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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [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: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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2
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Martínez-Rodríguez A, Rubio-Arias JÁ. Effects and optimal dosage of resistance training on strength, functional capacity, balance, general health perception, and fatigue in people with multiple sclerosis: a systematic review and meta-analysis. Disabil Rehabil 2022; 45:1595-1607. [PMID: 35579532 DOI: 10.1080/09638288.2022.2069295] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze the effectiveness of resistance training programs (RTP) on strength, functional capacity, balance, general health perception, and fatigue for people with Multiple Sclerosis (MS) and to determine the most effective dose of RTP in this population. METHODS Studies examining the effect of RTP on strength, functional capacity, balance, general health perception, and fatigue in MS patients were included. 44 studies were included. The meta-analysis, subgroup analysis and meta-regression methods were used to calculate the mean difference and standardized mean difference. RESULTS Significant group differences were observed in knee extensor (p = 0.01) and flexor (p < 0.001), but not in 1-repetition maximum. Regarding functional capacity and balance, differences between groups, in favour of the RTP group, were found in the Timed Up and Go Test (p = 0.001), walking endurance, (p = 0.02) gait speed (p = 0.02) and balance (p = 0.02). No significant differences between groups were observed in fatigue or general health perception. The results regarding the optimal dose are inconsistent. CONCLUSIONS RTP improves strength, functional capacity, balance, and fatigue in people with MS. Registration: (PROSPERO): CRD42020182781Implications for rehabilitationResistance training is a valid strategy to improve isometric strength and functional capacity in MS patients.RTP using long durations (more than 6 weeks), high intensity (more than 80% 1-RM) and two-day weekly training frequency may be a correct stimulus to improve strength, functional capacity, balance, and fatigue in people with MS.Trainers and rehabilitators should consider these indicators in order to maximize muscular and functional adaptations in this population.
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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.,LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Madrid, Spain
| | - Domingo J Ramos-Campo
- Faculty of Sport, Catholic University of Murcia, Murcia, Spain.,LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Madrid, Spain
| | - Linda H Chung
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Sciences Faculty of Sciences, University of Alicante, Alicante, Spain
| | - Jacobo Á Rubio-Arias
- Health Research Centre, Department of Education, Faculty of Educational Sciences, University of Almería, Almería, Spain
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3
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Edwards T, Michelsen AS, Fakolade AO, Dalgas U, Pilutti LA. Exercise training improves participation in persons with multiple sclerosis: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:393-402. [PMID: 34325022 PMCID: PMC9189702 DOI: 10.1016/j.jshs.2021.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although previous studies have examined the effects of exercise training on other International Classification of Functioning, Disability and Health (ICF) component levels in persons with multiple sclerosis (MS), the effects of exercise training on participation remain unclear. The objectives of this review were to: (1) characterize systematically the use of outcome measures that capture participation in exercise training studies; (2) quantify the effect of exercise training on participation in persons with MS. METHODS A search of 6 electronic databases (CINAHL, SPORTDiscuss, Embase, MEDLINE, Cochrane Central, and Scopus) was conducted to identify controlled and noncontrolled trials involving exercise training and participation in persons with MS. Search strings were built from Medical Subject Headings and CINAHL headings. ICF linking rules were used to identify participation chapters and categories captured. Meta-analysis was used to quantify the effect of exercise training on participation in randomized controlled trials comparing exercise effects to no intervention/usual care. RESULTS We included 49 articles involving controlled and noncontrolled exercise trials in the systematic review of outcome measures. We captured 16 different outcome measures that captured all 9 participation chapters and identified 89 unique participation categories. Across these 16 outcome measures, mobility was the most commonly represented participation chapter, with 108 items. A subsample of 23 randomized controlled trials was included in the meta-analysis. An overall effect of 0.60 (standard error = 0.12, 95% confidence interval: 0.36-0.84, z = 4.9, p < 0.001) was calculated, indicating a moderate, positive effect of exercise training on participation. CONCLUSION The current review provides information that can be used to guide the selection of outcome measures that capture participation in studies of exercise training in persons with MS. Exercise training has a positive effect on outcomes that capture participation, providing further evidence for the role of exercise training in promoting and maintaining engagement in everyday life.
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Affiliation(s)
- Thomas Edwards
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N6N5, Canada
| | - Anne Sophie Michelsen
- Department of Public Health-Exercise Biology, Aarhus University, Aarhus C 8000, Denmark
| | - Afolasade O Fakolade
- School of Rehabilitation Therapy, Queens University, Kingston, ON K7L3N6, Canada
| | - Ulrik Dalgas
- Department of Public Health-Exercise Biology, Aarhus University, Aarhus C 8000, Denmark
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1N6N5, Canada.
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4
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Plummer P, Markovic-Plese S, Giesser B. Dalfampridine for Mobility Limitations in People With Multiple Sclerosis May Be Augmented by Physical Therapy: A Non-randomized Two-Group Proof-of-Concept Pilot Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:795306. [PMID: 36188834 PMCID: PMC9397954 DOI: 10.3389/fresc.2021.795306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022]
Abstract
Purpose: To demonstrate proof-of-concept for a combined physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning physical therapy intervention with and without concurrent dalfampridine treatment on gait speed in people with mobility limitations due to multiple sclerosis (MS). Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed dalfampridine as part of their routine medical care, and 4 individuals with MS not taking dalfampridine completed a 3-week drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced physical therapy twice weekly for 6 weeks. Participants taking dalfampridine took the medication for the study duration. The physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week physical therapy program. Results: For the 4 participants taking dalfampridine, average improvement in T25FW on drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking dalfampridine (mean difference = −0.93 s, 95% CI −1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the physical therapy plus dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%). Conclusions: Further research is warranted to examine whether dalfampridine for mobility impairment may be augmented by physical therapy in people with MS.
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Affiliation(s)
- Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, United States
- *Correspondence: Prudence Plummer
| | - Silva Markovic-Plese
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Barbara Giesser
- Multiple Sclerosis Neurology, Brain Health Center, Pacific Neuroscience Institute, Santa Monica, CA, United States
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5
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Manonelles P, Vilas Boas JP, Rubio-Arias JÁ. Fast-velocity resistance training improves force development and mobility in Multiple Sclerosis. Int J Sports Med 2021; 43:593-599. [PMID: 34847589 DOI: 10.1055/a-1710-1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to analyze the benefits of a lower-limb fast-velocity concentric resistance training on rate of force development, mobility, and quality of life in people with Multiple Sclerosis. A randomized controlled trial was conducted in 30 people with Multiple Sclerosis, who were randomly assigned to either an experimental (n=18) or a control (n=12) group. The experimental group carried out 10-weeks of fast-velocity concentric resistance training, while the control group did not perform any intervention. Early and late rate of force development during knee extension in both legs, sit-to-stand and Timed Up and Go tests and quality life questionnaire were evaluated before and after intervention. The training program evoked an increase in early rate of force development in experimental group (0-30; Rightleg: 63.9%, p<0.001;ES=-1.4; Leftleg: 52.7%, p<0.001;ES=-1.0) compared to control group (showed modest increases). Furthermore, experimental group improved mobility after training (Sit-to-stand: 22.2%, p<0.001;ES=1.0; Timed Up and Go Test: 10.1%, p<0.001;ES=1.1) and increased the perception of quality of life after training, while control showed no changes. The fast-velocity concentric resistance training has the potential to improve early rate of force development and mobility after 10-weeks of training. In addition, the increase in self-perceived quality of life following this training modality demonstrates promising results in the Multiple Sclerosis population.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sport, Universidad Católica San Antonio de Murcia, Murcia, Spain.,International Chair of Sports Medicine, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | | | - Linda H Chung
- UCAM Research Center for High Performance Sport, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Pedro Manonelles
- International Chair of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
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6
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Harrison AM, Safari R, Mercer T, Picariello F, van der Linden ML, White C, Moss-Morris R, Norton S. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27:1657-1678. [PMID: 33876986 PMCID: PMC8474304 DOI: 10.1177/1352458521996002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
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Affiliation(s)
- Anthony M Harrison
- Department of Clinical and Health Psychology,
Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Reza Safari
- Health and Social Care Research Centre, College
of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation
Research, Queen Margaret University, Edinburgh, UK
| | - Federica Picariello
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | | | - Claire White
- School of Population Health & Environmental
Sciences, Faculty of Life Sciences & Medicine, King’s College London,
London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | - Sam Norton
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
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7
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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial. ACTA ACUST UNITED AC 2021; 57:medicina57070713. [PMID: 34356994 PMCID: PMC8306232 DOI: 10.3390/medicina57070713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.
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Gooch H, Hill J, Clegg A. Strength training for people with multiple sclerosis and the current recommendations. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2021; 17:S32-S41. [PMID: 38736990 PMCID: PMC7615946 DOI: 10.12968/bjnn.2021.17.sup3.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Recent guidelines recommend strength and conditioning training for patients with multiple sclerosis (MS). This article evaluates and summarises four systematic reviews examining strength training for people with MS and examines if these reviews substantiate these current guidelines.
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Affiliation(s)
- Helen Gooch
- Clinical Lead Physiotherapist for Neurology, Core Therapies Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
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9
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Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:2032-2048. [PMID: 33901439 DOI: 10.1016/j.apmr.2021.03.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). DATA SOURCES Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. STUDY SELECTION Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. DATA EXTRACTION Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. DATA SYNTHESIS Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), -1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, -0.04 to 0.78]; RT: ES=0.36 [95% CI, -0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=-0.61 [95% CI, -1.10 to -0.11]; RT: ES=-0.41 [95% CI, -0.80 to -0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. CONCLUSIONS AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus "core battery" of physical function tests to facilitate a detailed comparison of results across modalities.
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10
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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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11
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Glue C, Haveron R, Smith ML, Thiagarajan P, Edwards H, Mulligan H, Wilkinson A. Six-minute walk test values for people with and without long-term conditions in relation to the Walk Score ®: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Caitlin Glue
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rowan Haveron
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Megan-Li Smith
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Pranav Thiagarajan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Heather Edwards
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hilda Mulligan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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12
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Manca A, Dvir Z, Deriu F. Meta-analytic and Scoping Study on Strength Training in People With Multiple Sclerosis. J Strength Cond Res 2019; 33:874-889. [DOI: 10.1519/jsc.0000000000002381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Baird JF, Motl RW. Response Heterogeneity With Exercise Training and Physical Activity Interventions Among Persons With Multiple Sclerosis. Neurorehabil Neural Repair 2018; 33:3-14. [PMID: 30585528 DOI: 10.1177/1545968318818904] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Multiple sclerosis (MS) is a heterogeneous disease, both in its pathology and symptomology. This poses a challenge for the medical management and rehabilitation of MS; however, physical activity and exercise training are rehabilitation approaches that have demonstrated beneficial effects on many of the burdensome consequences of MS such as mobility impairment and fatigue. Given the heterogeneous course of MS, it is possible that outcomes of physical activity and exercise training interventions demonstrate heterogeneity both in the magnitude and pattern of change, but there has been little focus on response heterogeneity with these interventions among persons with MS. In this narrative review, a search of the existing literature was performed to identify studies that reported individual participant data, which was used to describe the variability in the response to physical activity and exercise training interventions among persons with MS. Inter-individual variability seemingly occurs across outcomes and modalities, which underscores the consideration of factors that might influence response heterogeneity. Factors related to MS disease characteristics, nervous system damage, and the degree of MS-related disability might influence individual responsiveness. Large-scale studies that permit the examination of heterogeneity and its predictors will inform future research on the area of physical activity and exercise training in MS, and lead to the development of individually tailored rehabilitation approaches that will more effectively elicit change.
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Affiliation(s)
| | - Robert W Motl
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Jonsdottir J, Gervasoni E, Bowman T, Bertoni R, Tavazzi E, Rovaris M, Cattaneo D. Intensive Multimodal Training to Improve Gait Resistance, Mobility, Balance and Cognitive Function in Persons With Multiple Sclerosis: A Pilot Randomized Controlled Trial. Front Neurol 2018; 9:800. [PMID: 30323787 PMCID: PMC6172314 DOI: 10.3389/fneur.2018.00800] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Persons with multiple sclerosis (MS) have deficits in many aspects of physical and cognitive functioning that can impact on mobility and participation in daily life. The effect of a 4 week intensive multimodal treadmill training on functional mobility, balance, executive functions and participation in persons with MS with moderate to severe disability was investigated. Methods: Thirty eight persons with MS admitted to a rehabilitation center participated in a two arm randomized 2:1 controlled trial. Participants in the experimental group received supervised intensive treadmill training including cognitive and motor dual tasks (DT-group, N = 26), 5 sessions per week and a control group received the same amount of supervised strength training (S-group, N = 12). The participants were assessed before and after the rehabilitation period with the 2 Minutes Walking Test (2MWT), speed and, static and dynamic balance measures, the Frontal Assessment Battery and the Short Form-12 questionnaire. The main hypothesis was related to the superiority of the treadmill intervention based on a greater proportion of people making a clinically relevant gain (15% increase on 2MWT) in gait resistance following treatment. ANCOVA (Analysis of covariance) models adjusting for baseline measurement of the respective outcome variable, as well as sex and age, were used to evaluate differences in efficacy for all variables. P was set at 0.05. Results: Nineteen out of 26 persons in the DT-group made a clinically relevant gain and two out of 12 in the S-Group (P = 0.001). The DT-group improved more in gait resistance, speed and mobility (P < 0.01). Balance and executive functions instead improved moderately in both groups following training while perception of health remained similar in both groups. Conclusion: A four week multimodal training on treadmill was highly effective in augmenting gait resistance and mobility in moderately to severely affected persons with MS.
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Affiliation(s)
- Johanna Jonsdottir
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Elisa Gervasoni
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Thomas Bowman
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Rita Bertoni
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Eleonora Tavazzi
- Department of Multiple Sclerosis, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Marco Rovaris
- Department of Multiple Sclerosis, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Davide Cattaneo
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
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Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation. Mult Scler 2018; 24:886-894. [DOI: 10.1177/1352458518777377] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While early medical treatment has proven effective in MS, early-phase MS rehabilitation has not gained much attention in MS research and clinical practice. Exercise therapy is one of the most promising treatment strategies in MS rehabilitation. Here, we provide a topical review investigating when exercise therapy is initiated in existing MS studies, showing that exercise is initiated at a rather late disease stage, where it predominantly serves as a symptomatic treatment. Recent findings in MS suggest that exercise may have neuroprotective and disease-modifying effects. Such findings along with the findings from medical trials that an early-stage “window of opportunity” exists leads to the proposal that early exercise therapy should be an increased focus in research and clinical practice for persons with MS. A further perspective relates to other rehabilitation interventions that are also initiated at a later disease stage, as these may also take advantage of an early-phase approach.
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Affiliation(s)
- Morten Riemenschneider
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Lars G Hvid
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) and the most widespread nontraumatic cause of disability in young adults around the world. MS occurs in people of all ages, races, and ethnicities. MS is characterized by clinical symptoms resulting from lesions in the brain, spinal cord, or optic nerves that can affect balance, gait, and fall risk. Lesions accumulate over time and occur in different areas of the CNS causing symptoms that include weakness, spasticity, and fatigue, as well as changes in sensation, coordination, vision, cognition, and bladder function. Thus, it is not surprising that imbalance, gait dysfunction, and falls are common in people with MS. The overwhelming majority have abnormalities of postural control and gait even early in the disease course. In all, 50-80% have balance and gait dysfunction and over 50% fall at least once each year. Balance dysfunction in MS is conceptualized as three interrelated problems: decreased ability to maintain position, limited and slowed movement towards limits of stability, and delayed responses to postural displacements and perturbations. In addition, functional balance performance may be affected by impaired dual-task integration. Walking changes in MS include reduced gait speed, impaired walking balance, and reduced walking-related physical activity. Falls in people with MS are associated with injuries, reduced participation, and increased fear of falling. A wide and growing range of rehabilitation and medical interventions are available to address the changes in balance, gait, and fall risk associated with MS.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Ylva Nilsagard
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev 2017; 17:53-72. [PMID: 29108826 DOI: 10.1016/j.autrev.2017.11.010] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
Abstract
Physical activity, by definition, is any skeletal muscle body movement that results in energy expenditure. In the last few decades, a plethora of scientific evidences have accumulated and confirmed the beneficial role of physical activity as a modifiable risk factor for a wide variety of chronic diseases including cardiovascular diseases (CVDs), diabetes mellitus and cancer, among others. Autoimmune diseases are a heterogeneous group of chronic diseases, which occur secondary to loss of self-antigen tolerance. With the advent of biological therapies, better outcomes have recently been noted in the management of autoimmune diseases. Nonetheless, recent research highlights the salient role of modifiable behaviors such as physical inactivity on various aspects of the immune system and autoimmune diseases. Physical activity leads to a significant elevation in T-regulatory cells, decreased immunoglobulin secretion and produces a shift in the Th1/Th2 balance to a decreased Th1 cell production. Moreover, physical activity has been proven to promote the release of IL-6 from muscles. IL-6 released from muscles functions as a myokine and has been shown to induce an anti-inflammatory response through IL-10 secretion and IL-1β inhibition. Physical activity has been shown to be safe in most of autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), inflammatory bowel diseases (IBD), as well as others. Additionally, the incidence of RA, MS, IBD and psoriasis has been found to be higher in patients less engaged in physical activity. As a general trend, patients with autoimmune diseases tend to be less physically active as compared to the general population. Physically active RA patients were found to have a milder disease course, better cardiovascular disease (CVD) profile, and improved joint mobility. Physical activity decreases fatigue, enhances mood, cognitive abilities and mobility in patients with MS. In SLE patients, enhanced quality of life and better CVD profile were documented in more physically active patients. Physically active patients with type 1 diabetes mellitus have a decreased risk of autonomic neuropathy and CVD. Both fibromyalgia and systemic sclerosis patients report decreased disease severity, pain, as well as better quality of life with more physical activity. Further, SSc patients improve their grip strength, finger stretching and mouth opening with increased level of exercise. The purpose of this paper is to review the clinical evidence regarding the safety, barriers to engagement, and impact of physical activity on autoimmune diseases.
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18
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Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities. Am J Phys Med Rehabil 2017; 96:748-761. [DOI: 10.1097/phm.0000000000000743] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Manca A, Dvir Z, Dragone D, Mureddu G, Bua G, Deriu F. Time course of strength adaptations following high-intensity resistance training in individuals with multiple sclerosis. Eur J Appl Physiol 2017; 117:731-743. [DOI: 10.1007/s00421-017-3534-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
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Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: A meta-analysis. J Affect Disord 2016; 202:67-86. [PMID: 27253219 DOI: 10.1016/j.jad.2016.03.063] [Citation(s) in RCA: 432] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND This meta-analysis of randomized controlled trials (RCTs) examines the efficacy of physical exercise as treatment for unipolar depression, both as an independent intervention and as an adjunct intervention to antidepressant medication. METHODS We searched PsycINFO, EMBASE, MEDLINE, CENTRAL, and Sports Discus for articles published until November 2014. Effect sizes were computed with random effects models. The main outcome was reduction in depressive symptoms or remission. RESULTS A total of 23 RCTs and 977 participants were included. Physical exercise had a moderate to large significant effect on depression compared to control conditions (g=-0.68), but the effect was small and not significant at follow-up (g=-0.22). Exercise compared to no intervention yielded a large and significant effect size (g=-1.24), and exercise had a moderate and significant effect compared to usual care (g=-0.48). The effects of exercise when compared to psychological treatments or antidepressant medication were small and not significant (g=-0.22 and g=-0.08, respectively). Exercise as an adjunct to antidepressant medication yielded a moderate effect (g=-0.50) that trended toward significance. LIMITATIONS Use of the arms with the largest clinical effect instead of largest dose may have overestimated the effect of exercise. CONCLUSIONS Physical exercise is an effective intervention for depression. It also could be a viable adjunct treatment in combination with antidepressants.
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Affiliation(s)
- Siri Kvam
- Sogndal Child and Adolescent Psychiatric Outpatient Clinic, Division of Medicine, District General Hospital of Førde, postboks 1000, 6807 Førde, Norway.
| | | | | | - Anders Hovland
- Department of Clinical Psychology, University of Bergen, Norway; Solli District Psychiatric Centre (DPS), Norway
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Lamers I, Maris A, Severijns D, Dielkens W, Geurts S, Van Wijmeersch B, Feys P. Upper Limb Rehabilitation in People With Multiple Sclerosis. Neurorehabil Neural Repair 2016; 30:773-93. [DOI: 10.1177/1545968315624785] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background. There has been an increasing research interest in upper limb rehabilitation in multiple sclerosis (MS). The current changes in the research field inquire a new literature review. Objective. This systematic review aimed to provide an overview of the upper limb rehabilitation strategies in people with MS (PwMS). Methods. Articles published in PubMed and Web of Knowledge were selected when written in English, published in the past 25 years, peer reviewed, that included at least 5 PwMS, and described the effects of an intervention study including rehabilitation strategies targeting the upper limbs. Included articles were screened based on title/abstract and full text by 2 independent reviewers. Results. Thirty articles met the criteria and were included for data extraction. Only half of the included studies investigated the effects of a training program specially targeted toward the upper limbs, while in the other studies, a general whole body therapy was used. The therapy content and dosage varied greatly between the different included studies. Multidisciplinary and robot-based rehabilitation were the most investigated rehabilitation strategies and showed to improve upper limb capacity. Strength and endurance training improved the upper limb body functions and structures but did not influence the upper limb capacity and performance. Conclusions. The results of this systematic review indicated that different types of upper limb rehabilitation strategies can improve upper limb function in PwMS. Further research is necessary to compare directly the effects of different rehabilitation strategies and to investigate the optimal therapy dosage according to the upper limb disability level.
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Affiliation(s)
- Ilse Lamers
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Anneleen Maris
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Deborah Severijns
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wouter Dielkens
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sander Geurts
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Bart Van Wijmeersch
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Rehabilitation and MS Center, Overpelt, Belgium
| | - Peter Feys
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Normann B, Salvesen R, Christin Arntzen E. Group-based individualized core stability and balance training in ambulant people with multiple sclerosis: a pilot feasibility test–retest study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.3109/21679169.2016.1170204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Britt Normann
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
| | - Rolf Salvesen
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway
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Heine M, van de Port I, Rietberg MB, van Wegen EEH, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 2015; 2015:CD009956. [PMID: 26358158 PMCID: PMC9554249 DOI: 10.1002/14651858.cd009956.pub2] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system affecting an estimated 1.3 million people worldwide. It is characterised by a variety of disabling symptoms of which excessive fatigue is the most frequent. Fatigue is often reported as the most invalidating symptom in people with MS. Various mechanisms directly and indirectly related to the disease and physical inactivity have been proposed to contribute to the degree of fatigue. Exercise therapy can induce physiological and psychological changes that may counter these mechanisms and reduce fatigue in MS. OBJECTIVES To determine the effectiveness and safety of exercise therapy compared to a no-exercise control condition or another intervention on fatigue, measured with self-reported questionnaires, of people with MS. SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Trials Specialised Register, which, among other sources, contains trials from: the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 10), MEDLINE (from 1966 to October 2014), EMBASE (from 1974 to October 2014), CINAHL (from 1981 to October 2014), LILACS (from 1982 to October 2014), PEDro (from 1999 to October 2014), and Clinical trials registries (October 2014). Two review authors independently screened the reference lists of identified trials and related reviews. SELECTION CRITERIA We included randomized controlled trials (RCTs) evaluating the efficacy of exercise therapy compared to no exercise therapy or other interventions for adults with MS that included subjective fatigue as an outcome. In these trials, fatigue should have been measured using questionnaires that primarily assessed fatigue or sub-scales of questionnaires that measured fatigue or sub-scales of questionnaires not primarily designed for the assessment of fatigue but explicitly used as such. DATA COLLECTION AND ANALYSIS Two review authors independently selected the articles, extracted data, and determined methodological quality of the included trials. Methodological quality was determined by means of the Cochrane 'risk of bias' tool and the PEDro scale. The combined body of evidence was summarised using the GRADE approach. The results were aggregated using meta-analysis for those trials that provided sufficient data to do so. MAIN RESULTS Forty-five trials, studying 69 exercise interventions, were eligible for this review, including 2250 people with MS. The prescribed exercise interventions were categorised as endurance training (23 interventions), muscle power training (nine interventions), task-oriented training (five interventions), mixed training (15 interventions), or 'other' (e.g. yoga; 17 interventions). Thirty-six included trials (1603 participants) provided sufficient data on the outcome of fatigue for meta-analysis. In general, exercise interventions were studied in mostly participants with the relapsing-remitting MS phenotype, and with an Expanded Disability Status Scale less than 6.0. Based on 26 trials that used a non-exercise control, we found a significant effect on fatigue in favour of exercise therapy (standardized mean difference (SMD) -0.53, 95% confidence interval (CI) -0.73 to -0.33; P value < 0.01). However, there was significant heterogeneity between trials (I(2) > 58%). The mean methodological quality, as well as the combined body of evidence, was moderate. When considering the different types of exercise therapy, we found a significant effect on fatigue in favour of exercise therapy compared to no exercise for endurance training (SMDfixed effect -0.43, 95% CI -0.69 to -0.17; P value < 0.01), mixed training (SMDrandom effect -0.73, 95% CI -1.23 to -0.23; P value < 0.01), and 'other' training (SMDfixed effect -0.54, 95% CI -0.79 to -0.29; P value < 0.01). Across all studies, one fall was reported. Given the number of MS relapses reported for the exercise condition (N = 25) and non-exercise control condition (N = 26), exercise does not seem to be associated with a significant risk of a MS relapse. However, in general, MS relapses were defined and reported poorly. AUTHORS' CONCLUSIONS Exercise therapy can be prescribed in people with MS without harm. Exercise therapy, and particularly endurance, mixed, or 'other' training, may reduce self reported fatigue. However, there are still some important methodological issues to overcome. Unfortunately, most trials did not explicitly include people who experienced fatigue, did not target the therapy on fatigue specifically, and did not use a validated measure of fatigue as the primary measurement of outcome.
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Affiliation(s)
- Martin Heine
- University Medical Center Utrecht and Rehabilitation Center De HoogstraatBrain Center Rudolf Magnus and Center of Excellence for Rehabilitation MedicineRembrandkade 10UtrechtUtrechtNetherlands3583TM
| | - Ingrid van de Port
- University Medical Center Utrecht and Rehabilitation Center De HoogstraatBrain Center Rudolf Magnus and Center of Excellence for Rehabilitation MedicineRembrandkade 10UtrechtUtrechtNetherlands3583TM
| | - Marc B Rietberg
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
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Adamson BC, Ensari I, Motl RW. Effect of Exercise on Depressive Symptoms in Adults With Neurologic Disorders: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2015; 96:1329-38. [DOI: 10.1016/j.apmr.2015.01.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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Abstract
For decades, persons with multiple sclerosis (MS) were counseled to avoid excessive physical activity and exercise because of concerns about worsening disease activity. Recent studies indicate that, not only can those with MS tolerate physical exercise, but that it is helpful in managing symptoms, preventing complications and comorbidities, and may possibly have neuroprotective actions. This article reviews previous studies on the effects of different exercise protocols in people with MS, and provides summaries of suggested exercise regimens that may be appropriate and beneficial for this patient population.
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Affiliation(s)
- Barbara S Giesser
- Professor of Clinical Neurology, David Geffen UCLA School of Medicine, Los Angeles, CA 90095, USA
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26
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Kalron A, Nitzani D, Magalashvili D, Dolev M, Menascu S, Stern Y, Rosenblum U, Pasitselsky D, Frid L, Zeilig G, Barmatz C, Givon U, Achiron A. A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort. BMC Neurol 2015; 15:21. [PMID: 25884887 PMCID: PMC4351834 DOI: 10.1186/s12883-015-0281-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability. METHODS Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups. RESULTS All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group. CONCLUSIONS We presented comprehensive evidence verifying the effects of an intense goal-directed physical rehabilitation program on ambulation in people with multiple sclerosis presenting with different neurological impairment levels.
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Affiliation(s)
- Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. .,Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Dalia Nitzani
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | | | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Uri Rosenblum
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Diana Pasitselsky
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Gabi Zeilig
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Caroline Barmatz
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
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A pilot study of an exercise-based patient education program in people with multiple sclerosis. Mult Scler Int 2015; 2014:306878. [PMID: 25587449 PMCID: PMC4283388 DOI: 10.1155/2014/306878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022] Open
Abstract
There is increasing evidence that physical exercise leads to numerous positive effects in PwMS. However, long-term effects of exercise may only be achievable if training is implemented in daily routine. Enabling patients to exercise regularly, we developed a patient education program focused on evidence-based information of training. PwMS were educated in neurophysiological effects of physical exercise, exercise-induced benefits for PwMS, and risk factors (e.g., weather). Fifteen PwMS were analyzed before (T 0) and after (T 1) a 12-week patient education. Afterwards, participants performed their exercises autonomously for 32 weeks and were tested in sustainability tests (T 2). Guided interviews were carried out, additionally. Significant improvements from T 0 to T 1 were found in 6MWT, gait velocity, TUG, fatigue, and quality of life. Significant results of TUG and gait velocity from T 1 to T 2 demonstrated that participants kept few effects after the 32-week training phase. Qualitative analyses showed improved self-confidence and identified training strategies and barriers. This pilot study provides evidence that PwMS are able to acquire good knowledge about physical exercise and apply this knowledge successfully in training management. One might conclude that this exercise-based patient education seems to be a feasible option to maintain or improve patients' integral constitution concerning physical and mental health.
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Cruickshank TM, Reyes AR, Ziman MR. A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine (Baltimore) 2015; 94:e411. [PMID: 25634170 PMCID: PMC4602948 DOI: 10.1097/md.0000000000000411] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Strength training has, in recent years, been shown to be beneficial for people with Parkinson disease and multiple sclerosis. Consensus regarding its utility for these disorders nevertheless remains contentious among healthcare professionals. Greater clarity is required, especially in regards to the type and magnitude of effects as well as the response differences to strength training between individuals with Parkinson disease or multiple sclerosis. This study examines the effects, magnitude of those effects, and response differences to strength training between patients with Parkinson disease or multiple sclerosis. A comprehensive search of electronic databases including Physiotherapy Evidence Database scale, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL was conducted from inception to July 2014. English articles investigating the effect of strength training for individuals with neurodegenerative disorders were selected. Strength training trials that met the inclusion criteria were found for individuals with Parkinson disease or multiple sclerosis. Individuals with Parkinson disease or multiple sclerosis were included in the study. Strength training interventions included traditional (free weights/machine exercises) and nontraditional programs (eccentric cycling). Included articles were critically appraised using the Physiotherapy Evidence Database scale. Of the 507 articles retrieved, only 20 articles met the inclusion criteria. Of these, 14 were randomized and 6 were nonrandomized controlled articles in Parkinson disease or multiple sclerosis. Six randomized and 2 nonrandomized controlled articles originated from 3 trials and were subsequently pooled for systematic analysis. Strength training was found to significantly improve muscle strength in people with Parkinson disease (15%-83.2%) and multiple sclerosis (4.5%-36%). Significant improvements in mobility (11.4%) and disease progression were also reported in people with Parkinson disease after strength training. Furthermore, significant improvements in fatigue (8.2%), functional capacity (21.5%), quality of life (8.3%), power (17.6%), and electromyography activity (24.4%) were found in individuals with multiple sclerosis after strength training. The limitations of the study were the heterogeneity of interventions and study outcomes in Parkinson disease and multiple sclerosis trials. Strength training is useful for increasing muscle strength in Parkinson disease and to a lesser extent multiple sclerosis.
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Affiliation(s)
- Travis M Cruickshank
- From the School of Medical Sciences (TMC, ARR, MRZ), Edith Cowan University; and School of Pathology and Laboratory Medicine (MRZ), University of Western Australia, Perth, Australia
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Dalgas U, Stenager E, Sloth M, Stenager E. The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature. Eur J Neurol 2014; 22:443-e34. [DOI: 10.1111/ene.12576] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/25/2014] [Indexed: 01/27/2023]
Affiliation(s)
- U. Dalgas
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - E. Stenager
- MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle); Department of Neurology; Soenderborg Hospital; Soenderborg Denmark
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
| | - M. Sloth
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - E. Stenager
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Psychiatry; Abenra Denmark
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Pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with multiple sclerosis who use walking aids. Arch Phys Med Rehabil 2014; 96:197-204. [PMID: 25308884 DOI: 10.1016/j.apmr.2014.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/18/2014] [Accepted: 09/04/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the feasibility and preliminary outcomes of a home progressive resistance training (PRT) program augmented by neuromuscular electrical stimulation (NMES). DESIGN Randomized controlled pilot trial. SETTING Participant homes. PARTICIPANTS People with multiple sclerosis (MS) (N=37) who use a walking aid. INTERVENTIONS A 12-week home PRT program or the same program augmented by NMES. MAIN OUTCOME MEASURES Strength using hand-held dynamometry; repeated sit to stand test; Berg Balance Scale; timed Up & Go test; 12-Item Multiple Sclerosis Walking Scale; Multiple Sclerosis Impact Scale-29, version 2; and Modified Fatigue Impact Scale (MFIS). The NMES group also completed a device usability questionnaire. RESULTS Only change in MFIS score was significantly greater in the NMES group than the PRT group (P=.012). The NMES group improved significantly in quadriceps endurance (median of change, 8.5; P=.043), balance (median of change, 3.5; P=.001), physical impact of MS (median of change, -8.3; P=.001), and impact of fatigue (median of change, -17; P=.001). Participants rated the device as highly usable. CONCLUSIONS This pilot study suggests that a home PRT program with NMES is feasible, and the neuromuscular electrical stimulation device is usable by this population. Only reduction in impact of fatigue was greater in the NMES than the PRT group.
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Rogan S, Schmidtbleicher D, Radlinger L. Immediate effects after stochastic resonance whole-body vibration on physical performance on frail elderly for skilling-up training: a blind cross-over randomised pilot study. Aging Clin Exp Res 2014; 26:519-27. [PMID: 24700493 DOI: 10.1007/s40520-014-0212-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/28/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This pilot study examined the feasibility outcome recruitment, safety and compliance of the investigation for stochastic resonance whole-body vibration (SR-WBV) training. Another aim was to evaluate the effect size of one SR-WBV intervention session on Short Physical Performance Battery (SPPB), Expanded Timed Get Up-and-Go (ETGUG), isometric maximal voluntary contraction (IMVC) and rate of force development (IRFD) and chair rising (CR). DESIGN Randomised double-blinded controlled cross-over pilot study. METHOD Feasibility outcomes included recruitment, safety and compliance. For secondary outcomes, SPPB, ETGUG, IMVC, IRFD and CR were measured before and 2-min after intervention. Nonparametric Rank-Order Tests of Puri and Sen L Statistics to Ranked Data were proposed. Wilcoxon signed-ranked tests were used to analyse the differences after SR-WBV intervention and sham intervention. Treatment effects between the interventions were compared by a Mann-Whitney U test. RESULTS Among 24 eligible frail elderly, 12 agreed to participate and 3 drop out. The adherence was 15 of 24 intervention sessions. For secondary outcome, effect sizes (ES) for SR-WBV intervention on SPPB, ETGUG and CR were determined. CONCLUSION This pilot study indicate that the training protocol used in this form for frail elderly individuals is feasible but with modification due to the fact that not all defined feasibility outcomes target was met. SR-WBV with 6 Hz, noise level 4 shows benefit improvements on SPPB (ES 0.52), ETGUG (part sit-to-stand movement: ES 0.81; total time: ES 0.85) and CR (ES 0.66). Further research is desired to determine whether a new adapted training protocol is necessary for SR-WBV in the "skilling up" phase in frail elderly individuals.
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Khan F, Amatya B, Galea M. Management of fatigue in persons with multiple sclerosis. Front Neurol 2014; 5:177. [PMID: 25309504 PMCID: PMC4163985 DOI: 10.3389/fneur.2014.00177] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022] Open
Abstract
Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
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Kehoe M, Saunders J, Jakeman P, Coote S. Predictors of the physical impact of Multiple Sclerosis following community-based, exercise trial. Mult Scler 2014; 21:590-8. [DOI: 10.1177/1352458514549395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Studies evaluating exercise interventions in people with multiple sclerosis (PwMS) demonstrate small to medium positive effects and large variability on a number of outcome measures. No study to date has tried to explain this variability. Objective: This paper presents a novel exploration of data examining the predictors of outcome for PwMS with minimal gait impairment following a randomised, controlled trial evaluating community-based exercise interventions ( N = 242). Methods: The primary variable was the physical component of the Multiple Sclerosis Impact Scale-29, version 2 (MSIS-29, v2) after a 10-week, controlled intervention period. Predictors were identified a priori and were measured at baseline. Multiple linear regression was conducted. Results: Four models are presented lower MSIS-29, v2 scores after the intervention period were best predicted by a lower baseline MSIS-29,v2, a lower baseline Modified Fatigue Impact Score (physical subscale), randomisation to an exercise intervention, a longer baseline walking distance measured by the Six Minute Walk Test and female gender. This model explained 57.4% of the variance (F (5, 211) = 59.24, p < 0.01). Conclusion: These results suggest that fatigue and walking distance at baseline contribute significantly to predicting MSIS-29, v29 (physical component) after intervention, and thus should be the focus of intervention and assessment. Exercise is an important contributor to minimising the physical impact of MS, and gender-specific interventions may be warranted.
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Affiliation(s)
- M Kehoe
- University of Limerick, Limerick, Ireland
| | - J Saunders
- Statistical Consulting Unit / CSTAR @ UL, University of Limerick, Limerick, Ireland
| | - P Jakeman
- Department of Physical Education and Sports Science, University of Limerick, Ireland
| | - S Coote
- University of Limerick, Limerick, Ireland
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Ensari I, Motl RW, Pilutti LA. Exercise training improves depressive symptoms in people with multiple sclerosis: results of a meta-analysis. J Psychosom Res 2014; 76:465-71. [PMID: 24840141 DOI: 10.1016/j.jpsychores.2014.03.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is a high prevalence, yet under-treatment of depressive disorder and symptoms by conventional therapy in people with multiple sclerosis (MS). We conducted a meta-analysis examining the overall effect of exercise training on depressive symptoms in MS. METHODS We searched PubMed for randomized controlled trials (RCT) of exercise training and depression as an outcome in samples with MS. There were 13 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g. RESULTS The weighted mean ES was small, but statistically significant (Hedge's g=0.36, SE=0.09, 95% CI=0.18-0.54, z=3.92, p<.001) indicating the exercise training resulted in an improvement in depressive symptoms compared to control. The overall effect was not heterogeneous (Q=16.46, df=12, p=0.17, I2=27.08); and post-hoc, exploratory analyses only identified depression symptom scale as a potential moderator variable (p=0.04). CONCLUSION The cumulative evidence indicates that exercise training can yield a small, yet statistically significant and reliable reduction in depressive symptoms for people with MS.
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Affiliation(s)
- Ipek Ensari
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Robert W Motl
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA.
| | - Lara A Pilutti
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
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Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Arch Phys Med Rehabil 2014; 95:1184-200. [PMID: 24631802 DOI: 10.1016/j.apmr.2014.02.023] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS. DATA SOURCES PubMed and Web of Knowledge. STUDY SELECTION Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction. DATA EXTRACTION All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed. DATA SYNTHESIS A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT. CONCLUSIONS The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.
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Affiliation(s)
- Ilse Lamers
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Silke Kelchtermans
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Baert
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Coote S. Progressive resistance therapy is not the best way to rehabilitate deficits due to multiple sclerosis: Yes. Mult Scler 2014; 20:143-4. [DOI: 10.1177/1352458513515087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Is walking capacity in subjects with multiple sclerosis primarily related to muscle oxidative capacity or maximal muscle strength? A pilot study. Mult Scler Int 2014; 2014:759030. [PMID: 24624296 PMCID: PMC3929060 DOI: 10.1155/2014/759030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose. Walking capacity is reduced in subjects with multiple sclerosis (MS). To develop effective exercise interventions to enhance walking capacity, it is important to determine the impact of factors, modifiable by exercise intervention (maximal muscle strength versus muscle oxidative capacity), on walking capacity. The purpose of this pilot study is to discriminate between the impact of maximal muscle strength versus muscle oxidative capacity on walking capacity in subjects with MS. Methods. From 24 patients with MS, muscle oxidative capacity was determined by calculation of exercise-onset oxygen uptake kinetics (mean response time) during submaximal exercise bouts. Maximal muscle strength (isometric knee extension and flexion peak torque) was assessed on dynamometer. All subjects completed a 6-minute walking test. Relationships between walking capacity (as a percentage of normal value) and muscle strength (of knee flexors and extensors) versus muscle oxidative capacity were assessed in multivariate regression analyses. Results. The expanded disability status score (EDSS) showed a significant univariate correlation (r = −0.70, P < 0.004) with walking capacity. In multivariate regression analyses, EDSS and mean response time, but not muscle strength, were independently related to walking capacity (P < 0.05). Conclusions. Walking distance is, next to disability level and not taking neurologic symptoms/deficits into account, primarily related to muscle oxidative capacity in subjects with MS. Additional study is needed to further examine/verify these findings.
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Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, Motl RW. Effects of Exercise Training on Fitness, Mobility, Fatigue, and Health-Related Quality of Life Among Adults With Multiple Sclerosis: A Systematic Review to Inform Guideline Development. Arch Phys Med Rehabil 2013; 94:1800-1828.e3. [DOI: 10.1016/j.apmr.2013.04.020] [Citation(s) in RCA: 411] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/15/2013] [Accepted: 04/07/2013] [Indexed: 11/28/2022]
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Hilfiker R, Vaney C, Gattlen B, Meichtry A, Deriaz O, Lugon-Moulin V, Anchisi-Bellwald AM, Palaci C, Foinant D, Terrier P. Local dynamic stability as a responsive index for the evaluation of rehabilitation effect on fall risk in patients with multiple sclerosis: a longitudinal study. BMC Res Notes 2013; 6:260. [PMID: 23835061 PMCID: PMC3720262 DOI: 10.1186/1756-0500-6-260] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 07/01/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures. METHODS Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer. RESULTS At the end of the rehabilitation process, patients reported reduced pain (Effect Size: -0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4). CONCLUSIONS The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk. TRIAL REGISTRATION Current Controlled Trials ISRCTN69803702.
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Affiliation(s)
- Roger Hilfiker
- Institute Health & Social Work; HES-SO Valais-Wallis, University of Applied Sciences Western Switzerland, Sion and Leukerbad, Switzerland.
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Tarakci E, Yeldan I, Huseyinsinoglu BE, Zenginler Y, Eraksoy M. Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clin Rehabil 2013; 27:813-22. [DOI: 10.1177/0269215513481047] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine the effectiveness of group exercise training on balance, functional status, spasticity, fatigue and quality of life in patients with multiple sclerosis. Design: A randomized single-blind controlled study. Setting: University hospital, outpatient physical therapy department. Subjects: Ambulatory patients with multiple sclerosis. Interventions: Exercise group completed a 12-week group exercise programme under the physical therapists’ supervision. Control group was included in the waiting list. Main measures: The primary outcome measures were the Berg Balance Scale, 10-metre walk test, 10-steps climbing test and secondary outcome measures were the Modified Ashworth Scale, Fatigue Severity Scale and Multiple Sclerosis International Quality of Life. Results: Ninety-nine patients completed the study. There were statistically significant improvements for all outcome measures in the group exercise group ( n = 51) ( p < 0.01). In the control group ( n = 48), there were statistically significant negative change in the Berg Balance Scale and 10-metre walk test measures ( p = 0.002, p = 0.001) and statistically significant increment only in the Fatigue Severity Scale score ( p = 0.002). The Berg Balance Scale score was increased 4.33 in the exercise group, while a decreased of 2.33 in control group. The 10-metre walk test duration (second) was decreased 2.72 in exercise group, while increased 1.44 in control group. In comparing inter-groups changes, both primary and secondary outcome mesures showed significant improvements in favour of the exercise group after the training ( p < 0.05). Conclusion: The study demonstrated that supervised group exercise training is effective in improving balance, functional status, spasticity, fatigue and quality of life in moderately affected people with multiple sclerosis, with no worsening of their clinical status.
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Affiliation(s)
- Ela Tarakci
- Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Ipek Yeldan
- Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey
| | | | - Yonca Zenginler
- Department of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul University, Istanbul, Turkey
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Garrett M, Hogan N, Larkin A, Saunders J, Jakeman P, Coote S. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial. Mult Scler 2012; 19:782-9. [DOI: 10.1177/1352458512461966] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: While there is an increasing body of evidence supporting the efficacy of exercise in people with multiple sclerosis (MS), additional information on the effectiveness of combining aerobic and resistance training, and yoga is required. Objectives: This study evaluated the effectiveness of community exercise interventions for people with MS having minimal gait impairment. Methods: A multi-centred, block-randomised, assessor-blinded, controlled trial was conducted. Participants were randomised in groups of eight to physiotherapist (PT)-led exercise ( n = 80), yoga ( n = 77), fitness instructor (FI)-led exercise ( n = 86) and they took part in weekly community-based group exercise sessions. Those in the control group were asked not to change of their exercise habits ( n = 71). The primary outcome was the Multiple Sclerosis Impact Scale (MSIS) 29v2 physical component, measured before and after the 10-week intervention. Secondary outcomes were the MSIS 29v2 psychological component, the Modified Fatigue Impact Scale (MFIS) and the 6-Minute Walk Test (6MWT). Results: The group x time interaction approached significance for the MSIS-29v2 physical component ( f = 2.48, p = 0.061) and MFIS total ( f = 2.50, p = 0.06), and it was significant for the MFIS physical subscale ( f = 4.23, p = 0.006). All three exercise interventions led to a statistically significant improvement on the MSIS-29 psychological component and both the MFIS total and physical subscales, which were greater than the control ( p < 0.05). Only the PT-led and FI-led interventions significantly improved the MSIS-29 physical and 6MWT to levels greater than the control ( p < 0.05). Conclusions: This study provides evidence for the positive effect of exercise on the physical impact of MS and fatigue. The group nature of the classes may have contributed to the positive effects seen on the psychological impact of MS.
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Affiliation(s)
| | - N Hogan
- University of Limerick, Ireland
| | - A Larkin
- Multiple Sclerosis Society of Ireland, Galway, Ireland
| | | | | | - S Coote
- University of Limerick, Ireland
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Abstract
Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammatory demyelination and neurodegeneration within the CNS. This damage of CNS structures leads to deficits of body functions, which, in turn, affect patient activities, such as walking, and participation. The pathogenesis and resulting consequences of MS have been described as concepts within the International Classification of Functioning, Disability and Health (ICF) model--an international standard to describe and measure health and disability. Evidence suggests that exercise training in people with MS has the potential to target and improve many of the components outlined in the ICF model. Although the body of research examining the effects of exercise training on depression, cognition and participatory outcomes is not sufficiently developed, some preliminary evidence is promising. Exercise training is proposed to affect inflammation, neurodegeneration, and CNS structures, but current evidence is limited. In this Review, we discuss evidence from clinical trials that suggests beneficial effects of exercise training on muscle strength, aerobic capacity and walking performance, and on fatigue, gait, balance and quality of life. Issues with current studies and areas of future research are highlighted.
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Rehabilitation interventions in multiple sclerosis: an overview. J Neurol 2012; 259:1994-2008. [DOI: 10.1007/s00415-012-6577-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/29/2012] [Accepted: 05/30/2012] [Indexed: 11/30/2022]
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Feasibility and effect of aerobic exercise for lowering depressive symptoms among individuals with traumatic brain injury: a pilot study. J Head Trauma Rehabil 2012; 27:99-103. [PMID: 21386712 DOI: 10.1097/htr.0b013e31820e6858] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE : To establish the feasibility and effect of an aerobic exercise intervention on symptoms of depression among individuals with traumatic brain injury. DESIGN : A pre-post single group. PARTICIPANTS : our community dwelling participants (>11 months postinjury) with residual physical impairment recruited from an outpatient clinic. INTERVENTION : 12-week aerobic exercise program. OUTCOME MEASURES : The Hamilton Rating Scale for Depression; aerobic capacity (cycle ergometer, heart rate at reference resistance, perceived exertion); Rosenberg Self-Esteem Scale and program perception (survey). ANALYSIS : Descriptive statistics to depict change in outcome measure scores. Answers from the survey were collated and presented as summary statements. RESULTS : All participants had fewer symptoms of depression, improved aerobic capacity and higher self esteem after the intervention. High satisfaction with the program was reported with no adverse effects. CONCLUSION : The aerobic exercise program was feasible and effective for individuals with traumatic brain injury, leading to improved mood, cardiovascular fitness, and self-esteem. Future research is needed to determine the intensity, frequency, and duration required to reach and maintain improvement.
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Validation of the comprehensive ICF core set for multiple sclerosis from the perspective of physical therapists. Phys Ther 2012; 92:799-820. [PMID: 22403092 DOI: 10.2522/ptj.20110056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of people with MS. OBJECTIVES The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physical therapists. DESIGN A 3-round survey based on the Delphi technique was used. METHODS Physical therapists experienced in the management of MS were asked about problems and resources of people with MS as well as environmental aspects treated by physical therapists (eg, use of assistive devices, support). Statements were linked to the ICF and compared with the Comprehensive ICF Core Set for MS. RESULTS Eighty physical therapists from 23 countries mentioned 2,133 issues that covered all of the ICF components. Two hundred thirty-eight ICF categories were linked to the statements. Forty-six categories in the Comprehensive ICF Core Set for MS were confirmed by physical therapists at the same level or a more specific level of classification. Nineteen additional ICF categories were reported by at least 75% of the participants. CONCLUSIONS The results of this study support the content and face validity of the Comprehensive ICF Core Set for MS. Areas of functioning and health that physical therapists believe should be assessed were identified. The findings of this study as well as the results of completed and ongoing validation studies will further elucidate the validity of the Comprehensive ICF Core Set for MS from different perspectives.
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Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Mult Scler 2012; 18:1215-28. [DOI: 10.1177/1352458512437418] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recently progressive resistance training (PRT) has been recognised as an effective tool in the rehabilitation of persons with multiple sclerosis (MS). The objective of this study was to systematically review the literature of PRT studies for persons with MS. A comprehensive literature search (PubMed, SveMed+, Embase, Cochrane, PEDro, SPORTDiscus and Bibliotek.dk) was conducted. Identified papers were rated according to the PEDro-scale. Sixteen studies were included and scored between 3 and 8 of 11 total points on the PEDro-scale, showing a general lack of blinding. Strong evidence regarding the beneficial effect of PRT on muscle strength was observed. Regarding functional capacity, balance and self-reported measures (fatigue, quality of life and mood) evidence is less strong, but the tendency is overall positive. Indications of an effect on underlying mechanisms such as muscle morphological changes, neural adaptations and cytokines also exist, but the studies investigating these aspects are few and inconclusive. PRT has a positive effect on muscle strength for persons with MS. Heterogeneous results exist regarding the effect on functional capacity and self-reported measures probably because of differences in training protocols, samples sizes, type and severity of MS. The area of underlying mechanisms deserves more attention in future research.
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Affiliation(s)
- T Kjølhede
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - K Vissing
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - U Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
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Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upright postural control: a randomized controlled trial. Phys Ther 2011; 91:1166-83. [PMID: 21680771 DOI: 10.2522/ptj.20100399] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatigue and impaired upright postural control (balance) are the 2 most common findings in people with multiple sclerosis (MS), with treatment approaches varying greatly in effectiveness. OBJECTIVES The aim of this study was to investigate the benefits of implementing a vestibular rehabilitation program for the purpose of decreasing fatigue and improving balance in patients with MS. DESIGN The study was a 14-week, single-blinded, stratified blocked randomized controlled trial. SETTING Measurements were conducted in an outpatient clinical setting, and interventions were performed in a human performance laboratory. PATIENTS Thirty-eight patients with MS were randomly assigned to an experimental group, an exercise control group, or a wait-listed control group. INTERVENTION The experimental group underwent vestibular rehabilitation, the exercise control group underwent bicycle endurance and stretching exercises, and the wait-listed control group received usual medical care. MEASUREMENTS Primary measures were a measure of fatigue (Modified Fatigue Impact Scale), a measure of balance (posturography), and a measure of walking (Six-Minute Walk Test). Secondary measures were a measure of disability due to dizziness or disequilibrium (Dizziness Handicap Inventory) and a measure of depression (Beck Depression Inventory-II). RESULTS Following intervention, the experimental group had greater improvements in fatigue, balance, and disability due to dizziness or disequilibrium compared with the exercise control group and the wait-listed control group. These results changed minimally at the 4-week follow-up. Limitations The study was limited by the small sample size. Further investigations are needed to determine the underlying mechanisms associated with the changes in the outcome measures due to the vestibular rehabilitation program. CONCLUSION A 6-week vestibular rehabilitation program demonstrated both statistically significant and clinically relevant change in fatigue, impaired balance, and disability due to dizziness or disequilibrium in patients with MS.
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Cameron MH, Wagner JM. Gait Abnormalities in Multiple Sclerosis: Pathogenesis, Evaluation, and Advances in Treatment. Curr Neurol Neurosci Rep 2011; 11:507-15. [DOI: 10.1007/s11910-011-0214-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Frohman TC, Castro W, Shah A, Courtney A, Ortstadt J, Davis SL, Logan D, Abraham T, Abraham J, Remington G, Treadaway K, Graves D, Hart J, Stuve O, Lemack G, Greenberg B, Frohman EM. Symptomatic therapy in multiple sclerosis. Ther Adv Neurol Disord 2011; 4:83-98. [PMID: 21694806 DOI: 10.1177/1756285611400658] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis is the most common disabling neurological disease of young adults. The ability to impact the quality of life of patients with multiple sclerosis should not only incorporate therapies that are disease modifying, but should also include a course of action for the global multidisciplinary management focused on quality of life and functional capabilities.
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Affiliation(s)
- Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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