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Does Tai Chi/Qi Gong help patients with Multiple Sclerosis?
Abstract
Tai Chi posture, has recently been shown in a number of random controlled trials to improve balance, posture, vigour and general well-being in a variety of client groups. These are problems commonly encountered by people with Multiple Sclerosis. The present study was therefore designed as a pilot evaluation of the usefulness of Tai Chi/Qi Gong for people with Multiple Sclerosis. Eight individuals with Multiple Sclerosis were monitored over a 2-month baseline and 2-month intervention. Statistically significant pre to post improvements for the group as a whole were achieved on measures of depression and balance. A 21-item symptom check-list indicated small improvements over a broad range of other self-rated symptoms.
... Furthermore, other manifestations of MS, such as depression or cognitive impairment, can lead to a poorer quality of life 5,[5][6][7] . Along with pharmacological treatment, non-pharmacological interventions, especially physical activity 8 , are used with considerable effect in the management of MS. ...
... By maintaining these postures, individuals drive proprioception of the lower limb joints and require demanding coordination of the lower limb muscles. Several papers confirm the positive effect of Tai-chi on balance in MS 5,7,9,27,28 . On the other hand, to the best of our knowledge, no published work deals with the objective instrumental assessment of the effect of Tai-chi using posturography. ...
... In addition to affecting balance and coordination, it also addresses the impact on mood, cognitive performance, and, consequently, quality of life. The existing evidence supports the beneficial effect of Tai-chi on mood and quality of life for MS 7,9,10,[32][33][34][35] . From a one-year perspective, we have supported these findings. ...
Introduction:
One of the most debilitating problems encountered by people with multiple sclerosis (MS) is the loss of balance and coordination. Our study aimed to comprehensively evaluate the effectiveness of one year of Tai-chi exercise in patients with MS using both subjective and objective methods, including posturography.
Methods:
This was a single-group longitudinal one-year study performed from the 1st of January 2019 to the 1st of January 2020. The primary outcomes of interest were the Mini-Balance Evaluation Systems Test (Mini-BESTest) and static posturography measures as objective methods to detect subtle changes associated with postural control/balance impairment. Secondary outcomes were measures of depression, anxiety, cognitive performance, and quality of life. All objective and subjective parameters were assessed four times: at baseline, and after three, six and 12 months of regular Tai-chi training. The difference was calculated as a subtraction of baseline values from every timepoint value for each measurement. If the normality test was passed, parametric one-sample t-test was used, if failed, Wilcoxon signed ranks test was used to test the difference between the baseline and each timepoint. Alpha was set to 0.017 using Bonferroni correction for multiple comparisons.
Results:
Out of 25 patients with MS enrolled, 15 women with MS (mean age 44.27 years) were included for statistical analyses after completing the 12-month program. After 12 months, significant improvements were found in all objective balance and gait tests: Mini-BESTest (p<0.001), static posturography measures (total area of the centre of foot pressure - TA; p = 0.015), 25 Feet Walk Test (25FWT; p = 0.001), anxiety (Beck Anxiety Inventory - BAI; p = 0.005) and cognition tests (Paced Auditory Serial Addition Test - PASAT; p = 0.003). Measures of depression (Beck Depression Inventory - BDI; p = 0.071), cognition (Symbol Digit Modalities Test - SDMT; p = 0.079), and health-related quality of life (European Quality of Life 5-Dimensions Questionnaire - EQ-5D-5L; p = 0.095) showed a trend of improvement but were not significant, which could be the result of a small sample and increased bias due the type II error.
Conclusion:
According to these preliminary results, this study indicates the possible beneficial effects of long-term Tai-chi training on patients with MS. Although these findings need to be confirmed by further studies with a larger sample of participants of both genders and require more rigorous randomized controlled trials (RCT) design, our findings support the recommendation of regular and long-term Tai-chi exercise in patients with MS.
Gov identifier (retrospectively registered):
NCT05474209.
... Due to this complex interaction, balance can be altered in different ways and in some diseases such as Parkinson's disease (PD) and multiple sclerosis (MS) [7][8][9][10][11][12][13][14][15][16][17][18][19]. Apart from pathological condition and sedentary habits a bad proprioception can also modify balance capacity in a healthy person. ...
... A total of 45% of these publications were pilot studies with a small sample size in some cases [9]. This means that the number of subjects in the articles ranged between 8 and 120, which focuses the average in 41 and gave us a total of 591 participants. ...
... Just a few studies agree to use the same balance assessment scale. The most used was a single leg stance test [9,12,16,17] but other preferred to use other forms of measurement as the Berg Balance Scale [11,18,19] or a sensory organization test [14]. ...
... One of the most common problems encountered by people with MS is loss of balance which can result in falls and serious injuries [7]. People with MS have a normal life expectancy, therefore, they may have to live for many years with severe mobility problems and require regular therapeutic interventions [2]. ...
... There are three pilot studies which recommend Tai Chi as a treatment intervention for MS patients. Improvements in depression [7], quality of life [18] and balance [7,19,20] are the key findings in the relevant literature. ...
... There are three pilot studies which recommend Tai Chi as a treatment intervention for MS patients. Improvements in depression [7], quality of life [18] and balance [7,19,20] are the key findings in the relevant literature. ...
Background & Aim: Multiple Sclerosis (MS) is a chronic disease of central neurologic system that has a wide effect on neurological function and can cause disability or poor quality of life in patients. The purpose of this study was to assess the effect of the Tai Chi Chuan on quality of life in women with the MS .
Methods & Materials : This was a clinical trial which covered 34 women with MS in Iran Multiple Sclerosis Society in 2012. The participants were selected using purposive sampling and were randomly assigned to the experiment (n=16) and control (n=18) groups. Intervention was Tai Chi Chuan classes twice a week for 12 weeks. In this study, demographic questionnaire and Multiple Sclerosis quality of life questionnaire (MSQOL-54 scale) were used to collect data . Data were analyzed using the Chi-squared, independent samples T-test, paired samples T-test, Mann-Whitney U and Wilcoxon in the SPSS v.18.
Results: There were no significant differences between the mean quality of life and its subscales among patients in the experiment and control groups at baseline except for the emotional well-being subscale. After the Tai Chi training intervention, significant differences were found between the two groups in the mean of some subscales of the quality of life including role limitation due to emotional problems, pain, emotional well-being, energy, social function, health distress, overall quality of life, physical health composite score, mental health composite score and also total quality of life score (P
... Common MS symptoms include weakness, fatigability, depression, spasticity, visual disturbances and parasthesias. Fatigue is one of the most bothersome symptoms in patients with MS as the disease progresses [4]. ...
... Only two studies were found that looked at the effects of Tai Chi on fatigue in individuals with MS. Practicing Tai Chi for two months daily was associated with improvements in balance, lower depression, as well as some improvements in fatigue in individuals with MS [4]. Another study focused on the effects of 40 Tai Chi sessions performed in a swimming pool. ...
... The reviewed literature on the effects of Tai Chi suggests that its role in resolving fatigue may be two-fold. It was shown that practicing Tai Chi was associated with improvements in fatigue but also led to improvements in balance in individuals with MS [4]. As such, it was argued that as a result of improvements in balance, there could be improved mobility, and it may be easier for the individual to cope with fatigue [62]. ...
... Common MS symptoms include weakness, fatigability, depression, spasticity, visual disturbances and parasthesias. Fatigue is one of the most bothersome symptoms in patients with MS as the disease progresses [4]. ...
... Only two studies were found that looked at the effects of Tai Chi on fatigue in individuals with MS. Practicing Tai Chi for two months daily was associated with improvements in balance, lower depression, as well as some improvements in fatigue in individuals with MS [4]. Another study focused on the effects of 40 Tai Chi sessions performed in a swimming pool. ...
... The reviewed literature on the effects of Tai Chi suggests that its role in resolving fatigue may be two-fold. It was shown that practicing Tai Chi was associated with improvements in fatigue but also led to improvements in balance in individuals with MS [4]. As such, it was argued that as a result of improvements in balance, there could be improved mobility, and it may be easier for the individual to cope with fatigue [62]. ...
... The primary goal of Tai Chi is relaxation of the body and the mind. In MS, three pilot studies have shown an improvement in mood (36), QOL (26), balance (3,36), physical and mental health, and non-neuropathic pain (48). Two recent randomized controlled trials noted a positive effect of Tai Chi on balance and coordination compared to controls pursuing their usual activities (5,35). ...
... The primary goal of Tai Chi is relaxation of the body and the mind. In MS, three pilot studies have shown an improvement in mood (36), QOL (26), balance (3,36), physical and mental health, and non-neuropathic pain (48). Two recent randomized controlled trials noted a positive effect of Tai Chi on balance and coordination compared to controls pursuing their usual activities (5,35). ...
The practice of sport by multiple sclerosis patients has long been controversial. Recent studies, however, show that both sport and physical activity are essential for these patients. Indeed, they help to cope with the effects of multiple sclerosis, such as fatigue, reduced endurance, loss of muscle mass, and reduction of muscle strength. The beneficial effects of physical activity on these patients have been underlined in several studies, whereas those of practicing sport have been the subject of fewer evaluations and assessments. The aim of this update is to report on the effects of sport on multiple sclerosis patients. The benefits of sport have been demonstrated in several studies. It helps multiple sclerosis patients to increase their balance, resistance to fatigue, mobility and quality of life. Several biases in these studies do not enable us to recommend the practice of some of these sports on a routine basis.
... Husted et al. [39] reported improvements in walking distance, hamstring flexibility and psychological well-being, following a Tai Chi intervention. Mills et al. [40,41] observed improvements in balance and symptom management. Finally, Tavee et al. [42] reported improvements in perceived physical and mental health, as well as pain, but not in mobility. ...
... Nevertheless, to date the body of studies on this topic remains limited [16]. Previous work has indicated that Tai Chi, which incorporates a combination of physical exercises and mindfulness training, might yield health benefits in MS [16,[39][40][41][42]. In the current study, the therapeutic value of a newly devised structured Tai Chi course (Additional file 1: Supplement 1) for coordination, balance, fatigue and depression in mildly disabled MS patients was examined. ...
The contribution of exercise to physical and psychosocial health is beyond dispute. Especially
individuals with chronic diseases, such as multiple sclerosis (MS), have much to gain
from being physically active. MS predominantly occurs during young adulthood. Dependent
on disease activity, it leads to a gradual decline of mobility, social participation, and quality
of life. A long-term perspective is essential for effective MS management.
Research interest:
Pharmacological treatment primarily relies on early intervention to counter disease activity.
To detect functional impairment as early as possible, the development of assessment tools is
necessary. Further strategies to impede or even restore functional damage are scarce. Only
recently, exercise has been recognised as an essential part of MS management. Despite
substantial evidence in support of physical activity, specific recommendations on choice and
dose of available exercise programs are lacking. There are strong arguments in favour of Tai
Chi, a Chinese martial art, to meet the specific needs of this target population. Particularly
the principle of mindfulness, which is entangled with the concept of Tai Chi, could be a
valuable asset in coping with MS.
Strategies:
We evaluated dynamic characteristics of walking behaviour, comparing 37 persons with MS
to 25 healthy controls. To describe the change of speed in walking behaviour, we analysed
its approximation to three different velocity profiles in two time-framed walking tests. In
sum, the observed differences varied depending on test duration (6 versus 12 minutes), disease
severity (mild versus moderate disability level) and observed parameter (mean walking
speed versus temporal change of walking speed). Our findings indicate an early influence
of MS on walking behaviour. We present the linear decline of walking speed as a new, clinically
relevant feature of walking ability in persons with MS. The decline in walking speed
is particularly suitable to assess walking behaviour with regard to fatigue, because it better
reflects the individual’s subjective constraints than the commonly assessed parameter mean
walking speed.
We analysed both the concept of Tai Chi and research on Tai Chi with special regard to
methodology. The concept of Tai Chi is highly pluralistic. Scientific research on Tai Chi is
just as manifold. Such divergent investigation makes it difficult to collect convergent evidence.
The complexity within this field should receive more attention. Tai Chi is a complex
intervention that requires an elaborate and well-designed scientific approach. A first step
into this direction is to improve the quality of reporting and standardisation. In addition, the
inclusion of high quality qualitative research should be pushed forward.
We devised a standardised Tai Chi program and analysed its therapeutic value for persons
with MS.We evaluated the program within a 6-month intervention, comparing a Tai Chi group
(n = 15) to a group that received treatment as usual (n = 17). We found a consistent pattern
of beneficial effects on the following parameters: balance, coordination, fatigue, depression,
and life satisfaction.
Conclusion:
Dynamic characteristics of walking behaviour could support improved monitoring of mobility
in MS. Tai Chi is a promising opportunity for persons with MS to engage in long-term physical
activity and foster both physical and psychosocial resources.
... The most commonly reported and primary signs and symptoms are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance and pain (6). One of the most common problems encountered by people with MS is loss of balance which can result in falls and serious injuries (7). People with MS have a normal life expectancy, therefore, they may have to live for many years with severe mobility problems and require regular therapeutic interventions (2). ...
... There are three pilot studies which recommend Tai Chi as a treatment intervention for MS patients. Improvements in depression (7), quality of life (18) and balance (7,19) (20) are the key findings in the relevant literature. The purpose of this study was to investigate the effect of Tai Chi intervention on balance in women with MS in Iran. ...
To examine the effect of Tai Chi Chuan on balance in women with multiple sclerosis in Iran.Design36 women with multiple sclerosis who were members of the Iranian Multiple Sclerosis Society participated in this study. 18 participants were allocated to the intervention group and 18 allocated to the control group. The intervention consisted of Yang style Tai Chi Chuan exercise sessions twice a week for 12 weeks.Main Outcome MeasuresThis study used a demographic questionnaire and the Berg Balance Scale (BBS) to collect data.ResultsAfter 12 weeks, the mean score of the BBS in the intervention group demonstrated a statistically significant improvement in comparison with baseline status.Conclusions
The results suggest that Tai Chi Chuan could be used as a safe complementary intervention to increase balance in patients with multiple sclerosis.
... Husted et al. [39] reported improvements in walking distance, hamstring flexibility and psychological well-being, following a Tai Chi intervention. Mills et al. [40,41] observed improvements in balance and symptom management. Finally, Tavee et al. [42] reported improvements in perceived physical and mental health, as well as pain, but not in mobility. ...
... Nevertheless, to date the body of studies on this topic remains limited [16]. Previous work has indicated that Tai Chi, which incorporates a combination of physical exercises and mindfulness training, might yield health benefits in MS [16,[39][40][41][42]. In the current study, the therapeutic value of a newly devised structured Tai Chi course (Additional file 1: Supplement 1) for coordination, balance, fatigue and depression in mildly disabled MS patients was examined. ...
Background
Patients suffering from Multiple Sclerosis (MS) experience a wide array of symptoms, including balance problems, mobility impairment, fatigue and depression. Physical exercise has recently been acknowledged as a treatment option complementary to medication. However, information regarding putative effects of structured exercise programs on neurological symptoms is sparse. Tai Chi, a Chinese martial art incorporating physical exercise and mindfulness training, has been shown to yield health benefits in various neurological groups. It seems particularly suitable for patients with motoric deficits as it challenges coordination and balance. The purpose of the current study was to explore the therapeutic value of structured Tai Chi training for coordination, balance, fatigue and depression in mildly disabled MS patients.MethodsA sample of 32 MS patients (Expanded Disability Status Scale, EDSS¿<¿5) was examined. A structured Tai Chi course was devised and a Tai Chi group participated in two weekly sessions of 90 minutes duration for six months, while a comparison group received treatment as usual (TAU). Both groups were examined prior to and following the six-months interval with regards to balance and coordination performance as well as measures of fatigue, depression and life satisfaction.ResultsFollowing the intervention, the Tai Chi group showed significant, consistent improvements in balance, coordination, and depression, relative to the TAU group (range of effect-sizes: partial ¿2¿=¿0.16 ¿ 0.20). Additionally, life satisfaction improved (partial ¿2¿=¿0.31). Fatigue deteriorated in the comparison group, whereas it remained relatively stable in the Tai Chi group (partial ¿2¿=¿0.24).Conclusions
The consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients. Further research is needed to determine underlying working mechanisms, and to verify the results in a larger sample and different MS subgroups.
... Also, acceptability of using complementary therapies has increased in health-care systems and using nonpharmacological interventions for completing advanced medication is increasing among nurses in clinical and health experiences (9). Complementary therapies can reduce the process of disease and number of attacks and can also postpone the onset of permanent disability (10). Aerobic exercises are an appropriate non-pharmacological treatment method that can enhance muscle and joint flexibility, bone movements and thus reduce muscular spasms and enhance people's power and strength (10). ...
... Complementary therapies can reduce the process of disease and number of attacks and can also postpone the onset of permanent disability (10). Aerobic exercises are an appropriate non-pharmacological treatment method that can enhance muscle and joint flexibility, bone movements and thus reduce muscular spasms and enhance people's power and strength (10). Many studies have shown positive effects of regular aerobic exercises in reducing the symptoms related to psychological disorders and enhancing life quality and improving mood state (11,12). ...
Multiple sclerosis is one of the most common chronic diseases of the central nervous system and one of the most important diseases that changes life, especially in passing adolescent to midlife periods. This causes a severe decrease in quality of life of affected patients that will gradually put the person towards disability. This research is aimed to investigate the effects of selective aerobic training program on quality of life in male patients with multiple sclerosis (MS) as a complementary therapy on quality of life in these individuals. Method: In a semi experimental study, 60 individuals from Iran's M.S association were availability selected from an elderly and disabled sanatorium in Kahrizak, Iran. Participants were divided into practice and control groups. After familiarizing experimental group with the goals and interventional methods, a selective aerobic exercise program (27 sessions of 60 minutes aerobic exercise during 9 weeks) was carried out while any intervention was not performed on the control group. Information gathering tools included demographic questionnaire, short form of Quality of Life (SF-8) and the self-reported forms. Descriptive statistical tests, ANOVA with repeated measures, and independent sample t test were used to analyze the data. Results: Results of repeated measure variance analysis showed that between subject effects (intervention effect), within subject effects (time effect), and interaction effects (interaction between intervention and time) were significant for physical and quality of Life dimensions, and total score in men with Multiple Sclerosis (MS). Conclusion: These results generally indicate that aerobic exercises lead to improved quality of life for people with MS and these effects increase as the time passes. Therefore, this complementary therapy is recommended as an effective and economical method for MS patients.
... 4 Qigong (QG) is an ancient Chinese practice developed to promote health and wellness and includes meditative postures, rhythmic movements, breath regulation, and selfmassage. 5 Tai Chi, originally a martial arts practice, has been adapted in the West as a mind-body exercise to promote health and can be considered a sub-type of QG. 6,7 Preliminary studies suggest that QG (including Tai Chi, which we include in our definition of QG) 6 may improve physical function, balance, cognition, mood, and quality of life in people with MS. [8][9][10][11][12][13][14] Possible explanations for why QG may benefit MS outcomes include its multi-component nature that integrates physical, psychological, and cognitive practices. 15 Postures and movements often incorporate strength-building, balance, and coordination combined with mindful attention to movements, visualization, and meditative practices. ...
Background
Preliminary evidence suggests that Qigong (QG), a mind-body therapy, may help address symptoms of multiple sclerosis (MS), but the heterogeneity of QG content and delivery may affect its feasibility, acceptability, and efficacy.
Objective
To survey researchers, clinicians, and QG instructors with experience working with people with MS to identify key components of MS-specific QG guidelines and protocols.
Methods
We conducted an online survey to identify QG forms and movements considered helpful for MS, reasons for selection, characteristics of effective learning environments, and recommended dosage and frequency of practice. Quantitative data were analyzed using summary statistics. Qualitative data were analyzed using reflexive thematic analysis.
Results
Forty-seven experts, including QG instructors, clinicians, and QG and MS researchers, completed the survey. Respondents had a mean (SD) of 20 (11) years of QG teaching experience, 26 (12) years of clinical practice, 24 (9) years of QG research experience, 13 (5) years of MS research experience, and worked with at least 3 (2) people with MS. Approximately 125 QG forms/movements were recommended. Some forms were specifically recommended to address MS symptoms (e.g., emotional regulation, balance and coordination, muscle strength and flexibility, immune regulation, and circulation). Some respondents felt that any QG form could be beneficial if basic principles were met (e.g., intentional movement, posture, focused awareness, rhythmic breathing/movement, and a relaxed mind and body). Instructor qualities included the ability to convey information clearly, being caring and compassionate, proficient in QG, and having basic knowledge of MS. To promote confidence in learning QG, recommendations included having simple, easy-to-learn movements with modifications based on physical ability. We provide a sample protocol based on these recommendations.
Conclusions
This study provides expert guidance for developing a QG protocol for an MS population, including content and delivery recommendations.
... 38,42,[48][49][50] The small number of qigong or tai chi studies in MS report quantitative outcome measures but lack qualitative information regarding specific benefits and challenges faced by study participants. 51 Future studies might consider more meditative styles of qigong for people with MS, as suggested by Mills, focused on developing body awareness and alignment. 52 Mills suggests a ''water approach'' style of qigong that encourages ''softening and flowing'' versus a ''fire approach'' that involves more forceful breathing and vigorous movements, which may exacerbate symptoms of heat intolerance commonly found with MS. 52 Awareness of the class environment, such as presence of air conditioning, and chairs or other equipment to help with balance, might be an important consider-ation for people with MS when investigating qigong classes in the community. ...
Introduction:
Multiple sclerosis (MS) is a progressive neurodegenerative disorder affecting motor and nonmotor function including physical and cognitive decline, fatigue, anxiety, and depression. Qigong is a mind-body self-care practice with the potential to address MS symptoms. Publicly available community qigong classes may provide opportunities for people with MS to access qigong, but little is known about the risks and benefits. A mixed methods study of community qigong was conducted for people with MS. In this article, the results of this qualitative analysis to identify benefits and challenges faced by people with MS attending community qigong classes were presented.
Methods:
Qualitative data were collected from an exit survey of 14 study participants with MS who enrolled in a pragmatic trial of community qigong classes for 10 weeks. Participants were new to community-based classes offered but some had experience with qigong/tai chi/other martial arts or yoga. Data were analyzed using reflexive thematic analysis.
Results and discussion:
Seven common themes were identified from this analysis: (1) physical function, (2) motivation/energy, (3) learning, (4) dedicating time for self, (5) meditation/centering/focus, (6) relaxation/stress relief, and (7) psychological/psychosocial. These themes reflected both positive and negative experiences with community qigong classes and home practice. Self-reported benefits centered around improved flexibility, endurance, energy, and focus; stress relief; and psychological/psychosocial benefits. Challenges included physical discomfort including short-term pain, balance difficulty, and heat intolerance.
Conclusion:
The qualitative findings provide evidence to support qigong as a self-care practice that may benefit people with MS. The challenges identified in the study will help to inform future clinical trials of qigong for MS.
Trial registration:
ClinicalTrials.gov (CTR#: NCT04585659).
... Some studies agree that taijiquan and qigong could be considered an effective, adjunctive therapy for asthma [103][104][105] and propose that it could be an effective rehabilitation technique for patients with chronic obstructive pulmonary disease. 106,107 In consonance with the scientific literature, we found that these therapies seem to improve the management of neurological conditions such as migraine and headache, 108,109 chronic fatigue syndrome, [110][111][112] multiple sclerosis, 113,114 and fibromyalgia, [115][116][117] and are also strongly associated with autonomic dysregulation. [118][119][120][121][122][123] Practitioners also perceived some benefits in other conditions such as diabetes, various hormonal imbalances, vertigo, and weight management. ...
Background • Taijiquan and qigong are traditional Chinese therapeutic disciplines with several health benefits and the ability to improve the quality of life of their practitioners. As traditional vegetative biofeedback therapies, they can activate functional vegetative changes in the body. These neurovegetative actions have been studied in the last few years to better explain the mechanisms through which these techniques of traditional Chinese medicine work.
Primary Study Objective • To support current research, it is important to further explore these neurovegetative actions according to contemporary Chinese medicine models to clarify the mechanisms of their working in light of conventional medical terms. This study aims to explore the health benefits that these practices may produce for practitioners.
Methods • 345 taijiquan and qigong practitioners were recruited for this study to assess the perceived health benefits of taijiquan and qigong. We conducted a survey to assist in this purpose.
Results • Taijiquan combined with qigong may be more beneficial than taijiquan alone. Additionally, these practices seem to produce notable benefits for anxiety, depression, and other emotional disturbances. They also seem to have positive results in addressing arthritis and pain in the back, shoulder, neck, and knees. In addition, taijiquan and qigong may have benefits in managing several digestive, neurological, cardiovascular, and respiratory diseases, and provide some assistance in the management of some oncologic conditions.
Conclusion • Breathing exercises, slow and controlled movement, self-massage, and directed thought are the therapeutic characteristics that allow this wide range of potential, perceived health benefits. More scientific studies are needed to confirm the mechanisms through which taijiquan and qigong may benefit health. However, it is suggested that these techniques may have an impact on health mainly via the modulation of the autonomic nervous system.
... [20][21][22] qigong has also been shown to benefit fatigue and depression, common MS symptoms. 21,23 The authors are aware of only one pilot study involving one-on-one qigong for 16 people with secondary progressive MS. 24 Statistically significant improvements in depression and balance were observed after six sessions. However, small sample size, loss to follow-up, and nonvalidated questionnaires limited interpretation of the findings. ...
Objectives:
qigong, a traditional Chinese mind-body exercise, has been shown to improve balance and gait in several neurological conditions; however, community-delivered qigong has never been assessed for people with multiple sclerosis (MS). The authors assessed the feasibility of community qigong classes for people with MS and explored outcomes of balance, gait, and quality of life (QOL).
Design:
Twenty adults with MS were randomly assigned to 10 weeks of community qigong classes or wait-list control.
Settings/Location:
Portland, Oregon.
Subjects:
People with MS.
Intervention:
Community qigong classes.
Outcome measures:
Feasibility criteria included recruitment, retention, adherence, and ability to participate in qigong movements. Secondary outcome measures included physical tests of mobility, gait, and balance and participant-reported mobility, depression, anxiety, fatigue, and QOL.
Results:
Recruitment of eligible and interested people with MS was feasible. Retention in the trial was 60%. Completers attended a mean of 7 of 10 classes. All completers participated with no or minor modifications to qigong movements. Exploratory within-group analyses showed trends toward improved mental health, QOL, and reduced fatigue and depression. Several participants spontaneously reported improved energy, flexibility, sleep, and mobility.
Conclusions:
Community qigong may be a feasible form of exercise for people with MS. To improve retention and capture potential effects of qigong on physical function and quality of life, future studies might consider pragmatic trials with tiered level classes, simpler forms of qigong, and/or refined inclusion criteria (CTR#: NCT04585659).
... 20 The results of a study by Mill et al. on the effectiveness of the tai chi technique on the debilitating symptoms of patients with multiple sclerosis also showed that the implementation of tai chi technique calms and relieves the body and reduces fatigue in MS patients. 21 Besides, Schreurs 7 showed that physical fatigue was associated with physical disability in MS patients. 7 Given the importance of the role of stress in inducing MS attacks, worsening symptoms, and increasing fatigue. ...
... It is by action and movement as achieved through Tai Chi, that strength and relaxation are attained. Tai Chi improves the global health of the individual, uniting the physical well-being with emotional wellbeing and mental state, so it serves to improve the quality of life of the individual who practices it at all levels of life [8,9,10]. ...
Introduction : Multiple sclerosis is a chronic, autoimmune, debilitating disease that affects the central nervous system, and the affected population is predominantly young. Over time, patients with multiple sclerosis end up developing an inability to perform physical activities, even the most basic, innate, such as walking or even coordination.
Purpose: Physical recovery of patients with multiple sclerosis, in fact, recovery from fatigue is the main goal of this study, because fatigue is a prevalent factor among these individuals, producing negative effects on the physical, mental, but also on the emotional status.
Method: We analyzed, from the point of view of the Modified Fatigue Impact Scale Test - 5-Item Version (MFIS-5), the level of fatigue in a group of 75 patients with multiple sclerosis, before and after a period of one month, where patients were divided into three groups and every group practiced one of the following sports activities: yoga, Tai Chi and aerobics.
Results: The effectiveness of each sport was analyzed, from the point of view of the level of fatigue, having as reference the first measurement performed before the beginning of the sports programs. A significant difference in effectiveness was found in the group of patients with multiple sclerosis who used yoga.
Conclusion: Our results provided evidence for the association of exercise methods that can affect beneficially the level of fatigue in multiple sclerosis patients, the most effective one being yoga.
... [7][8][9] A previous study suggested the efficacy of Tai-Chi in improving balance and depression in patients of Multiple Sclerosis. 10 However; these results were not conclusive IJCRR Section: Healthcare since they were mainly deduced from self-reported improvements in response to a subjective questionnaire. Therefore, the primary aim of this study was to test the hypothesis about the beneficial effects of Tai-Chi on balance and mobility in patients of Relapsing Remitting Multiple Sclerosis (n=16) using standardized, non-biased measuring scales. ...
Background: Tai Chi postures have recently been shown in a number of randomized controlled trials to improve balance and posture in a variety of patient groups. Balance and mobility are problems commonly encountered by people with Multiple Sclerosis (MS). This pilot study examines the effect of Tai-Chi ± Mental practise on balance, gait and mobility in people with MS.
... Complementary therapies can slow down or even inhibit the course of the disease, reduce the number of attacks, and delay its sudden onset [7] . In the mentioned studies, onethird of patients with multiple sclerosis use complementary therapies despite the availability of current and common treatments [10] . In a study conducted on the use of complementary and alternative therapies in MS patients, massage therapy has been one of the widely-used methods [11] . ...
Background and purpose of the study: Nowadays, Multiple Sclerosis (MS) is considered as a common disease among the young population. It is associated with many complications, including fatigue. The research was conducted to evaluate the effect of massage therapy on fatigue in patients with multiple sclerosis referred to Samenolhojaj Center in Kerman. Methodology: This is a clinical trial (11IRCT201611217844N) conducted to evaluate 80 MS patients, assigned randomly into two groups of intervention and control. Patients in the intervention group received a massage therapy program and the control group received routine medical care. The instrument used in this research included a 4-section questionnaire (including demographic information, fatigue severity scale, fatigue reducing methods, and visual scale of the effectiveness of massage therapy). Data were analyzed using SPSS, version 21, software and descriptive statistics, independent and paired t-test, Pearson correlation and ANOVA. Results: The mean score of fatigue severity was 47.72 ± 10.25 before intervention in the control group and it was 48.30 ± 9.78 before intervention in the intervention group (P = 0.7). After the intervention, the mean of fatigue severity was 46.91 ± 7.07 in the control group and it was 43.89 ± 8.33 in the intervention group. This change was significant in the intervention group (p <0.05). Conclusion: Massage therapy can be proposed as a non-medical, easy, and low-cost method for reducing fatigue in patients with multiple sclerosis. Further studies need to be conducted in this regard.
... Mood: POMS was used to measure mood, as described in Study 2. It has been used in earlier studies [51,61] to demonstrate the impact of kinetic meditation on mood enhancement. ...
Mindfulness practices are well-known for their benefits to mental and physical well-being. Given the prevalence of smartphones, mindfulness applications have attracted growing global interest. However, the majority of existing applications use guided meditation that is not adaptable to each user's unique needs or pace. This article proposes a novel framework called Attention Regulation Framework (ARF), which studies how more flexible and adaptable mindfulness applications could be designed, beyond guided meditation and toward self-regulated meditation. ARF proposes mindfulness interaction design guidelines and interfaces whereby practitioners naturally and constantly bring their attention back to the present moment and develop non-judgmental awareness. This is achieved by the performance of subtle movements, which are supported by non-intrusive detection-feedback mechanisms. We used two design cases to demonstrate ARF in static and kinetic meditation conditions. We conducted four user evaluation studies in unique situations where ARF is particularly effective, vis-à-vis mindfulness practice in busy environments and mindfulness interfaces that adapt to the pace of the user. The studies show that the design cases, compared with guided meditation applications, are more effective in improving attention, mindfulness, mood, well-being, and physical balance. Our work contributes to the development of self-regulated mindfulness technologies.
... In conclusion, findings from this study indicate that with appropriate treatment of depression and consultation, a resultant enhancement in a person's balance skills can be achieved. Depression and balance improved significantly after using Tai Chi posture treatment in a sample of MS (Mills et al., 2000). Similarly in a recent study, Tai Chi training significantly improved balance, coordination, and depression in mildly disabled individuals with MS (Burschka et al., 2014). ...
Background:
Balance impairments are common and multifactorial among people with multiple sclerosis (MS). Depression is the most common psychological disorder in MS population and is strongly correlated with MS disease. Depression might be one of the factors that contribute to balance deficits in this population. However, the relationship between depression and balance impairments has not been explored in people with MS.
Objective:
To investigate the association between depression and balance impairments in people with MS.
Methods:
Cross sectional design was used in patients with MS. The Activities-specific Balance Confidence scale (ABC) and Berg Balance Scale (BBS) was used to assess balance. Beck Depression Inventory (BDI-II) was used to quantify depression and Kurtizki Expanded Disability Status Scale (EDSS) was utilized for the evaluation of MS disability severity. Pearson correlation coefficient was used to examine the association between depression and balance measurements. Multiple linear stepwise regressions were also conducted to find out if depression is a potential predictor for balance deficits.
Results:
Seventy-five individuals with MS (Female = 69%) with a mean age (SD) of 38.8 (10) and a mean (SD) EDSS score of 3.0 (1.4) were recruited in this study. Depression was present in 53% of the patients. Depression was significantly correlated with balance measurements and EDSS. However, multiple linear stepwise regressions found that only depression and age significantly predict balance.
Conclusion:
Depression and balance were found frequent and associated in people with MS. Importantly depression was a significant predictor for balance impairments in individuals with MS. Balance rehabilitation may be hindered by depression. Therefore, depression should be evaluated and treated properly in individuals with MS.
... Los beneficios del Tai Chi están ampliamente descritos en diverso material bibliográfico donde se demuestra que genera gran variedad de beneficios en el manejo, y también interviene en el control de diferentes enfermedades que se presentan comúnmente en el anciano (9)(10)(11). ...
Objective: This research was aimed at determining the effects of an exercise program with the art of Tai Chi in older women. Material and Methods: A quasi-experimental study with a longitudinal cutting was conducted; the study population was a group of elderly in the city of Popayan. It consisted of three phases: in the first one, an initial evaluation of physical capacity (walking, balance, daily basic activities) was applied, afterward, the scale of Yesavage for signs of depression, and finally the Folstien Mini Mental Test to assess cognitive functions. In the second phase, a program of Tai Chi exercises in one weekly session for a twelve weeks period was implemented. In the third phase, the evaluation of the results of the program through participant re-evaluating was carried out. Results: The functional capacity improved in all the tested aspects, the difference in walking speed and the static and dynamic balance were statistically significant; in the same way, the cognitive ability improved in all the tested items, statistical significance was found in aspects such as memory,attention, calculation and language. All participants achieved full functionality of the daily basic activities. Conclusions: The application of a Tai Chi technique provides significant benefits in the balance and the cognitive ability of the elderly, leading to a breakthrough in their independent behavior and improving their functional capacity, so it could be recommended as an alternative technique of physiotherapeutic intervention in neuronal rehabilitation.
... The results of this study are in concurrence with the results of the present study. Even the results of a study carried out by Mills and associates investigating the Tai Chi technique on inability symptoms of multiple sclerosis patients showed that the Tai Chi technique led to calming, solace feeling and reduced fatigue in these patients (16) . The repeated measure statistical test in our study demonstrated that the fatigue scale between test and control groups in triple measurement during three months had a significant difference wherein this meaningful difference itself was an indicator of the effect of psychological education with the gradual muscle relaxation technique to reduce fatigue scale of test group patients in the different periods after an intervention. ...
Introduction: Fatigue is one of the most important symptoms of multiple sclerosis where in majority of patients that often suffer from it are young individuals in active life stage. This study was carried out with an aim to assess the effectiveness of psychological Training with gradual muscle relaxation technique on fatigue in multiple sclerosis patients. Material and methods: In this triple blind placebo-controlled clinical trial study, 60 multiple sclerosis patients that were Multiple Sclerosis Association Members of Yazd Province via an easy sampling method and considering the input and output criteria entered the study. The samples were randomly divided into two groups of test (30 persons) and control (30 persons) respectively, and test group received 12 sessions of psychological education with gradual muscle relaxation technique, two sessions a week, whereas for control group nil intervention were adopted. The information was collected using a demographic questionnaire and the Fatigue Severity Scale (FSS). Prior to intervention, immediately and three months after an intervention. For analysis of information the statistical tests; Pearson correlation, Repeated measures and t-student was used. Results: Considering that the patients were randomly divided into two groups of test and control, prior to education did not exhibit a statistical difference in the demographic characteristics, disease duration, body mass index, fatigue scale of patients. (P>0.05). The fatigue scale in the test and control groups prior to the intervention were 41.9 +/- 6.666 and 42.833 +/- 8.363, respectively, immediately after the intervention were 41 +/- 6.103 and 33.9 +/- 7.073, respectively, and three months after an intervention were 41.1 +/- 6.567 and 35.567 +/- 7.61, respectively and this difference from statistical viewpoint was significant (P<0.001). Likewise, the Repeated measures statistical test showed a significant reduction in the Fatigue Severity Scale in the education group in triple measurements (P<0.00001). Conclusion: The psychological Training with gradual muscle relaxation technique in the multiple sclerosis patients can lead to reduction of fatigue scale. Therefore, this method can be safely suggested as an effective and affordable in terms of cost and time for multiple sclerosis patients.
... [9][10][11][12][13] However, given the chronic and progressive nature of MS, one important aspect to consider for any balance training intervention is that it should be safe and feasible to carry out on a long-term basis in a community setting. Several small studies have investigated the effects of exercise programs that are more commonly offered in group and community settings including tai chi 14 and Feldenkrais Awareness Through Movement training. 15 Both of these programs focus on the conscious awareness of movement during slow, guided activity. ...
This study investigated the effects of a home balance training intervention on people with multiple sclerosis (MS). This quasi-experimental repeated-measures study involved 14 ambulatory community-dwelling individuals with MS. Subjects were assessed on three separate occasions: before and after a 6-week control period and after a 6-week home exercise program. After the intervention, subjects demonstrated significant improvement in measures of balance, including the Berg Balance Scale and specific components of the Sensory Organization and Limits of Stability Tests. In conclusion, a multidimensional home exercise program can improve certain measures of balance in individuals with MS who have mild to moderate disability. Whether these improvements lead to improved quality of life or a reduction in fall risk is yet to be determined.
... Los beneficios del Tai Chi están ampliamente descritos en diverso material bibliográfico donde se demuestra que genera gran variedad de beneficios en el manejo, y también interviene en el control de diferentes enfermedades que se presentan comúnmente en el anciano (9)(10)(11). ...
Objective: This research was aimed at determining the effects of an exercise program with the art of Tai Chi in older women. Material and Methods: A quasi-experimental study with a longitudinal cutting was conducted; the study population was a group of elderly in the city of Popayan. It consisted of three phases: in the first one, an initial evaluation of physical capacity (walking, balance, daily basic activities) was applied, afterward, the scale of Yesavage for signs of depression, and finally the Folstien Mini Mental Test to assess cognitive functions. In the second phase, a program of Tai Chi exercises in one weekly session for a twelve weeks period was implemented. In the third phase, the evaluation of the results of the program through participant re-evaluating was carried out. Results: The functional capacity improved in all the tested aspects, the difference in walking speed and the static and dynamic balance were statistically significant; in the same way, the cognitive ability improved in all the tested items, statistical significance was found in aspects such as memory, attention, calculation and language. All participants achieved full functionality of the daily basic activities. Conclusions: The application of a Tai Chi technique provides significant benefits in the balance and the cognitive ability of the elderly, leading to a breakthrough in their independent behavior and improving their functional capacity, so it could be recommended as an alternative technique of physiotherapeutic intervention in neuronal rehabilitation.
... Concurrent physical and psychological gains are also reported in progressive neurological conditions. A pilot study focusing on multiple sclerosis (MS) indicated improvements on measures of balance and depression following a TJ/qi gong intervention (Mills et al., 2000). A study of a twice-weekly six month TJ intervention for MS reported indications of gains in balance, coordination, and depression, relative to a treatment-as-usual group (Burschka et al., 2014). ...
This theoretical paper considers the attainment and maintenance of flow state experiences (FSEs) as as a guiding principle in the bespoke adaptation of tai ji (tai chi) with neurological groups. This adaptation is in response to heterogeneous physical, cognitive, and emotional difficulties within and across neuro-logical conditions. Fragmentation, cluttered minds, and inertia are common disturbances to self-experience in neurological conditions. Mindfulness-based meditation approaches have been increasingly applied with neurological populations, but may not address some of these distressing self-states, nor be accessible to all in the presence of varied physical, cognitive, and emotional difficulties. FSEs within Tai Ji practice are advocated here as a parallel opportunity for clinical application from eastern spiritual traditions. FSEs are characterised by experiential continuity, deep absorption, and a merging of self-awareness and activity. Their theoretical value for neurological patients are discussed, and FSEs are advocated as a driver for increased psychological and spiritual focus in tai ji neuro-rehabilitation practice.
... Qigong has also been used as an intervention (two to three months) for coping with and alleviating symptoms of diseases. Multiple sclerosis patients showed significant improvements in depression and balance (Mills, Allen, & Morgan, 2000), and fibromyalgia patients improved on measures of pain, physical and psychological functioning, anxiety and depression , and enhanced movement harmony (Mannerkorpi & Arndorw, 2004). Muscular dystrophy patients maintained perceived general health when performing Qigong while the control group deteriorated (Wenneberg, Gunnarsson, & Ahlström, 2004b). ...
... [7][8][9] A previous study suggested the efficacy of Tai-Chi in improving balance and depression in patients of Multiple Sclerosis. 10 However; these results were not conclusive IJCRR Section: Healthcare since they were mainly deduced from self-reported improvements in response to a subjective questionnaire. Therefore, the primary aim of this study was to test the hypothesis about the beneficial effects of Tai-Chi on balance and mobility in patients of Relapsing Remitting Multiple Sclerosis (n=16) using standardized, non-biased measuring scales. ...
Background: Tai Chi postures have recently been shown in a number of randomized controlled trials to improve balance and posture in a variety of patient groups. Balance and mobility are problems commonly encountered by people with Multiple Sclerosis (MS). This pilot study examines the effect of Tai-Chi ± Mental practise on balance, gait and mobility in people with MS.
... Chronic stroke patients who participated in a 12-week Tai Chi program showed improved static and dynamic balance compared to non-Tai Chi stroke controls (Au-Yeung and Hui-Chan 2009). Husted et al. (1999) found improvements in 25-ft walking speed, hamstring flexibility, and psychosocial well-being after an 8-week Tai Chi intervention in individuals with MS, while Mills et al. (2000) found positive effects on balance and reductions in depression following a 2-month Tai Chi intervention. We recently completed a 3-week Tai Chi pilot intervention study to assess changes in functional status and static balance in individuals with mild-to-moderate MS (Averill 2013). ...
People living with multiple sclerosis (MS) consistently rate balance and gait impairments as having the greatest negative impacts on their quality of life. Our research aims to understand the sensorimotor contributions to balance dysfunction and difficulty with walking in people with MS, with specific attention paid to how fatigue, muscle weakness, and sensory loss interact to limit physical function and mobility. Here, we relate aspects of somatosensory loss and symptomatic fatigue to balance function, and provide new insights in our understanding of the mechanisms of balance and gait dysfunction in MS through the use of novel analytical methods and experimental paradigms. We first review the existing methods and paradigms to assess postural and gait stability in research on MS. Next, we introduce novel measures to assess the stability and adaptability of posture and gait in people with MS that are based on nonlinear and complex systems methods. These novel methods include (1) boundary-relevant measures of postural stability and control (postural “time to contact”), and (2) entropy measures for assessing postural and gait adaptability. These novel methods allow us to differentiate between postural and gait variability caused by dysfunction that may interfere with movement control, and variability that is functional and provides stable and adaptable movement patterns. Finally, we discuss how these methods and paradigms could help to develop innovative treatments for balance and gait dysfunction in people with MS.
... All three authors described incomplete outcome data, including attrition rates, but only Grossman et al. [40] included this intention to treat and attrition data in the statistical analysis. There was no substantive evidence for selective outcome reporting in any of the studies, although Mills and Allen [41] omitted data on mood recording via Profile of Mood States (POMS), which is described elsewhere [43]. Overall, only the study by Grossman et al. [40] can be considered of high methodological quality (see Table 7). ...
Multiple sclerosis (MS) is a stressful condition; depression, anxiety, pain and fatigue are all common problems. Mindfulness based interventions (MBIs) mitigate stress and prevent relapse in depression and are increasingly being used in healthcare. However, there are currently no systematic reviews of MBIs in people with MS. This review aims to evaluate the effectiveness of MBIs in people with MS.
Systematic searches were carried out in seven major databases, using both subject headings and key words. Papers were screened, data extracted, quality appraised, and analysed by two reviewers independently, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Perceived stress was the primary outcome. Secondary outcomes include mental health, physical health, quality of life, and health service utilisation. Statistical meta-analysis was not possible. Disagreements were adjudicated by a third party reviewer.
Three studies (n = 183 participants) were included in the final analysis. The studies were undertaken in Wales (n = 16, randomised controlled trial - (RCT)), Switzerland (n = 150, RCT), and the United States (n = 17, controlled trial). 146 (80%) participants were female; mean age (SD) was 48.6 (9.4) years. Relapsing remitting MS was the main diagnostic category (n = 123, 67%); 43 (26%) had secondary progressive disease; and the remainder were unspecified. MBIs lasted 6-8 weeks; attrition rates were variable (5-43%); all employed pre- post- measures; two had longer follow up; one at 3, and one at 6 months. Socio-economic status of participants was not made explicit; health service utilisation and costs were not reported. No study reported on perceived stress. All studies reported quality of life (QOL), mental health (anxiety and depression), physical (fatigue, standing balance, pain), and psychosocial measures. Statistically significant beneficial effects relating to QOL, mental health, and selected physical health measures were sustained at 3- and 6- month follow up.
From the limited data available, MBIs may benefit some MS patients in terms of QOL, mental health, and some physical health measures. Further studies are needed to clarify how MBIs might best serve the MS population.
The practice of sport by multiple sclerosis patients has long been controversial. Recent studies, however, show that both sport and physical activity are essential for these patients. Indeed, they help to cope with the effects of multiple sclerosis, such as fatigue, reduced endurance, loss of muscle mass, and reduction of muscle strength. The beneficial effects of physical activity on these patients have been underlined in several studies, whereas those of practicing sport have been the subject of fewer evaluations and assessments. The aim of this update is to report on the effects of sport on multiple sclerosis patients. The benefits of sport have been demonstrated in several studies. It helps multiple sclerosis patients to increase their balance, resistance to fatigue, mobility and quality of life. Several biases in these studies do not enable us to recommend the practice of some of these sports on a routine basis.
Acquired brain injury (ABI) in adulthood is a sudden insult to the brain that does not worsen over time. Examples of ABIs include traumatic brain injury, stroke (ischaemic and haemorrhagic), infections (e.g. encephalitis, meningitis), hypoxia or oxygen starvation (often occurring following cardiac arrest) and enduring difficulties following the resection of brain tumours. Difficulties that emerge from these brain lesions are complex, multi-faceted and enduring. Psychological needs are central, including anxiety, depression, anger and irritability, post-traumatic stress and struggles to adjust to the condition (Williams and Evans 2003). These often occur alongside physical restrictions (reduced, mobility, balance, sensation), cognitive impairments (problems in information processing, attention, memory, planning and organising, visuospatial perception and social communication) and strain in interpersonal relationships, with progressive social isolation developing over time (Elsass and Kinsella 1987).
Background: Osteoarthritis is a chronic and debilitating disease that often occurs in elderly populations, causing pain and loss of balance. The aim of this study was to compare the effect of Tai Chi and isometric exercises on the pain and balance in patients with knee osteoarthritis. Methods: In this study, 24 male subjects with knee osteoarthritis were selected and divided into two groups of 12 persons. Visual Analog Scale was used for pain measurement and Berg Balance Scale (BBS) was applied to measure the balance. The training program included 3 sessions exercise per week, 60 minutes each (10-min warm up, 40-min specialized training, 10-min recovery and mild stretching exercises) for duration of 8 weeks. Data were analyzed through SPSS 16 and using Kolmogrov-Smirnov, t-test and independent t-test. Results: Tai Chi exercises had a significant effect on both pain severity (P=0.001) and balance (P=0.002). While, isometric exercises had a significant effect only on pain severity (P=0.004). Conclusion: It was concluded that Tai Chi exercises have a better effect on pain relief and balance improvement than isometric exercises, and it is advisable to use Tai Chi-isometric exercises to increase balance in patients with osteoarthritis. © 2017, Kerman University of Medical Sciences. All rights reserved.
Multiple sclerosis is one of the most common neurological disorders and causes of disability among young people. Although some people with MS have some disability in their lifetime, up to 60% or more of the patients have major implications for their quality of life and financial cost to society. Most people with MS have a normal or near-normal life expectancy. In rare cases, MS is so malignant, progressive and ends quickly. Despite our awareness of the significant impact of MS, there is a serious lack of information on resources which are available to deal in the health system with the disease. Significant findings: Globally, the average estimated prevalence of MS was 30 per 100,000 (range: 5-80); Regionally, the average estimated prevalence of MS is the largest in Europe (80 per 100,000), followed by the Eastern Mediterranean (14.9), America (8.3) in the Western Pacific (5), Southeast Asia (2.8) and Africa (0.3); Globally, the average estimated incidence of MS would be 2.5 per 100 000 (ranging from 1.1 to 4). There is globally a major gap in the provision of essential and more specific forms of information about this disease.
The position of WHO publication regarding the application of CAM is:
- The five most prevalent alternative or complementary approaches used in more than 50% of countries are diet and nutrition (88.3%), acupuncture (86.7%), herbal medicine (81.7%), massage (78.3 %) and homeopathy (73.3%).
- Other alternative or complementary approaches used in some countries, chiropractic and osteopathy (41.7%), aromatherapy (40%), hyperbaric oxygen (40%), cannabis (38.3%), ayurvedic medicine (36.7%), pilates (36.7%), dentistry (replacement of seals) (36.7%), biofeedback (35%), macrobiotic diet (31.7%), naturopathy (28.3%), hypnotherapy (21,7%), hypnosis (18.3%) and iridology (18.3%).
Our training program for non-pharmacological treatment of Multiple sclerosis is made according to the latest findings from the search of the medical database pubmed. The data on the effectiveness of treatment are mostly cited publications published in the last 5-10 years, while CAM methods are mostly in the last 5 years
Objectives
Conduct a systematic review to evaluate the effects of Tai Chi on physical and psychosocial function among individuals with Multiple Sclerosis.
Methods
An electronic literature search of 12 databases using controlled vocabulary function and keywords from inception through August 2016. All Tai Chi intervention studies assessing physical and psychosocial function among persons with Multiple Sclerosis were included. Study quality was scored using an established tool examining 16 study elements (range = 0–32).
Results
A total of 91 articles were retrieved, with 3 additional articles identified through reviewing bibliographies of relevant articles. A total of 8 studies (randomized controlled trials, n = 3; quasi-experimental, n = 5) enrolled 193 participants with Multiple Sclerosis. Studies were conducted in the USA (n = 3), Europe (n = 3), Iran, (n = 1), and India (n = 1). A total of 3 studies reported using the Yang style of Tai Chi (not specified, n = 5 studies). The Tai Chi intervention averaged 27 sessions over 11 weeks. Study quality scores for the randomized controlled trials had a mean score of 23 (range 19–26), while quality scores for quasi-experimental studies had a mean score of 20 (range 13–26). Overall, participants enrolled in Tai Chi had better balance, gait and flexibility, less fatigue and depression, and better quality of life after the intervention; though mixed results were reported.
Conclusion
The results indicate that Tai Chi is likely safe and may provide physical and psychosocial benefits in individuals with Multiple Sclerosis. Further research is needed using more rigorous study designs to assess the benefits of Tai Chi for individuals with Multiple Sclerosis.
The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS). After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL) and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients.
Because of multiple psychological-physical symptoms and failure to accept the reality, multiple sclerosis (MS), patients are suffering from negative mood disorders and fatigue which affects their life quality negatively. Therefore this study has been conducted to determine the effect of Dohsa Psycho-Motor Rehabilitation Method on fatigue severity, sleep quality, and Resilience promotion of Patients with Multiple Sclerosis in Isfahan, Iran. A quasi-experimental study with pre-test, post-test and follow up was administered on both the experimental and control groups. The population consisted of all patients diagnosed with multiple sclerosis in Isfahan with clinical and MS society records. By purposive sampling 30 patients were selected for the experimental (n=15) and control (n=15) groups. Patients completed fatigue (FSS), Scale of sleep quality (PSQI) and Resilience Scale (CD-RISC) questionnaire before the beginning of the treatment (pretest) and also later for post-test. Dohsa treatment duration was ten sessions, three sessions per week and their post test was administered 30 days later. Finally, data were analyzed using SPSS18. The results of the multivariable covariance analysis showed that Dohsa Psycho-Motor Rehabilitation Method decreases fatigue severity, increases quality of sleep, and resilience of patients with Multiple Sclerosis (p<0.001). Since MS disease has led to widespread symptoms and different clinical signs, MS patients may need psychological rehabilitation in the future, therefore Dohsa Psycho-Motor Rehabilitation Method is an effective treatment for reducing fatigue, improving sleep quality and increasing the resilience of multiple sclerosis patients.
Objective: Previous reports have documented the benefits of exercise on the well-being of renal patients. However, fewer than 50% of our end-stage renal disease (ESRD) patients engage in regular exercise. To promote exercise, we implemented a home-based exercise program. The aim of the program was to reduce barriers to exercise by helping patients to exercise at their convenience and without the need to travel. The effect of the program was evaluated 3 months after implementation. Patients and Methods: Each study participant received a videotape that demonstrated 30 minutes of low-capacity aerobic exercise. Participants were advised to exercise by following the demonstration on the videotape. Encouragement was given over the telephone. Self-reports on practice were recorded in a log book that was also provided. The effect of the program was evaluated by comparing outcomes data before, and 3 months after, implementation of the program. Outcomes assessment included functional mobility (timed "Up & Go" test), muscle flexibility ("Sit & Reach" test), physical capacity ("Six-Minute Walk"), and quality of life [Kidney Disease Quality of Life Short Form (KDOOL-SF)]. Results:The program began with 72 participants. Over time, 39 dropped out. The remaining 33 participants included 11 men and 22 women with a mean age of 52.8 +/- 9.8 years. They exercised 3 - 7 times weekly. Significant improvements were observed in the timed "Up & Go" (p = 0.003) and "Sit & Reach" (p < 0.001) tests. Improvements in the "Six-Minute Walk" (p = 0.130) and in KDQOL-SF scores for emotional well-being (p = 0.456), pain (p = 0.100), burden of kidney disease (p = 0.061), and general health (p= 0.085) were statistically insignificant. Conclusions: Physically, patients with ESRD benefit from home-based low-capacity aerobic exercise. A home-based program provides an alternative to outdoor and group exercise. In view of a high drop-out rate, intensive promotion and encouragement should be considered to achieve a positive outcome.
Resumen El Tai Chi es un tradicional arte marcial chino que ha sido practicado en China durante siglos. Combina profunda respiración del diafragma y relajación con varias posturas fundamentales que se continúan unas con otras con movimientos lentos, delicados y suaves. Ha sido apoyado para el desarrollo de la interacción de mente-cuerpo, regulación de la respiración con el cuerpo en movimiento, coordinación mano-ojo y relajación. Todo ello produce en la persona que lo realiza múltiples beneficios tanto a nivel físico como psicológico. Esto, acompañado de la facilidad con que puede ser practicado por cualquier tipo de persona, convierte al Tai Chi en un complemento eficaz para la Fisioterapia. Palabras clave: Tai Chi, movimiento, Fisioterapia, beneficios. Summary The Tai Chi is a traditional Chinese martial art that has been practiced in China during centuries. It combines deep respiration of diaphragm and relaxation with several fundamental positions that are continued with others with slow, delicate and smooth movements. The Tai Chi has been supported for the development of the mind-body interaction, the control of the respiration with the body in movement, hand-eye coordination and relaxation. All this things produces in the person who practices it, numerous physical and psychological benefits. This, accompanied by the facility whereupon can be practiced by any type of person, convert the Tai Chi to an effective complement for the Physiotherapy.
Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.
Introduction: Multiple sclerosis affects the patients’ quality of sleep. Acupressure is an
inexpensive and non invasive procedure that can be used to control symptoms of the
disease. The aim of this study was to investigate the effect of acupressure on quality of
sleep in women with MS.
Methods: In this single blind randomized clinical controlled trial, 100 women were
recruited from Esfahan MS association. Subjects were equally divided into two groups of
experimental and placebo, by random allocation method. ThenP.S.Q.I was used to
evaluate the quality of sleep in each group. The members of experimental group were
under acupressure in shen men point for 5 minutes bilaterally. In addition, the participants
were instructed to perform acupressure in same point once daily for four weeks. Subjects
in placebo group were trained to touch the placebo point. The quality of sleep was
measured in both groups four weeks after intervention. The data was analyzed by SPSS.
Results: The study findings showed no difference in sample characteristics between the
experimental and placebo groups. But there were no significant differences in quality of
sleep (p=0.89) at baseline in two groups. There was significant improving on quality of
sleep in experimental group compared to placebo group four weeks after intervention
(p≤0.0001).
Conclusion This study showed, that acupressure can be effective in improving sleep
quality in women with multiple sclerosis.
Traumatic brain injury (TBI) can result in a range of physical, cognitive, emotional and behavioural problems. Exercise is increasingly advocated in brain injury rehabilitation since individuals with long-term conditions are at particular risk of deconditioning and secondary disease or impairment as a result of inactivity. Maintaining an active lifestyle can help brain injured individuals to regain confidence and independence, and further, exercise has been associated with reductions in physical and cognitive impairments, fatigue and depression, which often accompany TBI. This chapter identifies some key arguments for promoting exercise in TBI, and provides an overview of the research evidence evaluating exercise intervention in this population identifies some major limitations of existing work in this field and provides suggestions for further investigation. A case study is presented which shows the introduction of an alternative form of exercise intervention into the community day centre setting.
This study investigated the effectiveness of a short course of mindfulness of movement to help with symptom management in eight people with multiple sclerosis. Progress was compared to a control group who were asked to continue with their current care. Each participant received six individual one-to-one sessions of instruction. They were also provided with audio and videotape aides. Each participant was assessed on a test of balance, pre- and post-intervention, and at 3-month follow-up. All participants completed a rating of change of 22 symptoms relevant to multiple sclerosis. A close relative or friend was also asked to assess independently the degree of change. The mindfulness group reported improvement over a broad range of symptoms. This was verified by the relatives’ independent rating and maintained at 3 month follow-up. The control group showed no improvement but instead tended towards a deterioration on many of the items. The physical assessment of balance also showed a significant improvement for the mindfulness group. This improvement was maintained at 3 month follow-up. In conclusion, training in mindfulness of movement appeared to result in improved symptom management for this group of people with multiple sclerois. This was a pilot study, using small numbers, so the results need to be treated with caution. Several improvements to the experimental design are suggested. The role of individual therapeutic ingredients is discussed.
Tai Chi Chuan has traditionally been used and is still practised by millions of Chinese people, especially the elderly as an exercise and therapeutic tool. Since the advent of Traditional Chinese Medicine in the west, there has been an increasing interest in its potential health benefits by an increasing number of health professionals, including doctors, nurses, physiotherapists and occupational therapists. This literature review focuses on the increasing evidence of Tai Chi as an exercise activity which can improve fitness, and that with regular application can lead to an increase in functional abilities of coordination and joint mobility, as well as improve self esteem and confidence. The literature review on Tai Chi provides evidence as to the potential for Tai Chi in the prevention and treatment of many conditions associated with ageing, amongst them loss of balance and strength (frailty), and cardiorespiratory function, as well as psychological factors associated with the ageing process.It is concluded that Tai Chi Chuan can prevent many of the problems associated with ageing, but that further research needs to be undertaken into the use of Tai Chi as a therapeutic tool for combating chronic disease.
This paper reports the findings of a single-case research design which examined the effects of 1-h, twice-weekly Tai Chi Chuan sessions on state anxiety and mood of children with severe learning disabilities. The participants were three upper elementary children (mean age=13.3 years). The intervention lasted 10 weeks. The State-Trait Anxiety Inventory for Children (STAIC) A-State Scale, a 28-item mood inventory, and Conners’ Teacher Rating Scales-39 (CTRS-39), a scale used to assess whether a child has attention deficits and/or hyperactivity, were given at intervals during the pre-treatment baseline (A1), treatment (B), and post-treatment baseline (A2). Individual scores were the unit of analysis in this exploratory piece of work. Mean state anxiety and mood scores and the split-middle technique were used to analyze the data. Results suggest that the intervention had the strongest effect on the participant who presented with hyperactivity and heightened anxiety. The findings support the benefits of using a single-case research design with this population.
SUMMARY Sixty-four patients with advanced multiple sclerosis were assessed on intellectual and memory tests. They were rated by occupational
therapists on an Activities of Daily Living scale according to their abilities, and by relatives on the same scale, according
to what they actually did. Results indicated that the multiple sclerosis patients had intellectual and memory deficits. A
few discrepancies occurred between patients' abilities as rated by an occupational therapist and what they actually did as
rated by a relative. These discrepancies were not significantly related to memory impairment.
The objective of this study was to evaluate the effect of Tai Chi Chuan (TCC) on health fitness in older individuals. Methods: Thirty-eight community-dwelling persons aged 58 to 70 yr completed this study. The TCC group included 9 men and 11 women; the control group included 9 men and 9 women. The TCC group practiced TCC for 11.2+/-1.4 months, with the attendance of 4.6+/-1.3 times x wk(-1). Each session included 20 min of warm-up, 24 min of TCC practice, and 10 min of cooldown. The exercise intensity was 52-63% of the heart rate range. Cardiorespiratory function, strength, flexibility, and percent of body fat were evaluated before and at the end of this study.
The male TCC group showed 16.1% increase in VO2max (P < 0.01), 11 degrees increase in thoracic/lumbar flexibility (P < 0.05), 18.1% increase in muscle strength of knee extensor (P < 0.01), and 15.4% increase of knee flexor (P < 0.05). The female TCC group showed 21.3% increase in VO2max (P < 0.01), 8.8 degrees increase in flexibility (P < 0.05), 20.3% increase in muscle strength of knee extensor (P < 0.05), and 15.9% increase of knee flexor (P < 0.05). The control group showed no significant change in these variables.
The results indicate that a 12-month Tai Chi Chuan program is effective for improving health fitness of the elderly.
For the past decade, our group of neurologists, biomedical engineers and statisticians has developed objective tests to quantify apropos neurological functions (cognition, strength, steadiness, reactions, speed, coordination, sensations, fatigue, gait, station and selected skills of daily living). Instrumented tests have been extensively evaluated and used in several randomized double-blind trials in multiple sclerosis and Parkinson's disease. Our long-term goal is to bring to clinical neurology a type of quantification of the nervous system which does not exist. In this report, a brief overview of test development, personnel training, test administration and selected situations for using the clinical quantitative neurological examination (CQNE) are discussed. In addition, 57 tests are illustrated and described.
We examined the relationship between memory impairment and functional disability in multiple sclerosis. Tests of memory, sensorimotor ability, and functional capacity were administered to fifty-six subjects with chronic-progressive or remitting-relapsing MS. Sensorimotor impairment, functional disability, and chronicity predicted impairment on various measures of memory acquisition, while age and type of diagnosis did not. After accounting for the effects of initial acquisition, delayed-recall performance was weakly-associated with disability. We suggest that: (1) Functional disability is associated with memory loss in MS; (2) MS-forgetting is caused by defective acquisition, rather by a deficit in consolidation or storage; (3) Level of disease activity, rather than type of MS diagnosis, determines the degree of memory impairment; and (4) MS disability needs to be evaluated multidimensionally, to account for both neurologic and functional impairment.
In this study, we investigated the potential value of t'ai chi in promoting postural control of the well elderly. T'ai chi, a traditional Chinese exercise, is a series of individual dancelike movements linked together in a continuous, smooth-flowing sequence. Performance on five balance tests of 9 t'ai chi practitioners was compared to that of 9 nonpractitioners. An analysis of variance demonstrated that in three of the tests, the t'ai chi practitioners had significantly better postural control than the sedentary nonpractitioners (p less than .05). It was also found that men performed significantly better than women in both the practitioner and non-practitioner groups on the same three tests (p less than .01).
The purpose of the study was to explore the utility of stress-reduction techniques within a population of hospitalized multiple sclerosis patients. Four stress-management groups, each composed of 8 to 10 patients, were formed with each participant receiving a pre- and posttest battery focusing on emotional/mood factors (the Profile of Mood States). Group sessions were held once/weekly for 13 wk. Relaxation, cognitive, and behavioral strategies were incorporated into the program. The findings indicate that stress-management techniques were effective in the reduction of psychological distress. Significant decreases were noted in scores on depression and anxiety and significant increase on vigor.
Static standing balance was compared in 10 subjects with hemiparesis resulting from a cerebrovascular accident (33-71 years of age), 10 young normal subjects (22-40 years of age), and 10 older normal subjects (48-78 years of age) using a quantitative maximal load test and a clinical evaluation. The maximal load test required subjects to maintain a standing position against static loads applied at the waist (sagittal and frontal planes). Maximal loads were recorded as a percentage of body weight at the point when subjects could no longer hold the initial standing position. Effects of mechanical and cognitive factors were minimized in the maximal load test. Hemiparetic subjects had significantly lower maximal loads and clinical balance scores than both normal subject groups. Maximal loads of the young and older normal subjects were comparable, but the older subjects had lower clinical scores than the young subjects. Low correlations between subjects' scores on the two tests imply that each test yielded different information about static balance. Implications of the study results for the evaluation and treatment of balance deficits in hemiparetic persons are discussed.
Antidepressant clinical drug trials conducted from 1955–1972 are analyzed to determine the most frequently used patient self-rating scales and to estimate their relative sensitivities (validities). Other analyses suggest how the methodology of the trials may have influenced measurement sensitivity. Interpretive problems are discussed, and some tentative recommendations are presented.
The purpose of this study was to assess the effect of T' ai Chi Chuan training on lateral stability, kinesthetic sense, and strength of voluntary knee extension. Subjects consisted of 24 naive volunteers (12 men and 12 women) between the ages of 20 and 45 years. Pre- and 12-week posttests included lateral body stability, kinesthetic sense in the glenohumeral joint for 30 degrees, 45 degrees, and 60 degrees, and strength of knee extension. After pretest data collection, 12 subjects performed T'ai Chi Chuan three times per week for 12 weeks, learning 108 forms of T'ai Chi Chuan. A 2 x 2 analysis of variance was used to estimate significance of group differences on all of the dependent variables. Significant group differences were found in lateral body stability, kinesthetic sense at 60 degrees, and strength of the dominant knee extensor. No significant differences between the T'ai Chi and the control group were found for kinesthetic sense at 30 degrees and 45 degrees rotation of the glenohumeral joint. Film analysis indicated that the two lesser angles were not as common in the T'ai Chi training as the greater angle (60 degrees) and thus may be less practiced. It appears that T'ai Chi Chuan presents a low-stress method to enhance stability, selected kinesthetic sense, and strength of knee extension.
Attempting to measure the impact of multiple sclerosis (MS) on the individuals patients has become a major issue stimulated by both the emergence of new therapeutic agents and the increasing demand to incorporate the patient's perspective. Disability has been the main focus. Recently, new disability scales have been developed and generic scales evaluated in an attempt to replace or complement the constantly used and much criticized Expanded Disability Status Scale (EDSS). There is, however, the growing realization that it is important to incorporate broader aspects of disease input such as are contained within the concepts of health-related quality of life. Current scales in this area are limited in either their scientific soundness and/or clinical usefulness, and it may be appropriate to consider the development of a new MS-specific measure of disease impact for use in clinical trials.
The presumed but as yet unspecified autoimmune- mediated basis for the pathogenesis of multiple sclerosis has led to attempts to modify the immune system of patients with this disease based on general and selective approaches. The rationale for using interferon-β for the treatment of multiple sclerosis is based on its antiviral and complex immunoregulatory activities.
Interferon-β-1a (Avonex®)
1is a recombinant molecule which is indistinguishable from natural interferon-β derived from human fibroblasts. Its precise mechanism of action is unknown, although effects on immune system processes which have been implicated in the pathogenesis of multiple sclerosis have been documented. T cell activation and migration into the CNS is a primary process in the pathogenesis of multiple sclerosis. In vitro and in vivo, interferon-β-1a, compared with placebo or no treatment, significantly reduced expression of T cell surface activation markers, and significantly increased CNS levels of interleukin- 10 — a potent inhibitor of cell- mediated immune responses. Pharmacokinetic studies indicate that intramuscular injection is the optimal route of administration for this formulation of interferon-β-1a.
In patients with relapsing- remitting multiple sclerosis who participated in a randomised double- blind trial, interferon-β-1a 30µg (6 MIU) administered by intramuscular injection once weekly for 2 years (n = 158), compared with placebo (n = 143), significantly extended the time to onset of sustained neurological disability. Interferon-β-1a also reduced the rate of disease relapse by approximately one-third compared with placebo, a finding which was supported by cranial magnetic resonance imaging (MRI) data showing significant reductions in lesion number and volume. Interferon-β-1a was well tolerated, with influenzalike symptoms making up the majority of adverse reactions. The clinical significance of the beneficial effect of interferon-β-1a on disease progression has been endorsed by the findings of a retrospective statistical analysis of the disability outcomes data obtained in the double-blind trial.
In patients with relapsing multiple sclerosis, interferon-β-1a is the only drug that has been demonstrated to significantly slow disease progression without excessive toxicity, in addition to significantly reducing the rate of relapse — measured clinically and by MRI. Notwithstanding the absence of long term tolerability data, and data from comparative trials with other agents, interferon-β-1a represents a promising advance in drug therapy for relapsing multiple sclerosis.
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