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Hill EC, Schmidt JT, Reedy KR, Lubiak SM, Proppe CE, Rivera PM, Gonzalez-Rojas DH, Lawson JE, Prajapati AJ, Shah NM, Patel NN, Guirgis AM, Silverio AA, Howard MA, Choi H, Keller JL. Progression and perceptual responses to blood flow restriction resistance training among people with multiple sclerosis. Eur J Appl Physiol 2024:10.1007/s00421-024-05584-2. [PMID: 39162881 DOI: 10.1007/s00421-024-05584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. METHODS Men and women with MS (n = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12 weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. RESULTS Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7-106.3%) than heavy-load RT (42.3-54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5-101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7-80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8-7.2 au) and compliance (97.9-99.0%) were similar for both interventions. CONCLUSION The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.
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Affiliation(s)
- Ethan C Hill
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA.
- Florida Space Institute, University of Central Florida, Partnership I, Research Parkway, Orlando, FL, 32826, USA.
- College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA.
| | - Jeffrey T Schmidt
- AdventHealth Sports Med and Rehab, 265 E Rollins St. Suite 9100, Orlando, FL, 32804, USA
| | - Kyle R Reedy
- AdventHealth Sports Med and Rehab, 265 E Rollins St. Suite 9100, Orlando, FL, 32804, USA
| | - Sean M Lubiak
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Chris E Proppe
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Paola M Rivera
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - David H Gonzalez-Rojas
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - John E Lawson
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Anuj J Prajapati
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Niriham M Shah
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Nihar N Patel
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Andrew M Guirgis
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Abner-Alexander Silverio
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Mason A Howard
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Hwan Choi
- College of Engineering, Mechanical and Aerospace, University of Central Florida, 4328 Scorpius St, Orlando, FL, 32816, USA
| | - Joshua L Keller
- College of Education and Professional Studies, University of South Alabama, 75 S University Blvd #3600, Mobile, AL, 36618, USA
- College of Medicine, Department of Physiology and Cell Biology, University of South Alabama, 5851 USA Dr. N, Mobile, AL, 36618, USA
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Ahola K, Dorstyn D, Prideaux N. Best practice exercise for emerging depression in multiple sclerosis: A systematic review and meta-analysis. Clin Rehabil 2024:2692155241262884. [PMID: 39053021 DOI: 10.1177/02692155241262884] [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: 07/27/2024]
Abstract
OBJECTIVE To examine the effects of instructor-led exercise on depression symptoms in adults with multiple sclerosis, with a focus on moderating factors to treatment response. DATA SOURCES Cochrane Library, Embase, PEDro, PsycINFO and PubMed databases were searched until 21 April 2024. REVIEW METHODS The reporting quality of included studies assessed (PEDro and TESTEX scales). Hedges' g effect sizes were calculated and pooled using random and mixed-effects modelling. RESULTS Twenty-two independent studies (k), representing 785 participants with relapsing remitting or progressive MS, were included. Individual studies varied in their reporting quality (PEDro range: 3-8) and did not routinely detail exercise parameters (TESTEX range: 5-13). Nonetheless, exercise reduced core symptoms of depression (gw = .52, CI: .30-.73, P < .01). Treatment effects were, however, not maintained once training had ceased (gw = -.53, CI: -.80 to .24, P ≤ .01, k = 5). Both aerobic and non-aerobic exercise groups experienced a significant (P < .01) reduction in depression scores. Larger gains were noted by those with better ambulation at baseline (P = .03). CONCLUSION Regular exercise can help to stabilise mood for people living with multiple sclerosis, regardless of session frequency or duration. Treatment efficacy could be maximised by addressing potential barriers for those with limited mobility, including exercise type, delivery and intensity. Protocol registered on Open Science Framework [https://osf.io/zfymq/].
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Affiliation(s)
- Kristiina Ahola
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Diana Dorstyn
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Nicole Prideaux
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, Australia
- Faculty of Health and Medical Sciences, School of Allied Health Sciences and Practice, The University of Adelaide, Adelaide, Australia
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Banasadegh S, Shahrbanian S, Gharakhanlou R, Kordi MR, Mohammad Soltani B. Enhancing brain health: Swimming-induced BDNF release and epigenetic influence in MS female mouse models. J Ethn Subst Abuse 2024:1-17. [PMID: 38900673 DOI: 10.1080/15332640.2024.2365230] [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: 06/22/2024]
Abstract
Multiple sclerosis (MS) is a condition characterized by inflammation in the central nervous system (CNS), impacting sensory, motor, and cognitive abilities. Globally, around three million individuals are affected by MS, with up to 97,000 cases in Iran attributed to genetic predispositions along with various environmental factors like smoking. Cognitive impairment affects a significant portion of patients, ranging from 45% to 70%. This study investigates the impact of regular aerobic swimming exercise for four weeks, mild cognitive impairment induced by encephalomyelitis, and their combination on the expression of microRNA-142-3p and its correlation with the release of brain-derived neurotrophic factor (BDNF) in relation to spatial memory. Twenty-one C57BL/6 mice were divided into three groups. RT-PCR was used for microRNA expression analysis, and BDNF levels were assessed via western blotting. Clinical scores and animal weights were monitored daily. EAE induction led to an increase in microRNA-142-3p expression and a decrease in BDNF levels compared to the control group. Exercise inversed them significantly, and improved spatial memory. Our findings indicate that engaging in regular swimming exercise can counteract the up-regulation of miR-142-3p in brain tissue, which likely contributes to mild cognitive impairment induced by MS. Additionally, the increase in BDNF following exercise appears to be associated with miR-142-3p and the enhancement of cognitive function. Thus, the therapeutic benefits of exercise, particularly in releasing BDNF to improve cognitive function in MS patients, warrant consideration. Lifestyle modifications have the potential to effectively modulate environmental influences and ethnicity, underscoring their significance in MS management.
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Du L, Xi H, Zhang S, Zhou Y, Tao X, Lv Y, Hou X, Yu L. Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Front Public Health 2024; 12:1387658. [PMID: 38660348 PMCID: PMC11039920 DOI: 10.3389/fpubh.2024.1387658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background A growing body of studies have examined the effect of exercise in people with multiple sclerosis (MS), while findings of available studies were conflicting. This meta-analysis aimed to explore the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Methods We searched PubMed, Web of Science, Scopus, and Cochrane databases, through March 1, 2024. Inclusion criteria were: (1) RCTs; (2) included an intervention and control group; (3) had people with MS as study subjects; (4) had balance, walking ability, walking endurance, fatigue, or quality of life as the outcome measures. Exclusion criteria were: (1) non-English publications; (2) animal model publications; (3) review articles; and (4) conference articles. A meta-analysis was conducted to calculate weighted mean difference (WMD) and 95% confidence interval (CI). Cochrane risk assessment tool and Physiotherapy Evidence Database (PEDro) scale were used to evaluate the methodological quality of the included studies. Results Forty studies with a total of 56 exercise groups (n = 1,300) and 40 control groups (n = 827) were eligible for meta-analysis. Exercise significantly improved BBS (WMD, 3.77; 95% CI, 3.01 to 4.53, P < 0.00001), TUG (WMD, -1.33; 95% CI, -1.57 to -1.08, P < 0.00001), MSWS-12 (WMD, -2.57; 95% CI, -3.99 to -1.15, P = 0.0004), 6MWT (WMD, 25.56; 95% CI, 16.34 to 34.79, P < 0.00001), fatigue (WMD, -4.34; 95% CI, -5.83 to -2.84, P < 0.00001), and MSQOL-54 in people with MS (WMD, 11.80; 95% CI, 5.70 to 17.90, P = 0.0002) in people with MS. Subgroup analyses showed that aerobic exercise, resistance exercise, and multicomponent training were all effective in improving fatigue in people with MS, with resistance exercise being the most effective intervention type. In addition, a younger age was associated with a larger improvement in fatigue. Furthermore, aerobic exercise and multicomponent training were all effective in improving quality of life in people with MS, with aerobic exercise being the most effective intervention type. Conclusion Exercise had beneficial effects in improving balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Resistance exercise and aerobic exercise are the most effective interventions for improving fatigue and quality of life in people with MS, respectively. The effect of exercise on improving fatigue was associated with the age of the participants, with the younger age of the participants, the greater the improvement in fatigue. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371056, identifier: CRD42022371056.
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Affiliation(s)
- Liwen Du
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Haoyu Xi
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yilun Zhou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xifeng Tao
- School of Physical Education, Xihua University, Chengdu, China
| | - Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Xiao Hou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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Beratto L, Bressy L, Agostino S, Malandrone F, Brichetto G, Ponzano M. The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis. Mult Scler Relat Disord 2024; 83:105473. [PMID: 38320418 DOI: 10.1016/j.msard.2024.105473] [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: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND A large body of evidence has tested the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). OBJECTIVE To determine the effect of exercise interventions on mental health and HRQoL in PwMS. METHODS We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS ≥18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. RESULTS Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d = 1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). CONCLUSION Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS ≥ 65 years or with higher level of impairments.
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Affiliation(s)
- Luca Beratto
- Department of Medical Sciences, University of Turin, Italy; School of Exercise and Sport Science, University of Turin, Italy
| | - Lara Bressy
- School of Exercise and Sport Science, University of Turin, Italy
| | - Samuel Agostino
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | - Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, BC, Canada.
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Cano-Sánchez J, Aibar-Almazán A, Hita-Contreras F, Afanador-Restrepo DF, Martínez-Amat A, Achalandabaso-Ochoa A, Carcelén-Fraile MDC. Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1378. [PMID: 38592200 PMCID: PMC10932173 DOI: 10.3390/jcm13051378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45-65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.
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Affiliation(s)
- Javier Cano-Sánchez
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | | | - Antonio Martínez-Amat
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina-Pereira, Pereira 660004, Colombia
| | | | - María del Carmen Carcelén-Fraile
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain
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Elhusein AM, Fadlalmola HA, Awadalkareem EM, Alhusain EYM, Alnassry SM, Alshammari M, Abdulrahman EE, Fadila DES, Ibrahim FM, Saeed AAM, Abdalla A, Moafa HN, El-Amin EI, Mamanao DM. Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis. BELITUNG NURSING JOURNAL 2024; 10:1-14. [PMID: 38425686 PMCID: PMC10900063 DOI: 10.33546/bnj.3006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/04/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Multiple sclerosis presents a significant burden, with balance disturbances impacting patients' daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options. Objective This study aimed to synthesize evidence on exergaming's role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis. Methods A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4. Results Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup. Conclusion Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.
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Affiliation(s)
- Amal Mohamed Elhusein
- Nursing Department, College of Applied Medical Sciences, University of Bisha, Bisha, Saudi Arabia
| | - Hammad Ali Fadlalmola
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
| | | | | | | | - Mukhlid Alshammari
- College of Applied Medical Science, University of Hafr Al Batin, Saudi Arabia
| | | | - Doaa El Sayed Fadila
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
- Gerontological Nursing Department, Faculty of Nursing, Mansoura University, Egypt
| | - Fatma M. Ibrahim
- Community Health Nursing, RAK Medical and Health Sciences University, United Arab Emirates
| | | | - Adel Abdalla
- Prince Sultan Military College of Health Sciences, Nursing Department, Al Dhahran, Saudi Arabia
| | - Hassan N Moafa
- Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Department of Tropical Medicine, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ehab I. El-Amin
- Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Daniel Mon Mamanao
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
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8
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Flores VA, Šilić P, DuBose NG, Zheng P, Jeng B, Motl RW. Effects of aerobic, resistance, and combined exercise training on health-related quality of life in multiple sclerosis: Systematic review and meta-analysis. Mult Scler Relat Disord 2023; 75:104746. [PMID: 37172366 DOI: 10.1016/j.msard.2023.104746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease of the central nervous system that manifests in symptoms that compromise health-related quality of life (HRQOL). HRQOL focuses on a person's overall, subjective evaluation of health status primarily in the physical and mental domains. Exercise training is a form of rehabilitation for managing MS-related outcomes that might influence HRQOL. Reviews on exercise training are available, but we are unaware of a recent comprehensive review and meta-analysis of exercise effects for improving physical and mental domains of HRQOL. This analysis provides an updated review and meta-analysis of randomized controlled trials (RCTs) examining interventions consisting of aerobic, resistance and combined exercise training for improving HRQOL in persons with MS. This systematic review 1) assessed the overall strength of evidence for exercise interventions on HRQOL, 2) evaluated the relative effect of exercise interventions on physical and mental domains of HRQOL, and 3) determined moderators of exercise intervention effects on HRQOL. METHODS Seven databases were searched for RCTs evaluating physical and/or mental domains of HRQOL with adults diagnosed with MS and undergoing an intervention of aerobic, resistance or combined exercise training compared with a non-exercise comparator. Data extraction included participant and intervention characteristics, and pre- and post-intervention HRQOL outcome data. Effect sizes (ESs) were calculated as standardized mean differences (SMDs) and a multilevel random-effects model was used to generate an aggregated SMD that compared exercise with non-exercise control conditions. RESULTS Twelve RCTs met the inclusion criteria and yielded 23 ESs to be analyzed. Participants (N = 593; 308 intervention vs. 285 control conditions) had a mean (±standard deviation) age of 42.4 (6.5) years and 80% (18.3%) were female. Results generated a medium effect of exercise for improving overall HRQOL (ES=0.64, p = 0.0001) with high heterogeneity (Q11=58.8, I2=86.7%). Exercise training yielded a large effect on the physical domain (k = 12, ES=0.82, p<0.0009) and a medium effect on the mental domain (k = 11, ES=0.41, p<0.0001). Moderator analyses identified exercise modality, supervision level, intervention delivery and length, HRQOL tool, and number of participants with relapsing-remitting MS as significant influences of ES for HRQOL. CONCLUSIONS Exercise training is clinically effective for improving overall HRQOL in MS and produces greater improvements in the physical domain of HRQOL than the mental domain. The moderator analysis suggests that supervised, aerobic, and group-delivered exercise training of ≥3 months yields the most influence on HRQOL. Such results may have major implications for MS treatment and care.
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Affiliation(s)
- Victoria A Flores
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States.
| | - Petra Šilić
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States
| | - Noah G DuBose
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States
| | - Peixuan Zheng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States
| | - Brenda Jeng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, 60612, United States
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9
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Amin NS, El Tayebi HM. More gain, less pain: How resistance training affects immune system functioning in multiple sclerosis patients: A review. Mult Scler Relat Disord 2023; 69:104401. [PMID: 36403379 DOI: 10.1016/j.msard.2022.104401] [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: 09/08/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
Multiple sclerosis (MS) is characterized by a complex etiology that is mirrored by the perplexing and inconsistent treatment responses observed across different patients. Although epigenetic research has garnered rightful interest in its efforts towards demystifying and understanding aberrant responses to treatment, the interim undoubtedly requires alternative non-pharmacological approaches towards attaining more effective management strategies. Of particular interest in this review is resistance training (RT) as a non-pharmacological exercise-based interventional strategy and its potential role as a disease-modifying tool. RT has been reported across literature to positively influence numerous aspects in the quality of life (QoL) and functional capacity of MS patients, and one of the attributes of these benefits may be a shift in the immune system of these individuals. RT has also been proven to affect different immune system key players associated with MS pathology. Ultimately, this brief review aims to provide a potential yet crucial link between RT, alterations in the expression profile of the immune system, and finally an imminent improvement in the overall well-being and QoL of MS patients, suggesting that utilizing RT as an interventional exercise modality may be an effective strategy that would aid in managing such a complex and debilitating disease.
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Affiliation(s)
- Nada Sherif Amin
- Department of Pharmacology and Toxicology, Molecular Pharmacology Research Group, Faculty of Pharmacy and Biotechnology, Head of Molecular Genetics and Pharmacology Research Group, German University in Cairo, Cairo 11835, Egypt
| | - Hend M El Tayebi
- Department of Pharmacology and Toxicology, Molecular Pharmacology Research Group, Faculty of Pharmacy and Biotechnology, Head of Molecular Genetics and Pharmacology Research Group, German University in Cairo, Cairo 11835, Egypt.
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10
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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Correale L, Martinis L, Tavazzi E, Pedullà L, Mallucci G, Brichetto G, Bove M, Ponzio M, Borrelli P, Monti MC, Bergamaschi R, Montomoli C. Barriers to exercise and the role of general practitioner: A cross-sectional survey among people with multiple sclerosis. Front Neurol 2022; 13:1016143. [DOI: 10.3389/fneur.2022.1016143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
IntroductionRegular exercise is strongly recommended for people with MS (pwMS), but recent studies still describe them as sedentary and insufficiently active. The purpose of this study is to identify the major barriers that prevent pwMS from exercising and underline the importance of the general practitioner (GP) in promoting an active lifestyle.Materials and methodsWe performed a multicenter cross-sectional study using a self-administered questionnaire among pwMS. Data about demographics, the disease, current exercise practice, barriers, previous GP's advice to practice, and motivation were collected.ResultsA total of 741 pwMS (age 55.6 ± 12.5 years, 66% females) completed the survey. Most responders (75.3%) did not practice any exercise. Fatigue was the most limiting factor to attending and/or starting an exercise program, followed by travel and/or moving issues, and the lack of time. Only 25.5% of participants received GP's advice to practice exercise, but 48.6% of them attended an exercise program. A greater likelihood of practice was evidenced for people that received the GP's advice than those who had not received it (OR 2.96; p < 0.001). Finally, among those who did not practice exercise but received advice from GPs, 69 out of 99 (69.7%) were motivated to start an exercise program.ConclusionFatigue and physical issues are the main barriers to exercise for pwMS, but also other factors not related to the disease seem to be relevant, like travel issues and lack of time. Although few participants received advice to exercise from their general practitioner, his role proved effective in encouraging the practice.
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12
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Portilla-Cueto K, Medina-Pérez C, Romero-Pérez EM, Hernández-Murúa JA, Vila-Chã C, de Paz JA. Reliability of Isometric Muscle Strength Measurement and Its Accuracy Prediction of Maximal Dynamic Force in People with Multiple Sclerosis. Medicina (B Aires) 2022; 58:medicina58070948. [PMID: 35888667 PMCID: PMC9323114 DOI: 10.3390/medicina58070948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Multiple sclerosis (MS) is a disease that manifests with varied neurological symptoms, including muscle weakness, especially in the lower extremities. Strength exercises play an important role in the rehabilitation and functional maintenance of these patients. The individualized prescription of strength exercises is recommended to be based on the maximum force determined by the one-repetition maximum (1RM), although to save time and because it requires less equipment, it is often determined by the maximum voluntary isometric contraction (MVIC). The purpose of this work was to study, in patients with MS (pwMS), the reliability of MVIC and the correlation between the MVIC and 1RM of the knee extensors and to predict the MVIC-based 1RM. Materials and Methods: A total of 328 pwMS participated. The study of the reliability of MVIC included all pwMS, for which MVIC was determined twice in one session. Their 1RM was also evaluated. The sample was randomized by MS type, sex, and neurological disability score into a training group and a testing group for the analysis of the correlation and prediction of MVIC-based 1RM. Results: MVIC repeatability (ICC, 2.1 = 0.973) was determined, along with a minimum detectable change of 13.2 kg. The correlation between MVIC and 1RM was R2 = 0.804, with a standard error estimate of 12.2 kg. The absolute percentage error of 1RM prediction based on MVIC in the test group was 12.7%, independent of MS type and with no correlation with neurological disability score. Conclusions: In patients with MS, MVIC presents very good intrasubject repeatability, and the difference between two measurements of the same subject must differ by 17% to be considered a true change in MVIC. There is a high correlation between MVIC and 1RM, which allows estimation of 1RM once MVIC is known, with an estimation error of about 12%, regardless of sex or type of MS, and regardless of the degree of neurological disability.
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Affiliation(s)
- Kora Portilla-Cueto
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (K.P.-C.); (C.M.-P.)
| | - Carlos Medina-Pérez
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (K.P.-C.); (C.M.-P.)
| | - Ena Monserrat Romero-Pérez
- Division of Biological Sciences and Health, University of Sonora, Hermosillo 83000, Mexico
- Correspondence: (E.M.R.-P.); (J.A.d.P.)
| | | | - Carolina Vila-Chã
- Research Center in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal;
| | - José Antonio de Paz
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (K.P.-C.); (C.M.-P.)
- Correspondence: (E.M.R.-P.); (J.A.d.P.)
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Calafiore D, Invernizzi M, Ammendolia A, Marotta N, Fortunato F, Paolucci T, Ferraro F, Curci C, Cwirlej-Sozanska A, de Sire A. Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:773459. [PMID: 34956054 PMCID: PMC8702427 DOI: 10.3389/fneur.2021.773459] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.
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Affiliation(s)
- Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Agnieszka Cwirlej-Sozanska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
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