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Wendebourg MJ, Poettgen J, Finlayson M, Gonzalez-Lorenzo M, Heesen C, Köpke S, Giordano A. Education for fatigue management in people with multiple sclerosis: Systematic review and meta-analysis. Eur J Neurol 2024:e16452. [PMID: 39225447 DOI: 10.1111/ene.16452] [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: 03/29/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND PURPOSE Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS-related fatigue. METHODS This was a systematic review and meta-analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue. RESULTS In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS-related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy-conservation-based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow-up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference -0.28; 95% confidence interval -0.53 to -0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference -0.21; 95% confidence interval -0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long-term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses. CONCLUSION Educational interventions for people with MS-related fatigue may be effective in reducing fatigue in the short term. More research is needed on long-term effects and the importance of specific intervention components, delivery and context.
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Affiliation(s)
- Maria Janina Wendebourg
- Department of Clinical Research, Neurology Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jana Poettgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Marien Gonzalez-Lorenzo
- Laboratorio di Metodologia delle Revisioni Sistematiche e Produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea Giordano
- Neuroepidemiology Unit, Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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2
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Sortino M, Petrigna L, Trovato B, Amato A, Castorina A, D’Agata V, Maugeri G, Musumeci G. An Overview of Physical Exercise Program Protocols and Effects on the Physical Function in Multiple Sclerosis: An Umbrella Review. J Funct Morphol Kinesiol 2023; 8:154. [PMID: 37987490 PMCID: PMC10660496 DOI: 10.3390/jfmk8040154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
Multiple sclerosis is a disease that concerns a growing number of people, especially females. There are different interventions proposed for this population, and physical activity is one of them. A proper and well-structured physical activity program can be a cheap, feasible, and practical instrument to help this population improve their quality of life. Consequently, the present study aimed to analyze, through an umbrella review, published articles to evaluate the protocols and the effect of intervention on different types of multiple sclerosis and eventually to propose a standardized intervention for this population. Systematic reviews and meta-analyses of randomized controlled trials on multiple sclerosis and physical activity effects were searched for on the electronic databases PubMed, Web of Science, and Scopus up to 22 December 2022. The quality of the studies included was determined and the results were narratively analyzed. The included studies present heterogeneity in the population, in the study design and protocols, and in the outcomes evaluated. Most of the studies detected positive outcomes on the physical function of people with multiple sclerosis. This study highlights the necessity of future studies on a population with similar characteristics, adopting similar protocols to evaluate their feasibility and validity to make physical intervention prescribed as a medicine.
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Affiliation(s)
- Martina Sortino
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Alessandra Amato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Alessandro Castorina
- Laboratory of Cellular and Molecular Neuroscience (LCMN), School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Velia D’Agata
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (M.S.); (L.P.); (B.T.); (A.A.); (V.D.); (G.M.)
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3
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Effects of two types of exercise training on psychological well-being, sleep and physical fitness in patients with high-grade glioma (WHO III and IV). J Psychiatr Res 2022; 151:354-364. [PMID: 35537372 DOI: 10.1016/j.jpsychires.2022.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is evidence that regular exercise training has the potential to improve psychological well-being among cancer survivors. However, limited findings are available for individuals with high-grade glioma (HGG; WHO grade III and IV) after neurosurgery and undergoing radiochemotherapy. Given this, endurance and strengths training were employed to investigate their impact on symptoms of depression, feelings of stress and anxiety, fatigue, insomnia, and physical fitness, compared to an active control condition. METHODS A total of 29 patients (M = 52.07, SD = 12.45, 55.2% women) participated in this randomized controlled trial (RCT). After neurosurgical treatment and during adjuvant radiotherapy and chemotherapy or combined radiochemotherapy, patients were randomly assigned to the following conditions: Endurance training (n = 10); strengths training (n = 11); active control condition (n = 8). At baseline, three weeks and six weeks later at the end of the study physical fitness was objectively measured with a 6-min walk test (6MWT) and a handgrip test. Participants completed a series of questionnaires covering sociodemographic information, symptoms of depression, stress, anxiety, fatigue, and insomnia. Further, experts rated participants' severity of symptoms of depression. RESULTS Over time and compared to the strengths and active control condition, self-rated symptoms of depression, state and trait anxiety, stress and insomnia decreased in the endurance condition. Over time and compared to the endurance and active control condition, no changes on symptoms of depression, anxiety, stress, or insomnia were observed in the strengths condition. Over time and compared to the endurance and strengths condition, symptoms of depression (self-ratings), stress, insomnia and fatigue decreased in the active control condition. Fatigue increased in both exercising conditions. Over time and irrespective from the study condition, physical fitness did neither improve nor decrease. CONCLUSIONS The pattern of results suggests that endurance training and an active control condition improved dimensions of depression, stress, and anxiety, while mere strengths training appeared to neither improve, nor decrease dimensions of psychological functioning. Further, exercise interventions did not change physical fitness, but increased fatigue. Overall, endurance training and an active control condition appeared to favorably impact on psychological well-being among patients with high-grade glioma after neurosurgery and undergoing radiochemotherapy.
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4
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Langeskov‐Christensen M, Hvid LG, Jensen HB, Nielsen HH, Petersen T, Stenager E, Dalgas U. Efficacy of high-intensity aerobic exercise on common multiple sclerosis symptoms. Acta Neurol Scand 2022; 145:229-238. [PMID: 34687036 DOI: 10.1111/ane.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Fatigue and walking impairment are disabling symptoms of multiple sclerosis (MS). We investigated the effects of progressive aerobic exercise (PAE) on fatigue, walking, cardiorespiratory fitness (VO2 max), and quality of life in people with MS (pwMS). MATERIALS & METHODS Randomized controlled trial (1:1 ratio, stratified by sex) with a 24-week crossover follow-up and intention-to-treat analysis. Allocation to an exercise (24 weeks of PAE followed by self-guided physical activity) and a waitlist (24 weeks of habitual lifestyle followed by PAE) group. PAE comprised two supervised sessions per week; 30-60 min, 65-95% of maximum heart rate. Fatigue impact (Modified Fatigue Impact Scale; MFIS) and severity (Fatigue Severity Scale; FSS), walking ability (12-item MS Walking Scale; MSWS-12) and capacity (Six-Minute Walk Test; 6MWT, Six Spot Step Test; SSST), quality of life (Short Form 36 health survey; SF-36), and VO2 max were measured at baseline, 24 weeks, and 48 weeks. RESULTS Eighty-six pwMS were enrolled. Following PAE between-group differences showed reductions in MFIStotal (-5.3 [95% CI: -10.9;0.4], point estimate >clinical relevance), MFISphysical subscore (-2.8 [-5.6;-0.1]), and MFISpsychosocial subscore (-0.9 [-1.6;-0.2]), and an increase in VO2 max (+3.5 ml O2 /min/kg [2.0;5.1]). MSWS-12 (-5.9 [-11.9; 0.2]) and 6MWT (+14 m [-5;33]) differences suggested potential small walking improvements. No changes observed in FSS, SSST, or SF-36. CONCLUSIONS In a representative sample of pwMS, PAE induced a clinically relevant reduction in fatigue impact, whereas small and no effects were seen for walking and quality of life, respectively. The results need confirmation in a future trial due to the study limitations.
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Affiliation(s)
| | - Lars Grøndahl Hvid
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
| | - Henrik Boye Jensen
- Brain and Nerve Diseases Lillebaelt Hospital Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Neurology Odense University Hospital Odense Denmark
- BRIDGE ‐ Brain Research ‐ Inter‐Disciplinary Guided Excellence Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Thor Petersen
- The Multiple Sclerosis Clinic Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Egon Stenager
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Ulrik Dalgas
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
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5
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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: 33] [Impact Index Per Article: 11.0] [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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Momsen AMH, Ørtenblad L, Maribo T. Effective rehabilitation interventions and participation among people with multiple sclerosis: an overview of reviews. Ann Phys Rehabil Med 2021; 65:101529. [PMID: 33940247 DOI: 10.1016/j.rehab.2021.101529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10 to 65 years. Evidence exists for the effectiveness of multidisciplinary rehabilitation and exercise. However, the effectiveness of other rehabilitation approaches in MS needs further evaluation. OBJECTIVE We aimed to systematically synthesize and evaluate knowledge on effectiveness of rehabilitation interventions and determinants for participation among people with MS (pwMS) to inform clinical guidelines on rehabilitation. METHODS Joanna Briggs Institute methodology was used. PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for reviews, systematic reviews, meta-analyses, and meta-syntheses published during 2009-2019. All types of rehabilitation interventions provided to pwMS at any time and in all settings were eligible. Two reviewers independently screened and extracted data. The most recently published reviews on mixed and specific modalities were included. The findings were reported in a narrative summary and a mixed-methods analysis. RESULTS Among 108 eligible reviews, 6 qualitative or mixed-methods reviews and 66 quantitative reviews were included (total pwMS >90,000). This overview provides solid evidence for the effectiveness of a spectrum of modalities. Among the modalities, there was strong evidence for the effectiveness of multidisciplinary, cognitive and exercise approaches, physiotherapy, and occupational therapy, including full body training on functioning, and participation outcomes. Employment significantly affected quality of life; thus, vocational rehabilitation should be initiated early. Healthcare professionals should identify personal factors including relations and coping, and the rehabilitation process should involve partners or close family. CONCLUSIONS The mixed-methods analysis revealed insufficient consensus between the perspectives of pwMS on their rehabilitation and reported effects, indicating that further research should target the experiences of pwMS. Furthermore, rehabilitation should be patient-centred, focus on the complexity of needs, and be organised and performed by an experienced multidisciplinary team. Evidence-based rehabilitation should be initiated early after pwMS are diagnosed and follow international guidelines. Database registration. PROSPERO ID (CRD42020152422).
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark.
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Thomas Maribo
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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7
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Marck CH, Learmonth YC, Chen J, van der Mei I. Physical activity, sitting time and exercise types, and associations with symptoms in Australian people with multiple sclerosis. Disabil Rehabil 2020; 44:1380-1388. [DOI: 10.1080/09638288.2020.1817985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Claudia H. Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Yvonne C. Learmonth
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Murdoch University, Western Australia, Australia
| | - Jing Chen
- Menzies Institute for Medical Research, The University of Tasmania, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, The University of Tasmania, Tasmania, Australia
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8
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Martínez-Lemos I, Martínez-Aldao D, Seijo-Martínez M, Ayán C. Nordic walking for people with relapsing-remittent multiple sclerosis: A case series study. Mult Scler Relat Disord 2020; 46:102479. [PMID: 32911307 DOI: 10.1016/j.msard.2020.102479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) show fatigue, impaired gait and decreased functional mobility, which lead to a low quality of life (QoL). Low-cost and easy to perform exercise modalities having a positive impact on the aforementioned symptoms are needed. The performance of Nordic Walking (NW) could be a useful rehabilitation strategy but, to our knowledge, no study has been published in this regard as yet. This case series study aims at providing information regarding the usefulness and impact of a three-month NW program on self-perceived fatigue, functional mobility, physical fitness and QoL on a group of people with mild relapsing-remitting MS. METHODS A case series study with multiple assessments was performed. Three data collection points at 1-week intervals for three weeks were done at baseline. The intervention consisted of a 12-weeks NW program with a total of four measurement occasions, one every three weeks. The Fatigue Severity Scale (FSS), the Timed up and Go test (TUG), the 6-Minute Walk test (6MWT) and the Multiple Sclerosis Impact Scale (MSIS-29), were used to assess the outcomes of the program on the participants' self-perceived fatigue, functional mobility, physical fitness and QoL, respectively. RESULTS Of the 14 participants who volunteered for the study, five completed at least 80% of the planned sessions and were included in the final analysis. The intervention did not have a clinical significant impact on the participants' fatigue while its impact on their QoL showed mixed results. Positive trends were found for all the participants in their functional mobility and physical fitness. Regarding functional mobility, clinically important changes were observed in three participants. None of the observed changes in physical fitness achieved clinical significance. CONCLUSION A 12-week Nordic walking program did not appear to be particularly feasible and had little impact on the functional levels on a group of people with mild relapsing-remitting MS. Given that beneficial effects were seen in some participants, and taken into account the low adherence rate observed, future studies should explore the feasibility of NW programs performed under different environmental conditions (i.e. outdoors) and including motivational strategies aimed at increasing participation.
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Affiliation(s)
- Iván Martínez-Lemos
- Well-Move Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain; Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, Pontevedra, Spain.
| | - Daniel Martínez-Aldao
- Well-Move Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain.
| | - Manuel Seijo-Martínez
- Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, Pontevedra, Spain; Department of Neurology, Complexo Hospitalario Pontevedra-Salnés, Spain
| | - Carlos Ayán
- Well-Move Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain; Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, Pontevedra, Spain.
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9
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Grubić Kezele T, Babić M, Kauzlarić-Živković T, Gulić T. Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study. Neurol Sci 2019; 41:65-74. [PMID: 31422507 DOI: 10.1007/s10072-019-04046-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The present small semi-controlled feasibility study investigated a possible efficacy of a combined upper limb and breathing exercise programme in managing pain in ambulatory and non-ambulatory patients with EDSS from 0.0-8.0. METHOD People with MS (N = 19) were enrolled in this single-blind randomized controlled study and divided into 2 groups: exercise group (5 ambulatory, 5 non-ambulatory; Expanded Disability Status Scale (EDSS), 1.0-8.0) and related control group that performed no exercise (4 ambulatory, 5 non-ambulatory; EDSS, 1.0-7.5). The exercise group performed combined upper limb and breathing exercises in a group led by a physiotherapist (2 days/week, 60 min/session) accompanied by independent home exercises (3 days/week, ≥ 20 min/session). Participants underwent measures of pain level (visual analogue scale) for physical pain, functional independence of daily activities (Barthel index) and handgrip strength (HGS) for dominant (D) and non-dominant (ND) hand evaluated by a dynamometer before and after the 4-week period by the blinded assessor. RESULTS The VAS for pain showed statistically significant group-by-time interaction only in non-ambulatory (p = .049) individuals, but with large intervention effects on both subgroups (ambulatory, p = .159; non-ambulatory, d = 0.97). Functional independence in daily activities (Barthel index) showed statistically non-significant group-by-time interaction in ambulatory (p = .195, d = 0.89) and non-ambulatory (p = .102, d = 1.64) individuals, but despite the absence of statistical significance, there were large intervention effects. Handgrip strength was significantly improved for both hands in ambulatory (D, p = .012; d = 2.07; ND, p = .025, d = 1.77) and only non-dominant hand in non-ambulatory individuals (D, p = .288, d = 0.83; ND, p = .012, d = 2.21). CONCLUSION This small pilot study provides preliminary proof-of-concept data supporting low-intensity upper limb and breathing exercise programme for potential reduction of pain and improvement of functional independence in both ambulatory and non-ambulatory individuals with MS in a larger sample and that strengthening the upper limbs might be an additional pain relief mechanism. TRIAL REGISTRATION NTC03222596.
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Affiliation(s)
- Tanja Grubić Kezele
- Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, B. Branchetta 20, 51000, Rijeka, Croatia.
| | - Matea Babić
- Department of Physiotherapy, University of Rijeka, Faculty of Health Studies, Rijeka, Croatia
| | | | - Tamara Gulić
- Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, B. Branchetta 20, 51000, Rijeka, Croatia
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10
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Wendebourg MJ, Pöttgen J, Giordano A, Finlayson M, Heesen C, Köpke S. Patient education for fatigue in people with multiple sclerosis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Jana Pöttgen
- University Medical Center Hamburg-Eppendorf; Institute of Neuroimmunology and Multiple Sclerosis Department of Neurology, Multiple Sclerosis Day Hospital; Martinistr. 52 Hamburg Germany 20246
| | - Andrea Giordano
- Fondazione I.R.C.C.S. - Neurological Institute Carlo Besta; Neuroepidemiology Unit; Via Celoria 11 Milan Italy 20133
| | - Marcia Finlayson
- Queen's University; School of Rehabilitation Therapy; 31 George Street Kingston ON Canada
| | - Christoph Heesen
- University Medical Center; Institute of Neuroimmunology and Multiple Sclerosis; Martinistr 52 Hamburg Germany 20246
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany D-23538
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11
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Dormer L. Introducing volume 8 of Neurodegenerative Disease Management. Neurodegener Dis Manag 2019; 8:1-4. [PMID: 29400629 DOI: 10.2217/nmt-2017-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Welcome to the eighth volume of Neurodegenerative Disease Management. At the start of a new volume, it is interesting to look back at which content proved most popular in 2017, and also to take a look forward to the content of this issue and beyond.
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Affiliation(s)
- Laura Dormer
- Future Medicine Ltd, Unitec House, London N3 1QB, UK
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