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Gravesteijn AS, Timmermans ST, Aarts J, Hulst HE, De Jong BA, Beckerman H, De Groot V. Relative aerobic load of walking in people with multiple sclerosis. J Rehabil Med 2024; 56:jrm13352. [PMID: 38353255 PMCID: PMC10875758 DOI: 10.2340/jrm.v56.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To examine the energy demand of walking relative to aerobic capacity in people with multiple sclerosis. DESIGN Cross-sectional cohort study. PATIENTS A total of 45 people with multiple sclerosis (32 females), median disease duration 15 years (interquartile range (IQR) 9; 20), median Expanded Disability Status Scale 4 (min-max range: 2.0; 6.0). METHODS Aerobic capacity, derived from a cardiopulmonary exercise test and gas exchange measurements, assessed during a 6-min overground walk test at comfortable speed, were analysed. The relative aerobic load of walking was determined as the energy demand of walking relative to oxygen uptake at peak and at the first ventilatory threshold. Healthy reference data were used for clinical inference. RESULTS People with multiple sclerosis walk at a mean relative aerobic load of 60.0% (standard deviation 12.8%) relative to peak aerobic capacity, and 89.1% (standard deviation 19.9%) relative to the first ventilatory threshold. Fourteen participants walked above the first ventilatory threshold (31%). Peak aerobic capacity was reduced in 45% of participants, and energy demands were increased in 52% of participants. CONCLUSION People with multiple sclerosis walk at a relative aerobic load close to their first ventilatory threshold. A high relative aerobic load can guide clinicians to improve aerobic capacity or reduce the energy demands of walking.
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Affiliation(s)
- Arianne S Gravesteijn
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands.
| | - Sjoerd T Timmermans
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jip Aarts
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Hanneke E Hulst
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; MS Center Amsterdam, Anatomy and Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Brigit A De Jong
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Heleen Beckerman
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
| | - Vincent De Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
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Nieste I, Franssen WMA, Duvivier BMFM, Spaas J, Savelberg HHCM, Eijnde BO. Replacing sitting with light-intensity physical activity throughout the day versus 1 bout of vigorous-intensity exercise: similar cardiometabolic health effects in multiple sclerosis. A randomised cross-over study. Disabil Rehabil 2023; 45:3293-3302. [PMID: 36190113 DOI: 10.1080/09638288.2022.2122601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Persons with Multiple Sclerosis (PwMS) are physically inactive and spend more time in sedentary behaviours than healthy persons, which increases the risk of developing cardiometabolic diseases. In this randomised crossover study, the cardiometabolic health effects of replacing sitting with light-intensity physical activity (LIPA) and exercise (EX) were investigated. MATERIALS AND METHODS Twenty-eight mildly disabled PwMS performed four 4-day activity regimens in free-living conditions; CONTROL (habitual activity), SIT, LIPA, and EX. Plasma glucose and insulin (oral glucose tolerance test), plasma lipids, inflammation, resting heart rate, blood pressure, body weight, and perceived exertion were measured (clinical-trials.gov: NCT03919058). RESULTS CONTROL: 9.7 h sitting/day, SIT: 13.3 h sitting/day, LIPA: 8.3 h sitting, 4.7 h standing, and 2.7 h light-intensity walking/day, and EX: 11.6 h sitting/day with 1.3 h vigorous-intensity cycling. Compared to SIT, improvements (p < 0.001) after LIPA and EX were found for insulin total area under the curve (-17 019 ± 5708 and -23 303 ± 7953 pmol/L*min), insulin sensitivity (Matsuda index +1.8 ± 0.3 and +1.9 ± 0.4) and blood lipids (triglycerides: -0.4 ± 0.1 and -0.5 ± 0.1 mmol/L; non-high-density lipoprotein cholesterol: -0.3 ± 0.1 and -0.5 ± 0.1 mmol/L), with no difference between LIPA and EX. Perceived exertion was higher after EX compared to LIPA (Borg score [6-20]: +2.6 ± 3.3, p = 0.002). CONCLUSION Replacing sitting with LIPA throughout the day exerts similar cardiometabolic health effects as a vigorous-intensity exercise in PwMS.IMPLICATIONS FOR REHABILITATIONIncreasing light-intensity physical activity (LIPA) throughout the day improves cardiometabolic health to the same extent as one vigorous-intensity exercise sessionIncreasing LIPA induces less exertion than performing a vigorous-intensity exercise.
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Affiliation(s)
- Ine Nieste
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
| | - Wouter M A Franssen
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | | | - Jan Spaas
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
| | - Bert O Eijnde
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
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Schlagheck ML, Bansi J, Wenzel C, Kuzdas-Sallaberger M, Kiesl D, Gonzenbach R, Zimmer P. Complexity and pitfalls in maximal exercise testing for persons with multiple sclerosis. Eur J Neurol 2023; 30:2726-2735. [PMID: 37209371 DOI: 10.1111/ene.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND PURPOSE Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS who attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET) and (ii) to provide insight into participant characteristics that limit maximal exercise performance. METHODS This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n = 380 inpatient pwMS (mean age = 48 ± 11 years, 66% female). Chi-squared or Fisher's exact tests were conducted to compare differences in the distribution of criteria achieved. Participants' characteristics were examined as potential predictors using binary logistic regression. RESULTS Only 60% of the overall sample attained a respiratory exchange ratio ≥ 1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six percent met at least two of three criteria. Disability status, gender, disease course, and body mass index were associated with the attainment of maximal effort. CONCLUSIONS Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimize CPET protocols in restrictive groups of pwMS.
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Affiliation(s)
- Marit L Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Jens Bansi
- Department of Neurology, Kliniken Valens, Rehabilitation Centre Valens, Valens, Switzerland
- Department of Health, OST-Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Charlotte Wenzel
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | | | - David Kiesl
- University Clinic for Hematology and Internal Oncology, Kepler University Hospital Linz, Johannes Kepler University Linz, Linz, Austria
| | - Roman Gonzenbach
- Department of Neurology, Kliniken Valens, Rehabilitation Centre Valens, Valens, Switzerland
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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Patejdl R, Zettl UK. The pathophysiology of motor fatigue and fatigability in multiple sclerosis. Front Neurol 2022; 13:891415. [PMID: 35968278 PMCID: PMC9363784 DOI: 10.3389/fneur.2022.891415] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple Sclerosis (MS) is a heterogeneous immune mediated disease of the central nervous system (CNS). Fatigue is one of the most common and disabling symptom of MS. It interferes with daily activities on the level of cognition and motor endurance. Motor fatigue can either result from lesions in cortical networks or motor pathways (“primary fatigue”) or it may be a consequence of detraining with subsequent adaptions of muscle and autonomic function. Programmed exercise interventions are used frequently to increase physical fitness in MS-patients. Studies investigating the effects of training on aerobic capacity, objective endurance and perceived fatigability have yielded heterogenous results, most likely due to the heterogeneity of interventions and patients, but probably also due to the non-uniform pathophysiology of fatigability among MS-patients. The aim of this review is to summarize the current knowledge on the pathophysiology of motor fatigability with special reference to the basic exercise physiology that underlies our understanding of both pathogenesis and treatment interventions.
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Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- *Correspondence: Robert Patejdl
| | - Uwe K. Zettl
- Department of Neurology, Clinical Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
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Ghasemi P, Mazaheri R, Tabesh MR, Ali AR, Sahraian MA, Fard HS, Abolhasani M. Effect of Endurance Training on Cardiopulmonary Fitness in people with Multiple Sclerosis. Mult Scler Relat Disord 2022; 64:103911. [DOI: 10.1016/j.msard.2022.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/30/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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He J, Fu J, Zhao W, Ren C, Liu P, Chen L, Li D, Zhou L, Tang L, Liu X, Ye S, Liu X, Ma Y, Zhang Y, Ma X, Zhang L, Zhang G, Li N, Fan D. Exercise Physiology Impairments of Patients With Amyotrophic Lateral Sclerosis: Cardiopulmonary Exercise Testing Findings. Front Physiol 2022; 13:792660. [PMID: 35370778 PMCID: PMC8967153 DOI: 10.3389/fphys.2022.792660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective In amyotrophic lateral sclerosis (ALS), progressive weakness significantly limits the ability to exercise. However, measurements of the impaired exercise function and their practical value to assess disease progression in ALS are scarce. Cardiopulmonary exercise testing (CPET) is a non-invasive accurate method used to comprehensively quantify exercise physiology in a variety of diseases. This study aimed to evaluate the clinical value of CPET and to explore its association with disease severity and prognosis prediction in ALS. Methods A total of 319 participants were enrolled in this 3-year prospective study. After strict quality control, 109 patients with ALS and 150 age- and sex-matched healthy controls were included with comprehensive clinical assessment and follow-ups. The incremental ramp protocol for symptom-limited CPET was applied in both groups. The exercise physiology during peak effort exercise was systematically measured, including the overall aerobic capacity of exercise (VO2 peak) and the respective capacity of the exercise-involved organs [cardiac response (heart rate peak—HR peak), ventilatory efficiency (VE/VCO2 slope), breathing economy (VE/VO2 peak), and other relevant parameters]. Disease severity and progression were evaluated using recognized scales. Survival was monitored with regular follow-ups every 6 months. Results Decreased exercise capacity (VO2 peak < 16 ml/kg/min) occurred more frequently in patients with ALS than in controls (44.95% vs. 9.33%, p < 0.01). In patients with ALS, the average VO2 peak (16.16 ± 5.43 ml/kg/min) and HR peak [135 (112–153) bpm] were significantly lower (p < 0.01) than in controls [22.26 ± 7.09 ml/kg/min; 148 (135–164) bpm], but the VE/VCO2 slope was significantly higher [28.05 (25.03–32.16) vs. 26.72 (24.37–29.58); p = 0.03]. In patients with ALS, the VO2 peak and HR peak were significantly correlated with disease severity and progression scores (p < 0.05). Survival analyses revealed the VO2 peak and HR peak as protective indicators while the VE/VO2 peak as a detrimental indicator for the prognostic prediction in ALS (HR = 0.839, p = 0.001; HR = 0.967, p < 0.001; HR = 1.137, p = 0.028, respectively). Conclusion Our prospective study quantified the significantly decreased exercise capacity in ALS through non-invasive CPET. The impaired VO2 peak and HR peak closely correlated with disease severity and independently predicted a worse prognosis. Our findings identified the clinical value of CPET as an objective indicator of disease progression in ALS.
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Affiliation(s)
- Ji He
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dan Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lequn Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaolu Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yan Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xinran Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Li
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- *Correspondence: Dongsheng Fan,
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The aerobic capacity – fatigue relationship in persons with Multiple Sclerosis is not reproducible in a pooled analysis of two randomized controlled trials. Mult Scler Relat Disord 2022; 58:103476. [DOI: 10.1016/j.msard.2021.103476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
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Bromley LE, Horvath PJ, Bennett SE, Weinstock-Guttman B, Rideout TC, Browne RW, Ray AD. Three-Day Dietary Manipulation in Multiple Sclerosis: Exercise and Fatigue Outcomes. Int J MS Care 2021; 23:199-205. [PMID: 34720759 DOI: 10.7224/1537-2073.2020-036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background In persons with multiple sclerosis (MS), the effect of nutrition on exercise performance and fatigue remains unknown. The objective was to determine whether a 3-day diet high in triglycerides (FAT) compared with a 3-day diet high in carbohydrates (CARB) would improve fatigue and exercise performance in persons with MS. Methods A randomized controlled crossover design was incorporated to study FAT versus CARB on submaximal cycling endurance (60% of peak oxygen consumption), substrate utilization, and fatigue in 12 persons with mild-to-moderate MS (Expanded Disability Status Scale score, 2.0-5.0) and 12 age- and sex-matched controls. Results There were no differences in cycling time between diets in either group (P = .29). The MS group had no changes in fatigue between diets (P = .64); the control group demonstrated increased total mental fatigue after FAT (P = .05). The control group increased carbohydrate oxidation by 24% at rest and 13% during exercise after CARB. Similarly, the control group significantly increased fat oxidation after FAT by 22% at rest and 68% during exercise (P = .01). These changes were not seen in the MS group. Compared with controls, persons with MS oxidized approximately 50% less fat during exercise after FAT (P = .05). Conclusions Neither CARB nor FAT altered submaximal exercise performance or baseline fatigue in the MS group. The results suggest that persons with MS are unable to adapt to dietary changes and oxidize fatty acids as efficiently as controls.
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Affiliation(s)
- Lacey E Bromley
- Department of Physical Therapy, D'Youville, Buffalo, NY, USA (LEB)
| | - Peter J Horvath
- Department of Exercise and Nutritional Sciences (PJH, TCR), University at Buffalo, Buffalo, NY
| | - Susan E Bennett
- Department of Rehabilitation Science (SEB), University at Buffalo, Buffalo, NY, USA
| | | | - Todd C Rideout
- Department of Exercise and Nutritional Sciences (PJH, TCR), University at Buffalo, Buffalo, NY
| | - Richard W Browne
- Department of Biotechnical and Clinical Laboratory Sciences (RWB), University at Buffalo, Buffalo, NY, USA
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Cancer Center, Buffalo NY, USA (ADR)
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Li R. SIMULATION OF THE RELATIONSHIP BETWEEN EXERCISE AND CARDIOPULMONARY FUNCTION AT HIGH ALTITUDE. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127042021_0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Due to various uncertain and unexpected factors in life such as diseases, natural disasters, traffic accidents, and congenital disabilities, the number and proportion of lower limb amputations are still rising for many reasons, so the research on lower limb prostheses is particularly important. Objective: This work aimed to study the relationship between altitude exercise and cardiopulmonary function. Methods: A model of abnormal changes in cardiopulmonary function was established, and then 40 plateau exercisers were selected, all of whom arrived in Tibet in March 2017. The relationship between pulmonary circulation volume and internal pressure in the chest was observed and compared. The relationship between cardiopulmonary sensory reflex and exercise (high altitude) breathing and heart rate was analyzed. A comparison of the cardiopulmonary function of subjects of different genders was implemented. Moreover, the influence of different altitudes on the subjects’ cardiopulmonary function and the subjects’ cardiopulmonary function changes before departure and during the first, second, and third week after departure were observed and compared. Results: I. As the pressure in the thoracic cavity increased, the subjects’ pulmonary circulation blood volume gradually decreased, and the decrease was most obvious in the stage of thoracic pressure −50 to 0. II. As the cardiorespiratory reflex coefficient increased, the subjects’ breathing and heart rate compensatory acceleration appeared. III. Tracking and monitoring of the subjects’ cardiopulmonary indicators revealed that with the increase in altitude, the subjects’ average arterial pressure, respiratory frequency, and heart rate all showed an upward trend, while the blood oxygen saturation value showed a downward trend. IV. No matter how high the altitude was, the average arterial pressure, respiratory rate, and heart rate monitored of the subjects under exercise were significantly superior to the indicator values under resting state. In contrast, the blood oxygen saturation value showed the opposite trend. V. The subjects’ average arterial pressure, respiration, and heart rate in the first week were higher than other periods, but the blood oxygen saturation was relatively lower. In the second and third weeks, the changes in cardiopulmonary function were relatively smooth (all P<0.05). VI. The changes in the index of the cardiopulmonary function of subjects of different genders were small (p>0.05). Conclusion: Through modeling, the results of the plateau environment on the cardiopulmonary function of the body were made clearer, and these research data provided theoretical references for the training of the sports field in the plateau area. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
- Rui Li
- Xi'an University of Finance and Economics, China
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10
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Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport 2021; 25:146-154. [PMID: 34538565 DOI: 10.1016/j.jsams.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. DESIGN AND METHODS Synthesis of published works within the field of exercise training in MS. RESULTS Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. CONCLUSIONS Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA), Australia; Australian Catholic University, Australia; Multiple Sclerosis Limited, Australia; School of Population Health, University of New South Wales, Australia.
| | - Stephen Lord
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
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Valet M, Stoquart G, de Broglie C, Francaux M, Lejeune T. Simplified indices of exercise tolerance in patients with multiple sclerosis and healthy subjects: A case-control study. Scand J Med Sci Sports 2020; 30:1908-1917. [PMID: 32608527 DOI: 10.1111/sms.13756] [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: 09/26/2018] [Revised: 09/02/2019] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
Among patients with multiple sclerosis (MS), the impairment of exercise tolerance is closely related to disability. Maximal oxygen uptake (VO2max ) is the gold standard to assess exercise tolerance in healthy subjects (HS). Among patients with MS, the accuracy of VO2max measurement is often impaired because the patients are unable to reach the maximal exercise intensity due to interdependent factors linked to the disease (such as pathological fatigue, pain, lack of exercise habit, and lack of mobility). This study assesses the accuracy of simplified indices for assessing exercise tolerance, which are more suitable in patients with MS. They are simple in the way they are either measurable during submaximal exercise (oxygen uptake efficiency slopes (OUES), physical working capacity at 75% of maximal heart rate (PWC75% ), oxygen consumption at a respiratory exchange ratio of 1 (VO2 @RER1)) or not based on gas exchange analysis (peak work rate (PWR)-based predictive equation and PWC75% ). All indices were significantly lower in the MS group compared to the HS group (P < .001). OUES appeared highly correlated (r > .70, P < .001) with VO2peak , in both groups, without difference between groups. PWR-based prediction of VO2peak showed a standard error of the estimate of 315 mL min-1 in HS and 176 mL min-1 in MS. PWC75% did not correlate to VO2peak in neither group. These findings suggest an impairment of exercise tolerance functions in mildly disabled persons with MS, independently from other factors. Submaximal indices involving gas exchange analysis or peakWR-based estimation of VO2peak are usable to accurately assess exercise tolerance.
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Affiliation(s)
- Maxime Valet
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gaëtan Stoquart
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Clémence de Broglie
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marc Francaux
- Institute of NeuroScience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Willingham TB, Backus D, McCully KK. Muscle Dysfunction and Walking Impairment in Women with Multiple Sclerosis. Int J MS Care 2019; 21:249-256. [PMID: 31889929 DOI: 10.7224/1537-2073.2018-020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Recent evidence suggests that skeletal muscle dysfunction is involved in disability progression in people with multiple sclerosis (MS). However, the relationship between muscle dysfunction and walking impairments in MS remains unclear. Thus, the cross-sectional relationships between muscle-specific oxidative capacity and walking endurance in women with MS were evaluated. Methods Twenty women with MS (11 African American, 9 white) were tested. Muscle oxidative capacity of the medial gastrocnemius was measured using near-infrared spectroscopy after electrical stimulation. Muscle endurance was evaluated using accelerometer-based mechanomyography during electrical stimulation. Muscle strength was measured during maximal voluntary plantarflexion using handheld dynamometry. Walking function was measured using the Timed 25-Foot Walk test and the 6-Minute Walk Test (6MWT). Results Reduced muscle oxidative capacity (R 2 = 0.68-0.71, P < .01) and muscle endurance (R 2 = 0.59-0.78, P < .01) were associated with lower Timed 25-Foot Walk time and 6MWT distance. Muscle strength was weakly correlated to 6MWT distance (R 2 = 0.21, P = .02). No differences in muscle function or clinical outcome measures were found between African American and white subgroups. Women with moderate-to-severe disability (Expanded Disability Status Scale [EDSS] score, 5.0-6.5) had significantly reduced muscle oxidative capacity, muscle endurance, and walking ability compared with women with mild disability (EDSS score, 2.5-4.5). Conclusions Reductions in muscle function in people with MS are related to declines in walking function across all levels of disability. Muscle dysfunction is not differentially related to walking impairment in African American and white women with MS.
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Acute effects of aerobic intensities on the cytokine response in women with mild multiple sclerosis. Mult Scler Relat Disord 2019; 31:82-86. [DOI: 10.1016/j.msard.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/17/2019] [Accepted: 03/31/2019] [Indexed: 12/18/2022]
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Prolonged cortical silent period is related to poor fitness and fatigue, but not tumor necrosis factor, in Multiple Sclerosis. Clin Neurophysiol 2019; 130:474-483. [PMID: 30771724 DOI: 10.1016/j.clinph.2018.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Poor fitness among people with Multiple Sclerosis (MS) aggravates disease symptoms. Whether low fitness levels accompany brain functioning changes is unknown. METHODS MS patients (n = 82) completed a graded maximal exercise test, blood was drawn, and transcranial magnetic stimulation determined resting and active motor thresholds, motor evoked potential latency, and cortical silent period (CSP). RESULTS Sixty-two percent of participants had fitness levels ranked below 10th percentile. Fitness was not associated with disability measured using the Expanded Disability Status Scale (EDSS). Regression analyses revealed that, cardiorespiratory fitness, when controlling for disease demographics, contributed 23.7% (p < 0.001) to the model explaining variance in CSP. Regression analysis using cardiorespiratory fitness and CSP as predictors showed that CSP alone explained 19.9% of variance in subjective fatigue (p = 0.002). Tumor necrosis factor was not associated with any variable. CONCLUSION Low fitness was associated with longer CSP in MS. Longer CSP was, in turn, related to greater MS fatigue. SIGNIFICANCE MS patients had extremely low levels of cardiorespiratory fitness. Poor fitness predicted longer CSP, a marker of greater intracortical inhibition, which was linked to MS fatigue. Future research should examine whether aerobic training could shorten CSP and potentially lessen inhibition of cortical networks.
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Heine M, Richards R, Geurtz B, Los F, Rietberg M, Harlaar J, Gerrits K, Beckerman H, de Groot V. Preliminary effectiveness of a sequential exercise intervention on gait function in ambulant patients with multiple sclerosis - A pilot study. Clin Biomech (Bristol, Avon) 2019; 62:1-6. [PMID: 30614444 DOI: 10.1016/j.clinbiomech.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/16/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (pwMS) often experience a decline in motor function and performance during prolonged walking, which potentially is associated with reduced ankle push-off power and might be alleviated through structured exercise. The objectives of this pilot study were to assess ankle push-off power and walking performance in pwMS and healthy controls, and the preliminary effectiveness of a sequential exercise program (resistance training followed by walking-specific endurance training) on ankle push-off power and walking performance. METHODS PwMS (N = 10) with self-reported reduced walking performance and healthy controls (N = 10; at baseline only) underwent 3D gait analysis during a self-paced 12-minute walking test to assess walking performance prior to and following a sequential exercise program. Secondary testing paradigms comprised isometric muscle testing (triceps surae), cardiopulmonary exercise testing and self-report measures. FINDINGS PwMS had a shorter 12-minute walking distance, and lower peak ankle push-off power (most-affected leg) in comparison to healthy controls. There was no minute-to-minute decline in walking performance. The 8-week resistance training significantly improved walking distance. In parallel, higher peak and speed-normalized ankle push-off power were found in the less-affected side. No additional changes were found following the walking-specific endurance training phase. INTERPRETATION There was no walking-related motor fatigue found during a self-paced 12-minute walking test despite reduced ankle push-off power, and self-reported walking problems. Preliminary effects suggest a positive effect of resistance training on walking performance, potentially associated with increases in ankle push-off power, interestingly, in the less-affected leg. The added effect of the walking-specific endurance training remains unclear.
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Affiliation(s)
- Martin Heine
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Rosie Richards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Bibi Geurtz
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Felicia Los
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Marc Rietberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Karin Gerrits
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
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Campbell E, Coulter EH, Paul L. High intensity interval training for people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2018; 24:55-63. [PMID: 29936326 DOI: 10.1016/j.msard.2018.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/07/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aerobic high intensity interval training (HIIT) is safe in the general population and more efficient in improving fitness than continuous moderate intensity training. The body of literature examining HIIT in multiple sclerosis (MS) is expanding but to date a systematic review has not been conducted. The aim of this review was to investigate the efficacy and safety of HIIT in people with MS. METHODS A systematic search was carried out in September 2017 in EMBASE, MEDline, PEDro, CENTRAL and Web of Science Core collections using appropriate keywords and MeSH descriptors. Reference lists of relevant articles were also searched. Articles were eligible for inclusion if they were published in English, used HIIT, and included participants with MS. Quality was assessed using the PEDro scale. The following data were extracted using a standardised form: study design and characteristics, outcome measures, significant results, drop-outs, and adverse events. RESULTS Seven studies (described by 11 articles) were identified: four randomised controlled trials, one randomised cross-over trial and two cohort studies. PEDro scores ranged from 3 to 8. Included participants (n = 249) were predominantly mildly disabled; one study included only people with progressive MS. Six studies used cycle ergometry and one used arm ergometry to deliver HIIT. One study reported six adverse events, four which could be attributed to the intervention. The other six reported that there were no adverse events. Six studies reported improvements in at least one outcome measure, however there were 60 different outcome measures in the seven studies. The most commonly measured domain was fitness, which improved in five of the six studies measuring aspects of fitness. The only trial not to report positive results included people with progressive and a more severe level of disability (Extended Disability Status Scale 6.0-8.0). CONCLUSION HIIT appears to be safe and effective in increasing fitness in people with MS and low levels of disability. Further research is required to explore the effectiveness of HIIT in people with progressive MS and in those with higher levels of disability.
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Affiliation(s)
- Evan Campbell
- School of Medicine, University of Glasgow, Glasgow, United Kingdom.
| | - Elaine H Coulter
- Division of Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography, Queen Margaret University, Edinburgh, United Kingdom; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
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Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports Med 2016; 45:905-23. [PMID: 25739555 DOI: 10.1007/s40279-015-0307-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS. OBJECTIVES The objectives of this study were to (1) systematically review the psychometric properties of the VO2max test; (2) systematically review the literature on VO2max compared with healthy populations; (3) summarize correlates of VO2max; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO2max in PwMS. DATA SOURCES AND STUDY SELECTION A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity (VO2max) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. STUDY APPRAISAL AND SYNTHESIS METHODS The psychometric properties of the VO2max test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO2max. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. RESULTS A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO2max testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having low-to-mild disability, and an ∼10% change between two tests performed on separate days can be considered the smallest reliable change (with 95% certainty) in VO2max in PwMS. The average body-weight-adjusted VO2max was significantly lower in PwMS (25.5 ± 5.2 mL·kg(-1)·min(-1)) compared with healthy controls (30.9 ± 5.4 mL·kg(-1)·min(-1)). The analysis of VO2max correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO2max by as much as 3.5 mL·kg(-1)·min(-1). CONCLUSIONS A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits.
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Comprehensive Profile of Cardiopulmonary Exercise Testing in Ambulatory Persons with Multiple Sclerosis. Sports Med 2016; 46:1365-79. [DOI: 10.1007/s40279-016-0472-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Feasibility and Safety of Cardiopulmonary Exercise Testing in Multiple Sclerosis: A Systematic Review. Arch Phys Med Rehabil 2015; 96:2055-66. [DOI: 10.1016/j.apmr.2015.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022]
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20
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Update in Exercise Testing. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0095-0] [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]
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Effects of a Short Physical Exercise Intervention on Patients with Multiple Sclerosis (MS). Int J Mol Sci 2015; 16:15761-75. [PMID: 26184173 PMCID: PMC4519923 DOI: 10.3390/ijms160715761] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this prospective randomized controlled trial was to investigate if a short-term endurance or combined endurance/resistance exercise program was sufficient to improve aerobic capacity and maximum force in adult patients (18-65 years) with multiple sclerosis (MS). METHODS All patients performed a three-month exercise program consisting of two training sessions per week, lasting 40 min each, with moderate intensity. All patients had a maximum value of 6 (low to moderate disability) on the Expanded Disability Status Scale (EDSS). One group (combined workout group (CWG); 15 females, 4 males) completed a combined endurance/resistance workout (20 min on a bicycle ergometer, followed by 20 min of resistance training), while the other group (endurance workout group (EWG); 13 females, 5 males) completed a 40 min endurance training program. Aerobic capacity was assessed as peak oxygen uptake, ventilatory anaerobic threshold, and workload expressed as Watts. Maximum force of knee and shoulder extensors and flexors was measured using isokinetic testing. Quality of life was assessed with the SF-36 questionnaire, and fatigue was measured using the Modified Fatigue Impact Scale. RESULTS Both training groups increased in aerobic capacity and maximum force. EWG, as well as CWG, showed improvement in several subscales of the SF-36 questionnaire and decrease of their fatigue. CONCLUSION A short exercise intervention increased both aerobic capacity and maximum force independent of whether endurance or combined endurance/resistance workouts were performed.
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Heine M, Wens I, Langeskov-Christensen M, Verschuren O, Eijnde BO, Kwakkel G, Dalgas U. Cardiopulmonary fitness is related to disease severity in multiple sclerosis. Mult Scler 2015; 22:231-8. [PMID: 26014607 DOI: 10.1177/1352458515581437] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. OBJECTIVE To investigate the association between disease severity and cardiopulmonary fitness. METHODS Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin. RESULTS The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation (r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R(2) = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg(-1)∙min(-1)); VO2peak = 36.622 - 5.433 (Sex (1=men)) - 0.124 (Age) - 2.082 (EDSS) + 2.737 (Belgium) + 8.674 (Denmark). CONCLUSION There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS.
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Affiliation(s)
- Martin Heine
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Inez Wens
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Bert O Eijnde
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
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Heine M, van den Akker LE, Verschuren O, Visser-Meily A, Kwakkel G. Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability. PLoS One 2015; 10:e0122260. [PMID: 25789625 PMCID: PMC4366200 DOI: 10.1371/journal.pone.0122260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 02/15/2015] [Indexed: 12/27/2022] Open
Abstract
Background Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied. Objective (1) to investigate the reliability of cardiopulmonary exercise parameters in PwMS; (2) to determine the responsiveness, in terms of the smallest detectable change (SDC), for each parameter. Design Two repeated measurements of cardiopulmonary exercise outcomes were obtained, with a median time interval of 16 days. Methods Thirty-two PwMS suffering from subjective fatigue performed cardiopulmonary exercise tests on a cycle ergometer, to voluntary exhaustion. We calculated the reliability, in terms of the intra-class correlation coefficient (ICC [2,k]; absolute agreement), and the measurement error, in terms of standard error of measurement (SEM) and SDC at individual (SDCindividual) and group level (SDCgroup). Results The ICC for VO2peak was 0.951, with an SEM of 0.131 L∙min−1 and an SDCindividual of 0.364 L∙min−1. When corrected for bodyweight, the ICC of VO2peak was 0.933, with an SEM of 1.7 mL∙kg−1∙min−1 and in an SDCindividual of 4.6 mL∙kg−1∙min−1. Limitations Generalization of our study results is restricted to fatigued PwMS with a low to mild level of disability. Conclusions At individual level, cardiopulmonary exercise testing can be used reliably to assess physical fitness in terms of VO2peak, but less so to determine significant changes. At group level, VO2peak can be reliably used to determine physical fitness status and establish change over time.
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Affiliation(s)
- Martin Heine
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Lizanne Eva van den Akker
- Department of Rehabilitation Medicine & EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Anne Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands
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Sandroff BM, Pilutti LA, Benedict RHB, Motl RW. Association between physical fitness and cognitive function in multiple sclerosis: does disability status matter? Neurorehabil Neural Repair 2014; 29:214-23. [PMID: 25009224 DOI: 10.1177/1545968314541331] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cognitive impairment is a highly prevalent, poorly managed, and disabling consequence of multiple sclerosis (MS). Exercise training that improves physical fitness represents a promising approach for managing cognitive impairment in persons with MS. There is limited evidence that physical fitness is associated with multiple domains of cognitive dysfunction across levels of MS disability. OBJECTIVE This cross-sectional study examined the associations among aerobic capacity, lower limb muscle strength, and cognitive functions in persons with mild, moderate, and severe MS disability. METHODS The sample included 62 persons with mild (n = 20), moderate (n = 21), and severe (n = 21) MS disability. The participants underwent neuropsychological assessments of cognitive processing speed (CPS; Symbol Digit Modalities Test [SDMT]), verbal memory (California Verbal Learning Test-2 [CVLT-2]), and visual memory (Brief Visuospatial Memory Test-Revised [BVMT-R]). All participants further underwent testing for measuring aerobic capacity (ie, peak oxygen consumption) and muscular strength (ie, peak torque of knee flexors and extensors). RESULTS Aerobic capacity and muscular strength outcomes were associated with SDMT (r = .35-.41), but not CVLT-2 or BVMT-R (r < .19) scores in the overall sample. Aerobic capacity (r = .42) and knee flexor peak torque (r = .39) were associated with SDMT scores in persons with mild disability, but not in those with moderate (r < .06) and severe (r < .14) disability. CONCLUSIONS These results support examining aerobic and resistance exercise training programs for improving CPS, particularly among persons with mild MS disability.
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Affiliation(s)
| | - Lara A Pilutti
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Robert W Motl
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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