
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Affiliation(s)
- Ana Torres-Costoso
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Diana P Pozuelo-Carrascosa
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha. Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Toledo, Spain
| | | | - Mairena Sanchez-López
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
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Annesi JJ. Mediators of relations of obesity treatment-associated changes in mood and weight: extending cross-sectional research. Transl Behav Med 2021; 11:2071-2080. [PMID: 34245301 DOI: 10.1093/tbm/ibab074] [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: 11/14/2022] Open
Abstract
Significant cross-sectional associations between mood and weight have been made in women; however, data on associated longitudinal effects and their psychological and behavioral mechanisms are required to inform obesity treatments that mostly have limited success beyond the very short term. Women participating in behavioral obesity treatments were assessed on psychological and behavioral measures, and weight change over 12 months. A treatment focused on physical activity and self-regulation (n = 67) had significantly better improvements than a treatment centered around weight-loss education (n = 64) on measures of mood (overall mood, depression, anxiety), self-regulation, emotional eating, eating behaviors, physical activity, and weight in women with obesity. Incorporating a lagged variable design, 12-month weight loss was significantly predicted (separately) by changes in overall negative mood, depression, and anxiety. When changes in measures of self-regulation, emotional eating, and eating behaviors were sequentially entered as mediators, mood change-weight change relationships were rendered non-significant. Significant mediation paths were: mood change→self-regulation change→weight change, and mood change→self-regulation change→eating behavior change→weight change. They were unaffected by the treatment group. Findings contributed to both theory and obesity intervention architectures via a design sensitive to the dynamic psychological and behavioral changes occurring within weight-loss processes.
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Affiliation(s)
- James J Annesi
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Pau M, Porta M, Coghe G, Cocco E. What gait features influence the amount and intensity of physical activity in people with multiple sclerosis? Medicine (Baltimore) 2021; 100:e24931. [PMID: 33655958 PMCID: PMC7939208 DOI: 10.1097/md.0000000000024931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/29/2021] [Indexed: 01/04/2023] Open
Abstract
Although the mutual relationship between ambulation and physical activity (PA) in people with multiple sclerosis (pwMS) has been described in several studies, there is still a lack of detailed information about the way in which specific aspects of the gait cycle are associated with amount and intensity of PA. This study aimed to verify the existence of possible relationships among PA parameters and the spatio-temporal parameters of gait when both are instrumentally assessed.Thirty-one pwMS (17F, 14 M, mean age 52.5, mean Expanded Disability Status Scale (EDSS) score 3.1) were requested to wear a tri-axial accelerometer 24 hours/day for 7 consecutive days and underwent an instrumental gait analysis, performed using an inertial sensor located on the low back, immediately before the PA assessment period. Main spatio-temporal parameters of gait (i.e., gait speed, stride length, cadence and duration of stance, swing, and double support phase) were extracted by processing trunk accelerations. PA was quantified using average number of daily steps and percentage of time spent at different PA intensity, the latter calculated using cut-point sets previously validated for MS. The existence of possible relationships between PA and gait parameters was assessed using Spearman rank correlation coefficient rho.Gait speed and stride length were the parameters with the highest number of significant correlations with PA features. In particular, they were found moderately to largely correlated with number of daily steps (rho 0.62, P< .001), percentage of sedentary activity (rho = -0.44, P < .001) and percentage of moderate-to-vigorous activity (rho = 0.48, P < .001). Small to moderate significant correlations were observed between PA intensity and duration of stance, swing and double support phases.The data obtained suggest that the most relevant determinants associated with higher and more intense levels of PA in free-living conditions are gait speed and stride length. The simultaneous quantitative assessment of gait parameters and PA levels might represent a useful support for physical therapists in tailoring optimized rehabilitative and training interventions.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health University of Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health University of Cagliari, Italy
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Bombardier CH, Motl RW, Benedict RHB, Temkin N, Qian P, Alexander K, Evans A, Thomas A, Toms K, Carey CM, Kraft GH. Exercise training and cognition in multiple sclerosis: The GET Smart trial protocol. Contemp Clin Trials 2021; 104:106331. [PMID: 33652128 DOI: 10.1016/j.cct.2021.106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) causes cognitive impairment in approximately 50% of cases. Disease modifying medications and cognitive rehabilitation produce only small positive effects on cognition in MS. Converging animal and human research suggests that aerobic exercise may improve cognition in people with MS, but definitive trials are lacking. We describe the design of the GET Smart study, a randomized controlled trial comparing the effects of aerobic exercise versus stretching and toning on cognition in MS. METHODS The study is a single-blind, parallel group randomized (1:1) controlled trial that compares aerobic exercise training with an active control group consisting of stretching and toning exercises for improving cognition. Participants are nondepressed, ambulatory, non-exercising adults with MS aged 18-54 years who have below average cognitive processing speed. Both treatments were designed to generate equivalent outcome expectancies and entailed supervised, progressive exercise programs, 3 times per week for up to 40 min over a 6 month period. PROJECTED PATIENT OUTCOMES The primary hypothesis is that the aerobic training group will demonstrate significantly greater cognitive processing speed compared with the control group at the end of the treatment phase (6 months) as measured by a composite of the Paced Auditory Serial Additon Test and the oral Symbol-Digit Modalities Test using intent-to treat analyses. Secondary outcomes are neuropsychological functioning and cardiorespiratory fitness as well as participant reported outcomes such as depression, sleep, and fatigue. Study findings will inform future research, patient education, clinical care and policymaking. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02106052.
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Affiliation(s)
- Charles H Bombardier
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA.
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama, SHPB 336, 1716 9th Avenue South, Birmingham, AL 35233, USA
| | - Ralph H B Benedict
- Departments of Neurology and Psychiatry, University at Buffalo, UBMD Physicians Group, 1001 Main Street, 4th Floor, Buffalo, NY 14203, USA
| | - Nancy Temkin
- Departments of Neurological Surgery, School of Medicine and Biostatistics, School of Public Health, University of Washington, Box 359925, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - Peiqing Qian
- Multiple Sclerosis Center, Swedish Neuroscience Institute, 1600 E Jefferson St, Seattle, WA 98122, USA
| | - Katharine Alexander
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - Annabeth Evans
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - Andrea Thomas
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - Kristin Toms
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - Cathea M Carey
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA
| | - George H Kraft
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA; Departments of Rehabilitation Medicine and Neurology, University of Washington, Box 356490, UW Medical Center-Montlake, 1959 NE Pacific St., Seattle, WA 98195, USA
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Rubio-Arias JÁ. Dosage and Effectiveness of Aerobic Training on Cardiorespiratory Fitness, Functional Capacity, Balance, and Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:1826-1839. [PMID: 33567335 DOI: 10.1016/j.apmr.2021.01.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the benefits of aerobic training (AT) programs on cardiorespiratory fitness, functional capacity, balance, and fatigue in individuals with multiple sclerosis (MS) and to identify the optimal dosage of AT programs for individuals with MS via a systematic review with meta-analysis. DATA SOURCES Two electronic databases were searched until March 2020 (PubMed-Medline and Web of Science). STUDY SELECTION Studies examining the effect of AT program on cardiorespiratory fitness, functional capacity, balance, and fatigue were included. DATA EXTRACTION After applying the inclusion and exclusion criteria, we included 43 studies. A total sample of 1070 individuals with MS (AT group, n=680; control group, n=390) were analyzed. DATA SYNTHESIS The AT group demonstrated a significant increase in cardiorespiratory fitness (standardized mean difference [SMD], 0.29; P=.002), functional capacity (timed Up and Go Test: SMD, -1.14; P<.001; gait speed: SMD, -1.19; P<.001; walking endurance: SMD, 0.46; P<.001), and balance (SMD, 3.49; P<.001) after training. Fatigue perception also decreased (SMD, -0.45; P<.001). However, no significant differences were observed when compared with the control group in either cardiorespiratory fitness (SMD, 0.14; P=.19) or fatigue perception. Nevertheless, we observed significant differences between the AT and control groups in balance (P=.02), gait speed (P=.02), and walking endurance (P=.03), favoring the participants who performed AT. Regarding the subgroup analysis, no significant differences were observed between subgroups in any of the variables studied except for gait speed, for which a greater increase in posttraining was observed when the AT program applied the continuous method (χ2=7.75; P=.005) and the exercises were performed by walking (χ2=9.36; P=.002). CONCLUSIONS Aerobic training improves gait speed, walking endurance, and balance. Cardiorespiratory fitness and fatigue perception also improved after AT, but we found no differences with the control group. In addition, subgroup analysis suggested that training using continuous and walking methods could optimize gait speed.
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Affiliation(s)
- Luis Andreu-Caravaca
- International Chair of Sports Medicine, Catholic University of Murcia, Murcia, Spain; Faculty of Sport, Catholic University of Murcia, Murcia, Spain
| | | | - Linda H Chung
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Jacobo Á Rubio-Arias
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Madrid; Department of Education, University of Almería, Almeria, Spain.
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9
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Pau M, Porta M, Coghe G, Frau J, Lorefice L, Cocco E. Does Multiple Sclerosis Differently Impact Physical Activity in Women and Man? A Quantitative Study Based on Wearable Accelerometers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8848. [PMID: 33260721 PMCID: PMC7729610 DOI: 10.3390/ijerph17238848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
In people with multiple sclerosis (pwMS), fatigue, weakness and spasticity may reduce mobility and promote sedentary behavior. However, little is known about the existence of possible differences in the way MS modifies the propensity to perform physical activity (PA) in men and women. The present study aimed to partly close this gap by means of quantitative analysis carried out using wearable sensors. Forty-five pwMS (23 F, 22 M, mean age 50.3) and 41 unaffected age- and sex-matched individuals wore a tri-axial accelerometer 24 h/day for 7 consecutive days. Raw data were processed to calculate average number of daily steps, vector magnitude (VM) counts, and percentage of time spent in sedentary behavior and in PA of different intensities (i.e., light and moderate-to-vigorous, MVPA). Women with MS spent more time in sedentary behavior and exhibited a reduced amount of light intensity activity with respect to men, while MVPA was similar across sexes. However, in comparison with unaffected individuals, the overall PA patterns appear significantly modified mostly in women who, in presence of the disease, present increased sedentary behavior, reduced MVPA, number of daily steps and VM counts. The findings of the present study highlight the urgency of including sex as variable in all studies on PA in pwMS.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy;
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy;
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Jessica Frau
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
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10
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Manfredini F, Straudi S, Lamberti N, Patergnani S, Tisato V, Secchiero P, Bernardi F, Ziliotto N, Marchetti G, Basaglia N, Bonora M, Pinton P. Rehabilitation Improves Mitochondrial Energetics in Progressive Multiple Sclerosis: The Significant Role of Robot-Assisted Gait Training and of the Personalized Intensity. Diagnostics (Basel) 2020; 10:diagnostics10100834. [PMID: 33080806 PMCID: PMC7602995 DOI: 10.3390/diagnostics10100834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
Abnormal levels of pyruvate and lactate were reported in multiple sclerosis (MS). We studied the response of markers of mitochondrial function to rehabilitation in relation to type, intensity and endurance performance in severely disabled MS patients. Forty-six progressive MS patients were randomized to receive 12 walking sessions of robot-assisted gait training (RAGT, n = 23) or conventional overground therapy (CT, n = 23). Ten healthy subjects were also studied. Blood samples were collected to determine lactate, pyruvate, and glutathione levels and lactate/pyruvate ratio pre–post rehabilitation. In vivo muscle metabolism and endurance walking capacity were assessed by resting muscle oxygen consumption (rmVO2) using near-infrared spectroscopy and by six-minute walking distance (6MWD), respectively. The levels of mitochondrial biomarkers and rmVO2, altered at baseline with respect to healthy subjects, improved after rehabilitation in the whole population. In the two groups, an enhanced response was observed after RAGT compared to CT for lactate (p = 0.012), glutathione (<0.001), lactate/pyruvate ratio (p = 0.08) and rmVO2 (p = 0.07). Metabolic biomarkers and 6MWD improvements were exclusively correlated with a training speed markedly below individual gait speed. In severely disabled MS patients, rehabilitation rebalanced altered serum metabolic and muscle parameters, with RAGT being more effective than CT. A determinable slow training speed was associated with better metabolic and functional recovery. Trial Registration: ClinicalTrials.gov NCT02421731.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Sofia Straudi
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Nicola Lamberti
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
- Correspondence: ; Tel.: +39-0532-236187
| | - Simone Patergnani
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
| | - Veronica Tisato
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (V.T.); (P.S.)
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (V.T.); (P.S.)
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy;
| | - Nicole Ziliotto
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Giovanna Marchetti
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
| | - Nino Basaglia
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Massimo Bonora
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
| | - Paolo Pinton
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
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11
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Exercise-Induced Brain Excitability Changes in Progressive Multiple Sclerosis: A Pilot Study. J Neurol Phys Ther 2020; 44:132-144. [DOI: 10.1097/npt.0000000000000308] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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Huang MH, Fry D, Doyle L, Burnham A, Houston N, Shea K, Smith H, Wiske L, Goode J, Khitrik E, Kolanda M. Effects of inspiratory muscle training in advanced multiple sclerosis. Mult Scler Relat Disord 2020; 37:101492. [DOI: 10.1016/j.msard.2019.101492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
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13
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Stennett A, De Souza L, Norris M. A qualitative exploration of physiotherapists' perceptions about exercise and physical activity: reflections on the results from a Delphi Study. Disabil Rehabil 2019; 42:3142-3151. [PMID: 31012331 DOI: 10.1080/09638288.2019.1585969] [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: 10/27/2022]
Abstract
Purpose: This study explored physiotherapists' interpretation of exercise and physical activity, examined physiotherapists' views and opinions about the prioritised physical activity practices of people with multiple sclerosis and its implication for clinical practice.Method: Fourteen physiotherapists (12 females, 2 males) with experience of working with people with multiple sclerosis in the community participated in three focus groups. Physiotherapists commented on the results of a previous Delphi study which highlighted the prioritised exercise and physical activity practices and reasons people with multiple sclerosis engage in exercise and physical activity. The focus groups were audio recorded and transcribed verbatim. Data were analysed using framework analysis.Results: Four themes were developed from the analysis namely, Blurred terminologies, Influencing factors for the meaning of exercise and physical activity, When professional expertise meets experiential expertise and The resolve: resolving professional and experiential tensions.Conclusion: Physiotherapists described exercise and physical activity as movement with a focus on the physiological attributes. Nonetheless they valued and use exercise and physical activity as strategies to manage the symptoms associated with multiple sclerosis. Physiotherapists are strategically placed in the community to initiate discussions, assess, and create opportunities to enhance the physical activity practices of people with multiple sclerosis. However, there is greater scope for the application of physical activity to be embedded in routine clinical practice in the management of multiple sclerosis in the community.Implications for rehabilitationPhysiotherapists should design flexible physical activity programmes which are meaningful, engaging and foster the necessary environment to sustain physical activity participation in people with multiple sclerosis.Health professionals should be aware of and understand the individuals' priorities as these are key drivers to engaging and sustaining physical activity in community dwelling people with multiple sclerosis.Physiotherapists should be aware of their own beliefs and theoretical principles that guide designs and treatment programmes as these might either enhance or restrict physical activity in people with multiple sclerosis.
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Affiliation(s)
- Andrea Stennett
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Lorraine De Souza
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, UK
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Young HJ, Mehta TS, Herman C, Wang F, Rimmer JH. The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis. Arch Phys Med Rehabil 2019; 100:391-400. [DOI: 10.1016/j.apmr.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
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Prolonged cortical silent period is related to poor fitness and fatigue, but not tumor necrosis factor, in Multiple Sclerosis. Clin Neurophysiol 2019; 130:474-483. [PMID: 30771724 DOI: 10.1016/j.clinph.2018.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Poor fitness among people with Multiple Sclerosis (MS) aggravates disease symptoms. Whether low fitness levels accompany brain functioning changes is unknown. METHODS MS patients (n = 82) completed a graded maximal exercise test, blood was drawn, and transcranial magnetic stimulation determined resting and active motor thresholds, motor evoked potential latency, and cortical silent period (CSP). RESULTS Sixty-two percent of participants had fitness levels ranked below 10th percentile. Fitness was not associated with disability measured using the Expanded Disability Status Scale (EDSS). Regression analyses revealed that, cardiorespiratory fitness, when controlling for disease demographics, contributed 23.7% (p < 0.001) to the model explaining variance in CSP. Regression analysis using cardiorespiratory fitness and CSP as predictors showed that CSP alone explained 19.9% of variance in subjective fatigue (p = 0.002). Tumor necrosis factor was not associated with any variable. CONCLUSION Low fitness was associated with longer CSP in MS. Longer CSP was, in turn, related to greater MS fatigue. SIGNIFICANCE MS patients had extremely low levels of cardiorespiratory fitness. Poor fitness predicted longer CSP, a marker of greater intracortical inhibition, which was linked to MS fatigue. Future research should examine whether aerobic training could shorten CSP and potentially lessen inhibition of cortical networks.
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Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. Mult Scler Relat Disord 2019; 29:41-47. [PMID: 30658263 DOI: 10.1016/j.msard.2019.01.009] [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] [Received: 10/29/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Body composition refers to the relative distribution of different tissue types within the body, including fat, lean, and bone tissues. There is evidence for associations between body composition and the development of multiple sclerosis (MS). The relationship between body composition and disease progression and disability accumulation, however, is unclear. OBJECTIVES To examine: a) differences in overall and regional body composition by disability status in persons with multiple sclerosis (MS); and b) the relationship between body composition and other outcomes reflecting impairments and limitations due to MS. METHODS Cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0-4.0; n = 26) or moderate (4.5-6.5; n = 21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat (BF), fat mass (FM), and fat-free soft tissue mass (FFM)), bone mineral content (BMC), and bone mineral density (BMD) determined from dual-energy X-ray absorptiometry (DXA). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). RESULTS Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability (all p < .05). There were no significant differences in whole-body or regional FFM by disability status. In the overall sample, body fat correlated significantly with cardiorespiratory fitness (prs = -.52 to -.56), pain symptoms (prs = .32), and psychological HRQOL (prs = .34). FFM (prs = .38-.48) and BMC (prs = .53-.69) correlated primarily with measures of muscular strength. CONCLUSIONS Persons with MS who have greater disability present with higher body fat and lower bone tissue content and density than those with mild disability. These findings highlight the need for strategies that address potential changes in body composition with disability accumulation.
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Affiliation(s)
- Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, 200 Lees Avenue, Ottawa, ON K1N 6N5, Canada.
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 1705 University Blvd., Birmingham, AL 35233-1212, USA
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Edwards T, Motl RW, Sebastião E, Pilutti LA. Pilot randomized controlled trial of functional electrical stimulation cycling exercise in people with multiple sclerosis with mobility disability. Mult Scler Relat Disord 2018; 26:103-111. [DOI: 10.1016/j.msard.2018.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
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18
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Moffat F, Paul L. Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique. Disabil Rehabil 2018; 41:2775-2783. [DOI: 10.1080/09638288.2018.1479456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Fiona Moffat
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Paul
- Nursing and Healthcare School, University of Glasgow, Glasgow, UK
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19
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Casey B, Coote S, Galvin R, Donnelly A. Objective physical activity levels in people with multiple sclerosis: Meta-analysis. Scand J Med Sci Sports 2018; 28:1960-1969. [DOI: 10.1111/sms.13214] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Affiliation(s)
- B. Casey
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - S. Coote
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - R. Galvin
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - A. Donnelly
- Faculty of Education and Health Sciences; Department of Physical Education and Sport Sciences; University of Limerick; Limerick Ireland
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20
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Feter N, Freitas M, Gonzales N, Umpierre D, Cardoso R, Rombaldi A. Effects of physical exercise on myelin sheath regeneration: A systematic review and meta-analysis. Sci Sports 2018. [DOI: 10.1016/j.scispo.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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Sikes EM, Richardson EV, Cederberg KJ, Sasaki JE, Sandroff BM, Motl RW. Use of the Godin leisure-time exercise questionnaire in multiple sclerosis research: a comprehensive narrative review. Disabil Rehabil 2018; 41:1243-1267. [PMID: 29343122 DOI: 10.1080/09638288.2018.1424956] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE The Godin Leisure-Time Exercise Questionnaire has been a commonly applied measure of physical activity in research among persons with multiple sclerosis over the past decade. This paper provides a comprehensive description of its application and inclusion in research on physical activity in multiple sclerosis. METHOD This comprehensive, narrative review included papers that were published between 1985 and 2017, written in English, involved participants with multiple sclerosis as a primary population, measured physical activity, and cited one of the two original Godin papers. RESULTS AND CONCLUSION There is a broad scope of research that has included the Godin Leisure-Time Exercise Questionnaire in persons with multiple sclerosis. Overall, 8 papers evaluated its psychometric properties, 21 evaluated patterns of physical activity, 24 evaluated correlates or determinants of physical activity, 28 evaluated outcomes or consequences of physical activity, and 15 evaluated physical activity interventions. The Godin Leisure-Time Exercise Questionnaire is a valid self-report measure of physical activity in persons with multiple sclerosis, and further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity, and provides a sensitive outcome for measuring change in physical activity after an intervention. Implications for rehabilitation There is increasing interest in physical activity and its benefits in multiple sclerosis. The study of physical activity requires appropriate and standardized measures. The Godin Leisure-Time Exercise Questionnaire is a common self-report measure of physical activity for persons with multiple sclerosis. Godin Leisure-Time Exercise Questionnaire scores are reliable measures of physical activity in persons with multiple sclerosis. The Godin Leisure-Time Exercise Questionnaire further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity participation, and is an advantageous primary outcome for measuring change in physical activity in response to an intervention.
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Affiliation(s)
- Elizabeth Morghen Sikes
- a School of Health Professions - Rehabilitation Science , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Emma V Richardson
- b Department of Physical Therapy , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Katie J Cederberg
- a School of Health Professions - Rehabilitation Science , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jeffer E Sasaki
- b Department of Physical Therapy , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Brian M Sandroff
- b Department of Physical Therapy , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Robert W Motl
- b Department of Physical Therapy , University of Alabama at Birmingham , Birmingham , AL , USA
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22
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Rietberg MB, Veerbeek JM, Gosselink R, Kwakkel G, van Wegen EEH. Respiratory muscle training for multiple sclerosis. Cochrane Database Syst Rev 2017; 12:CD009424. [PMID: 29267988 PMCID: PMC6486138 DOI: 10.1002/14651858.cd009424.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. OBJECTIVES To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. DATA COLLECTION AND ANALYSIS One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH2O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I2 = 0%) or maximal expiratory pressure (MD -8.22 cmH2O, 95% CI -26.20 to 9.77, P = 0.37, I2 = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH2O, 95% CI 6.03 to 35.81, P = 0.006, I2 = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH2O, 95% CI -10.63 to 22.35, P = 0.49, I2 = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH2O, 95% CI -0.93 to 17.59, P = 0.18, I2 = 42%) or maximal inspiratory pressure (MD 3.54 cmH2O, 95% CI -5.04 to 12.12, P = 0.42, I2 = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I2 = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. AUTHORS' CONCLUSIONS This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.
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Affiliation(s)
- Marc B Rietberg
- VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdan Movement Sciences, MS Center AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Janne M Veerbeek
- University of Zurich, University Hospital ZurichDepartment of NeurologyFrauenklinikstrasse 26ZurichSwitzerlandCH‐8091
| | - Rik Gosselink
- Universitaire Ziekenhuizen Leuven, Katholieke Universiteit LeuvenRespiratory Division and Respiratory Rehabilitation UnitTervuursevest 101LeuvenBelgium3000
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdam Movement SciencesPO Box 7057AmsterdamNetherlands1007 MB
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Ensari I, Pilutti LA, Motl RW. Depressive symptomology in multiple sclerosis: Disability, cardiorespiratory fitness and heart rate variability. Acta Neurol Scand 2017; 136:440-446. [PMID: 28239850 DOI: 10.1111/ane.12748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to investigate whether neurological disability status, heart rate variability (HRV), cardiorespiratory fitness (CRF) explained the variance in depressive symptoms in multiple sclerosis (MS). METHODS Associations between CRF (via maximal oxygen uptake; VO2peak ), HRV indices of normalized ultra-low (nULF) and very low frequency domains (nVLF), neurological disability status and depressive symptoms (using the Depression subscale of the Hospital Anxiety Depression Scale; HADS-D) were assessed in 53 participants with MS and 17 matched controls. Hierarchical linear regression analysis was conducted within the MS subsample to examine the variance explained by neurological disability alone and CRF. RESULTS The groups were similar in mean age (MS=52.0 years, Control=51.1 years) and sex (MS=72% female, Control=77% female). Among individuals with MS, HADS-D scores significantly correlated with disability status (sample mean score=4) and VO2peak (r=-.62, P<.001), whereas VO2peak only correlated with nVLF (r=0.29, P<.05), but not nULF (r=0.26, P=.06). The hierarchical linear regression indicated that VO2peak (P<.05) attenuated the effect of disability status on HADS-D scores such that disability was no longer a predictor of depressive symptomology at step 2 (P>.05). CONCLUSION Heart rate variability does not seem to significantly differ between individuals with MS and healthy controls. When accounting for CRF, disability status no longer explains significant variance in depressive symptoms in MS. Accordingly, targeting CRF might be an effective approach for effectively managing depressive symptoms in individuals with MS.
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Affiliation(s)
- I. Ensari
- Department of Kinesiology and Community Health; University of Illinois Urbana-Champaign; Urbana IL USA
| | - L. A. Pilutti
- Department of Kinesiology and Community Health; University of Illinois Urbana-Champaign; Urbana IL USA
| | - R. W. Motl
- Department of Kinesiology and Community Health; University of Illinois Urbana-Champaign; Urbana IL USA
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Sangelaji B, Smith C, Paul L, Treharne G, Hale L. Promoting physical activity engagement for people with multiple sclerosis living in rural settings: a proof-of-concept case study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1381306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Bahram Sangelaji
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Catherine Smith
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, UK
| | - Gareth Treharne
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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25
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Schlüter K, Maier J, Patra S, Gold SM, Heesen C, Schulz KH. Aberrant peak lactate response in MS. NeuroRehabilitation 2017; 41:811-822. [PMID: 29036843 DOI: 10.3233/nre-172182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The peak blood lactate response to an exhaustive exercise test in a number of chronic conditions has been shown to differ from that seen in healthy, untrained individuals. However, this has not been investigated for patients with multiple sclerosis (MS). OBJECTIVE The main objective was to determine and compare the peak blood lactate response to exercise and the maximal workload between two groups of MS patients with different illness severity. METHODS Twenty-five patients with a relapsing-remitting disease course (Group RR) and 41 patients with a secondary- or primary chronic progressive disease course (group CP) performed an exhaustive incremental bicycle ergometry. Peak blood lactate, maximal workload, peak oxygen consumption and maximal heart rate were measured. RESULTS The peak blood lactate levels and maximal workload differed significantly between the groups (group CP < group RR; p < 0.001). Furthermore spiroergometric peak performance markers in both groups were significantly lower than predicted for healthy age and sex matched untrained groups. CONCLUSION A reduced peak blood lactate response to exercise is a novel finding for MS patients. This calls into doubt if the lactate performance tests and lactate thresholds used for healthy individuals can be transferred to MS patients.
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Affiliation(s)
- Kathrin Schlüter
- Universitäres Kompetenzzentrum für Sport-und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Abteilung für Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Josephina Maier
- Universitäres Kompetenzzentrum für Sport-und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Patra
- Universitäres Kompetenzzentrum für Sport-und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Charité Universitätsmedizin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Christoph Heesen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Schulz
- Universitäres Kompetenzzentrum für Sport-und Bewegungsmedizin (Athleticum), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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26
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Sandroff BM, Bollaert RE, Pilutti LA, Peterson ML, Baynard T, Fernhall B, McAuley E, Motl RW. Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability. Contemp Clin Trials 2017; 61:39-47. [DOI: 10.1016/j.cct.2017.07.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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27
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Edwards T, Motl RW, Pilutti LA. Cardiorespiratory demand of acute voluntary cycling with functional electrical stimulation in individuals with multiple sclerosis with severe mobility impairment. Appl Physiol Nutr Metab 2017; 43:71-76. [PMID: 28881147 DOI: 10.1139/apnm-2017-0397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise training is one strategy for improving cardiorespiratory fitness (CRF) in multiple sclerosis (MS); however, few modalities are accessible for those with severe mobility impairment. Functional electrical stimulation (FES) cycling is an adapted exercise modality with the potential for improving CRF in people with severe MS. The objective of this study was to characterize the cardiorespiratory response of acute voluntary cycling with FES in people with MS with severe mobility impairment, and to compare this response to passive leg cycling. Eleven participants with MS that required assistance for ambulation completed a single bout of voluntary cycling with FES or passive leg cycling. Oxygen consumption, heart rate (HR), work rate (WR), and ratings of perceived exertion (RPE) were recorded throughout the session. For the FES group, mean exercising oxygen consumption was 8.7 ± 1.8 mL/(kg·min)-1, or 63.5% of peak oxygen consumption. Mean HR was 102 ± 9.7 bpm, approximately 76.4% of peak HR. Mean WR was 27.0 ± 9.2 W, or 57.3% of peak WR, and median RPE was 13.5 (interquartile range = 5.5). Active cycling with FES was significantly (p < 0.05) more intense than passive leg cycling based on oxygen consumption, HR, WR, and RPE during exercise. In conclusion, voluntary cycling with FES elicited an acute response that corresponded with moderate-to vigorous-intensity activity, suggesting that active cycling with FES can elicit a sufficient stimulus for improving CRF.
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Affiliation(s)
- Thomas Edwards
- a Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Robert W Motl
- b Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35233-1212, USA
| | - Lara A Pilutti
- c Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Casey B, Coote S, Donnelly A. Objective physical activity measurement in people with multiple sclerosis: a review of the literature. Disabil Rehabil Assist Technol 2017; 13:124-131. [DOI: 10.1080/17483107.2017.1297859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Blathin Casey
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Susan Coote
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Alan Donnelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Lefeber N, Swinnen E, Kerckhofs E. The immediate effects of robot-assistance on energy consumption and cardiorespiratory load during walking compared to walking without robot-assistance: a systematic review. Disabil Rehabil Assist Technol 2016; 12:657-671. [DOI: 10.1080/17483107.2016.1235620] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nina Lefeber
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
- C4N, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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Sebastião E, Hubbard EA, Klaren RE, Pilutti LA, Motl RW. Fitness and its association with fatigue in persons with multiple sclerosis. Scand J Med Sci Sports 2016; 27:1776-1784. [PMID: 27747926 DOI: 10.1111/sms.12752] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/28/2022]
Abstract
This study compared physical fitness components between fatigued and non-fatigued persons with MS and examined those components as correlates of fatigue. Sixty-two ambulatory persons with MS completed the Modified Fatigue Impact Scale (MFIS) and underwent assessments of cardiorespiratory capacity, lower extremity muscle strength (i.e., peak torque and asymmetry), body composition, and static balance over two different sessions 7 days apart. Participants were allocated into fatigue groups based on MFIS scores (non-fatigued group (i.e., MFIS ≤38), n = 26; and fatigued group (MFIS >38), n = 36). The fatigued group had significantly (P < 0.05) lower cardiorespiratory capacity (VO2peak ) and muscular strength (i.e., knee flexion peak torque) than the non-fatigued group. VO2peak and knee extension peak torque were the two physical fitness components significantly correlated with fatigue scores in the fatigued group (P < 0.05), and follow-up stepwise linear regression revealed that VO2peak was a significant predictor of fatigue scores (R2 = 0.13). Discriminant function analysis further identified VO2peak as a significant (P < 0.05) correlate of fatigue status. This model explained 21% of variance in group status (i.e., fatigued vs non-fatigued) and correctly classified approximately 76% of cases into fatigue status groups. The improvement of cardiorespiratory capacity should be considered in rehabilitation programs for persons with MS, especially those presenting with elevated fatigue.
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Affiliation(s)
- E Sebastião
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - E A Hubbard
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - R E Klaren
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - L A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - R W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Nedeljkovic U, Raspopovic ED, Ilic N, Vujadinovic ST, Soldatovic I, Drulovic J. Effectiveness of rehabilitation in multiple sclerosis relapse on fatigue, self-efficacy and physical activity. Acta Neurol Belg 2016; 116:309-15. [PMID: 26563405 DOI: 10.1007/s13760-015-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
Relapse of disease is one of the most prominent characteristics of multiple sclerosis. Effectiveness of rehabilitation programmes on fatigue, self-efficacy (SE) and physical activity (PA) has not been investigated so far in context of relapse. The aim of our study was to examine if rehabilitation programme in addition to high-dose methylprednisolone (HDMP) during relapse of disease can influence fatigue, SE and PA more than corticosteroid therapy alone. Patients were randomized in control group receiving only HDMP and experimental group which was in addition included in rehabilitation programme. Outcome measures used were Fatigue Severity Scale (FSS), Multiple Sclerosis Self- Efficacy scale (MSSES), Godin Leisure-Time Exercise Questionnaire (GLTEQ), completed on baseline, 1 and 3 months later. There was no significant change in FSS in both time points, despite different trend seen between groups. The mean MSSES for function and control improved significantly in treatment group after 1 month (807.1 ± 96.8, p = 0.005; 665.3 ± 145.1, p = 0.05) and 3 months (820 ± 83.5, p = 0.004; 720.0 ± 198.2, p = 0.016.) compared to baseline values. The mean GLTEQ score was significantly higher in the treatment group compared to the control at both follow-up time points (45.7 ± 7.6, p < 0.001; 34.3 ± 22.4, p < 0.01). Rehabilitation started along with corticosteroid treatment induced significant improvement in PA compared to HDMP therapy alone. It also influenced noticeable changes in self-efficacy, but effect on fatigue was insufficient.
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Affiliation(s)
- Una Nedeljkovic
- Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia.
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia.
| | - Emilija Dubljanin Raspopovic
- Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Nela Ilic
- Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Sanja Tomanovic Vujadinovic
- Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Ivan Soldatovic
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Jelena Drulovic
- School of Medicine, University of Belgrade, Doktora Subotica 8, 11000, Belgrade, Serbia
- Neurology Clinic, Clinical Centre of Serbia, Doktora Subotica 6, 11000, Belgrade, Serbia
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Body Mass Index Underestimates Adiposity in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:405-12. [DOI: 10.1016/j.apmr.2015.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
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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: 95] [Impact Index Per Article: 11.9] [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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João TMS, Rodrigues RCM, Gallani MCBJ, Miura CTP, Domingues GDBL, Amireault S, Godin G. Validity of the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire. CAD SAUDE PUBLICA 2015; 31:1825-38. [PMID: 26578007 DOI: 10.1590/0102-311x00189713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 07/06/2015] [Indexed: 11/22/2022] Open
Abstract
This study provides evidence of construct validity for the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), a 1-item instrument used among 236 participants referred for cardiopulmonary exercise testing. The Baecke Habitual Physical Activity Questionnaire (Baecke-HPA) was used to evaluate convergent and divergent validity. The self-reported measure of walking (QCAF) evaluated the convergent validity. Cardiorespiratory fitness assessed convergent validity by the Veterans Specific Activity Questionnaire (VSAQ), peak measured (VO2peak) and maximum predicted (VO2pred) oxygen uptake. Partial adjusted correlation coefficients between the GSLTPAQ, Baecke-HPA, QCAF, VO2pred and VSAQ provided evidence for convergent validity; while divergent validity was supported by the absence of correlations between the GSLTPAQ and the Occupational Physical Activity domain (Baecke-HPA). The GSLTPAQ presents level 3 of evidence of construct validity and may be useful to assess leisure-time physical activity among patients with cardiovascular disease and healthy individuals.
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Affiliation(s)
| | | | | | | | | | - Steve Amireault
- College of Health and Human Sciences, Purdue University, West Lafayette, U.S.A
| | - Gaston Godin
- Faculté des Sciences Infirmières, Université Laval, Québec, Canada
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Feasibility and Safety of Cardiopulmonary Exercise Testing in Multiple Sclerosis: A Systematic Review. Arch Phys Med Rehabil 2015; 96:2055-66. [DOI: 10.1016/j.apmr.2015.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022]
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Physical Fitness Assessment Across the Disability Spectrum in Persons With Multiple Sclerosis. J Neurol Phys Ther 2015; 39:241-9. [DOI: 10.1097/npt.0000000000000099] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Determinants of physical activity in minimally impaired people with multiple sclerosis. Clin Neurol Neurosurg 2015; 138:20-4. [PMID: 26264722 DOI: 10.1016/j.clineuro.2015.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 07/09/2015] [Accepted: 07/24/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite the commonly known benefits of physical activity, evidence shows that people with multiple sclerosis (pwMS) are relatively inactive. There are several studies about factors affecting physical activity in pwMS. However, these factors have not investigated in minimally impaired pwMS who do not have remarkable symptoms and walking disturbance. The objective was to determine factors affecting physical activity in minimally impaired pwMS. PATIENTS AND METHODS We recruited 52 minimally impaired pwMS and measured physical activity with Godin Leisure-Time Exercise Questionnaire (GLTEQ) and an accelerometer used for the 7-day period. Demographic data were recorded. Walking (speed, endurance, dexterity, and quality), fatigue, depression, and quality of life were measured. METHODS We recruited 52 minimally impaired pwMS and measured physical activity with Godin Leisure-Time Exercise Questionnaire (GLTEQ) and an accelerometer used for the 7-day period. Demographic data were recorded. Walking (speed, endurance, dexterity, and quality), fatigue, depression, and quality of life were measured. RESULTS The walking speed assessed by the Timed 25-Foot Walk and gender were found the determinants of physical activity level assessed by the GLTEQ and accelerometer, respectively. Walking (speed, endurance, and dexterity), gender, employment status, and quality of life were associated with physical activity. Either female or unemployed participants had significantly less physical activity. There were no significant difference between physical activity levels and the other subgroups. CONCLUSION Either to be a female or to have slower walking speed was associated with less physical activity. Strategies to improve walking should be focused on female pwMS with minimal impairment.
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Sandroff BM, Hillman CH, Motl RW. Aerobic fitness is associated with inhibitory control in persons with multiple sclerosis. Arch Clin Neuropsychol 2015; 30:329-40. [PMID: 25910783 DOI: 10.1093/arclin/acv022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is highly prevalent, disabling, and poorly managed in persons with multiple sclerosis (MS). Aerobic fitness might be a target of exercise training interventions for improving cognition in this population. It is unknown if the well-established pattern of associations between higher aerobic fitness and better inhibitory control in the general population exists among persons with MS. The current cross-sectional study examined the effects of aerobic fitness (VO2peak) on inhibitory control, using a modified flanker task, in 28 persons with MS and 28 healthy controls matched by age, sex, and body mass index. This involved performing bivariate correlations and hierarchical linear regression analyses on measures of aerobic fitness and inhibitory control. Persons with MS demonstrated lower VO2peak (d = -0.45), slower (d = 0.62-0.84), and less accurate (d = -0.60 to 0.71) performance on the flanker task than controls. VO2peak was similarly associated with reaction time measures of inhibitory control in the MS and control samples (ρ = -0.40 to 0.54). VO2peak (p < .01), but not group (p ≥ .08) (MS vs. control), predicted reaction time on the flanker task, irrespective of age, sex, and education. This supports the development of aerobic exercise interventions for improving reaction time on tasks of inhibitory control in persons with MS, much like what has been successfully undertaken in the general population.
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Affiliation(s)
- Brian M Sandroff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charles H Hillman
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Ezeugwu V, Klaren RE, A Hubbard E, Manns PT, Motl RW. Mobility disability and the pattern of accelerometer-derived sedentary and physical activity behaviors in people with multiple sclerosis. Prev Med Rep 2015; 2:241-6. [PMID: 26844077 PMCID: PMC4721432 DOI: 10.1016/j.pmedr.2015.03.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Low physical activity and high sedentary behavior levels are major concerns in persons with multiple sclerosis (MS) and these differ depending on the level of mobility disability. However, the manner in which daily activity is accumulated is currently unknown in this population. Methods A secondary analysis was performed on a combined data set of persons with MS from two previous investigations of physical activity and symptomatic or quality of life outcomes in the United States over a two year period (2007–2009). Mobility disability status was determined using the Patient Determined Disease Steps (PDDS) while activity behavior was objectively monitored using an ActiGraph accelerometer for 7 days. Results Persons with MS who have mobility disability were involved in sedentary behavior, light and moderate intensity activity for 65%, 34% and 1% of the day, respectively compared to 60%, 37%, and 3%, respectively in those without mobility disability (p < 0.05). Breaks in sedentary time did not differ by mobility disability status. Compared to those without mobility disability, the average number of sedentary bouts longer than 30 min was greater in those with mobility disability (p = 0.016). Conclusion Persons with MS with mobility disability are less active, engage in more sedentary behavior and accumulate prolonged sedentary bouts. MS patients with mobility disability had more daily sedentary time (65% vs. 60%). MS patients with mobility disability had less time in light activity (34% vs. 37%). MS patients with mobility disability had less time in MVPA (1% vs. 3%). MS patients with mobility disability engage more in prolonged sedentary bouts (5.1 vs. 4.3).
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Affiliation(s)
- Victor Ezeugwu
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Rachel E Klaren
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - Elizabeth A Hubbard
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | | | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
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40
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Relationships Among Physical Inactivity, Deconditioning, and Walking Impairment in Persons With Multiple Sclerosis. J Neurol Phys Ther 2015; 39:103-10. [DOI: 10.1097/npt.0000000000000087] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis. Contemp Clin Trials 2015; 41:280-6. [DOI: 10.1016/j.cct.2015.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/22/2022]
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42
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Attitude towards physical activity in patients with multiple sclerosis: a cohort study. Neurol Sci 2015; 36:889-93. [DOI: 10.1007/s10072-015-2100-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
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43
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Hassanpour-Dehkordi A, Jivad N. Comparison of regular aerobic and yoga on the quality of life in patients with multiple sclerosis. Med J Islam Repub Iran 2014; 28:141. [PMID: 25694999 PMCID: PMC4322326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 07/02/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The pathophysiology of multiple sclerosis (MS) is characterized by fatigue, motor weakness, and spasticity, to name a few. MS symptoms may lead to physical inactivity associated with the development of secondary diseases. This study was to investigate the effect of regular aerobic and yoga on the quality of life of patients with MS. METHODS The present quasi-experimental study was conducted on 90 patients with chronic MS chosen randomly and divided into two test and one control groups. Data were analyzed using SPSS software (version 11.5) through paired t-test, ANOVA, and Tukey's post hoc. RESULTS There were no significant differences among the scores of quality of life in the three groups prior to investigation. Although they were significant after intervention. The mean score of yoga group was higher than that of aerobic group, and aerobic group showed a higher mean score compared with the control. CONCLUSION Yoga and aerobic exercises may improve quality of life in patients with MS. It is highly recommended that the governor along with MS societies and other organizations servicing and supporting patients start to develop sport-regulated programs to help improve quality of life for these patients.
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Affiliation(s)
- Ali Hassanpour-Dehkordi
- 1. Assistant Professor, Department of Nursing, Faculty of Nursing and Midwifery, Medicinal Plants Research Center Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Nahid Jivad
- 2. Assistant Professor, Department of Neurology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Anens E, Emtner M, Zetterberg L, Hellström K. Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey. BMC Neurol 2014; 14:47. [PMID: 24612446 PMCID: PMC3975577 DOI: 10.1186/1471-2377-14-47] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey – Revised, Exercise Self-Efficacy Scale, Falls- Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active.
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Affiliation(s)
| | | | | | - Karin Hellström
- Department of Neuroscience, Section for Physiotherapy, Uppsala University, Uppsala, Sweden.
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Coote S, O'Dwyer C. Energy expenditure during everyday activities--a study comparing people with varying mobility limitations due to multiple sclerosis and healthy controls. Disabil Rehabil 2014; 36:2059-64. [PMID: 24564325 DOI: 10.3109/09638288.2014.890676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate energy expenditure of people with multiple sclerosis (MS) during everyday activities. METHODS Fifteen healthy controls, 19 people with MS who used at most a stick to walk outdoors (MS-A), and 11 people with MS who used bilateral support for gait (MS-B) completed scripted everyday activities. A portable indirect calorimetry unit calculated energy expenditure. Steps were counted from video. RESULTS There was no significant difference in kcal between the three groups (ANOVA: F(2, 42) = 2.877, p = 0.067). There was a significant difference in steps: F(2, 42) = 17.93, p < 0.001. (Controls-MS-A 470.5, 95% CI 85.2, 855.7, Control-MS-B 1091.3, 95% CI 648.5, 1534.1, MS-A-MS-B 620.8, 95% CI 198.2, 1043.4.) Energy cost of movement was estimated by dividing kcal by steps. The Kruskal-Wallis analysis found significant difference for total (x(2 )= 11.726, df2, p = 0.003), Walking (x(2 )= 9.01, p = 0.011), Stairs (x(2 )= 16.436, 2, p < 0.001). Post-hoc analysis revealed significant differences between MS-B group and control and MS-A groups. CONCLUSIONS People with MS do not use more energy than healthy controls during everyday activities at a self-selected pace. People with MS take significantly fewer steps during activities of daily living's. People who use bilateral support for gait have greater energy cost per step for walking and stairs activities. Implications for Rehabilitation This study found that the energy cost of movement is greater for people with MS with significant disability. Energy expenditure is an important consideration when prescribing physical activity and structured exercise for people with disability. It may be more appropriate to have energy, rather than movement, targets when prescribing physical activity for this population.
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Affiliation(s)
- Susan Coote
- Department of Clinical Therapies, Centre for Physical Activity and Health Research, University of Limerick , Limerick , Ireland
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Skjerbæk AG, Næsby M, Lützen K, Møller AB, Jensen E, Lamers I, Stenager E, Dalgas U. Endurance training is feasible in severely disabled patients with progressive multiple sclerosis. Mult Scler 2013; 20:627-30. [PMID: 24057428 DOI: 10.1177/1352458513505351] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1/6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min(-1) were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction was seen for VO2peak (p = 0.06). ET is feasible in severely disabled patients with progressive MS and it can probably be performed at sufficient intensity to induce cardiovascular adaptations.
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Abstract
Exercise is an intervention that may be used in the management of multiple sclerosis (MS). Certain exercise physiology characteristics are commonly seen among persons with MS, particularly in the more debilitated. Studies have shown that properly prescribed exercise programs can improve modifiable impairments in MS. Exercise is generally safe and well tolerated. General guidelines are available for exercise prescription for the MS population. There are several recommendations that may help improve the quality of future MS exercise trials.
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Affiliation(s)
- Alexius E G Sandoval
- Department of Rehabilitation Medicine, Eastern Maine Medical Center, 905 Union Street, Suite 9, Bangor, ME 04401, USA.
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São-João TM, Rodrigues RCM, Gallani MCBJ, Miura CTDP, Domingues GDBL, Godin G. Adaptação cultural da versão brasileira do Godin-Shephard Leisure-Time Physical Activity Questionnaire. Rev Saude Publica 2013; 47:479-87. [DOI: 10.1590/s0034-8910.2013047003947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 10/14/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Realizar adaptação cultural para versão brasileira do questionário de atividade física no tempo de lazer e avaliar a validade de conteúdo, praticabilidade, aceitabilidade e confiabilidade.MÉTODOS: Foram realizadas as etapas de tradução, síntese, retrotradução, avaliação por comitê de especialistas e pré-teste, seguidos pela avaliação da praticabilidade, aceitabilidade e confiabilidade (teste-reteste). Os juízes avaliaram as equivalências semântico-idiomática, conceitual, cultural e metabólica. A versão adaptada foi submetida ao pré-teste (n = 20) e teste-reteste (n = 80) em indivíduos saudáveis e pacientes com doenças cardiovasculares, em Limeira, SP, entre 2010 e 2011. A proporção de concordância do comitê de juízes foi quantificada por meio do Índice de Validade de Conteúdo. A confiabilidade foi avaliada segundo critério de estabilidade, com intervalo de 15 dias entre as aplicações, a praticabilidade pelo tempo gasto na entrevista e a aceitabilidade pelo percentual de itens não respondidos e proporção de pacientes que responderam a todos os itens.RESULTADOS: A versão traduzida do questionário apresentou equivalências semântico-idiomática, conceitual, cultural e metabólica adequadas, com substituição de algumas atividades físicas mais adequadas para a população brasileira. A análise da praticabilidade evidenciou curto tempo de aplicação do instrumento (média de 3,0 min). Quanto à aceitabilidade, todos os pacientes responderam a 100% dos itens. A análise do teste-reteste sugeriu estabilidade temporal do instrumento (Índice de Correlação Intraclasse = 0,84).CONCLUSÕES: A versão brasileira do questionário apresentou propriedades de medida satisfatórias. Recomenda-se sua aplicação a populações diversas em estudos futuros, a fim de disponibilizar propriedades de medida robustas.
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Motl RW, Pilutti LA, Sandroff BM, Klaren R, Balantrapu S, McAuley E, Sosnoff JJ, Fernhall B. Rationale and design of a randomized controlled, clinical trial investigating a comprehensive exercise stimulus for improving mobility disability outcomes in persons with multiple sclerosis. Contemp Clin Trials 2013; 35:151-8. [DOI: 10.1016/j.cct.2013.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 01/21/2023]
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Sandroff BM, Sosnoff JJ, Motl RW. Physical fitness, walking performance, and gait in multiple sclerosis. J Neurol Sci 2013; 328:70-6. [PMID: 23522499 DOI: 10.1016/j.jns.2013.02.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Walking impairment is a prevalent, life-altering feature of multiple sclerosis (MS). There has been recent speculation that physiological deconditioning (i.e., reductions in aerobic capacity, balance, and muscular strength) contributes to walking and gait impairments in MS. OBJECTIVE This study examined the associations among aerobic capacity, balance, and lower-limb strength asymmetries, walking performance, and gait kinematics in 31 persons with MS and 31 matched controls. METHODS Participants underwent standard assessments of peak aerobic capacity, muscular strength (i.e., asymmetry between knee muscles), and balance. Walking performance was measured using the timed 25-ft walk (T25FW) and six-minute walk (6MW). Gait parameters were captured using a GaitRite™ electronic walkway. RESULTS Aerobic capacity, balance, and knee-extensor asymmetry were associated with walking performance and gait in persons with MS (r=.2-.6) and explained differences in walking and gait variables between MS and control groups (∆R(2)=.27-.34). Aerobic capacity and lower-limb strength asymmetries, but not balance, explained significant variance in walking performance and gait kinematics in the MS sample (R(2)=.32-.58). CONCLUSIONS Physiological deconditioning explains variability in walking disability in persons with MS and might represent a target of multimodal exercise training interventions for improving mobility outcomes in this population.
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Affiliation(s)
- Brian M Sandroff
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL 61801, USA
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