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The role of aerobic exercise in improving functioning and treating the symptoms of individuals with multiple sclerosis

Authors:

Abstract

Multiple sclerosis (MS) is a progressive long-term neurological disorder of the central nervous system (CNS) that directly affects the lives of individuals and their environment. Early intervention through the systematic application of aerobic exercise can help to better treat the symptoms in people with MS by improving their balance, quality of movement and reducing their functional limitations. The aim of this review is to describe recent research data on the efficacy of this method in improving the functioning and treatment of symptoms in people with MS. The Google Scholar and PubMed database were searched in English and Greek with the following keywords: multiple sclerosis, aerobic exercise, functional ability, rehabilitation. The review included 10 articles from clinical trials, systematic reviews and books. Discussion-Conclusions: The application of aerobic exercise seems to have a positive effect on the treatment of motor disorders in people with MS when compared to conventional physiotherapy. The results of this review show that aerobic exercise two to three times a week for more than six weeks is able to improve the functional level of people with MS. Introduction Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). The pathological damage that characterizes MS is the presence of areas with specific demyelination that are scattered in the parenchyma and the space of the white matter of the CNS [1]. Loss of myelin, the fat that insulates nerves, dramatically affects the rapid and smooth travel along nerve pathways in the CNS. This myelin loss reduces the rate at which stimuli propagate, affecting smooth, rapid, and coordinated movement. As a result, the problems associated with MS range from mild to severe disability [2]. The physical, cognitive and psychological consequences of MS often have a wide range, are varied and complex. Because the disease progresses at a different rate over several decades, the needs of each individual change over time, sometimes quite suddenly and unexpectedly. Effective disease management therefore requires a long-term and preventive rehabilitation approach, with an interdisciplinary team working with the patient and their family. Ideally this collaboration starts at the time of diagnosis and progresses along with the disease [3]. Before the advent of MRI, it was more difficult to diagnose MS, as the clinical picture may include a single symptom or the symptoms may be mild and subside over a period of time [4]. MS is one of the most common neurological disorders, affecting approximately 300000 patients in the United States, with a higher incidence in young adults. Clinically, it is determined by the involvement of different parts of the CNS at different times-provided that other disorders causing multifocal central dysfunction have been ruled out. Initial symptoms generally appear before the age of 55, with a maximum incidence between the ages of 20 and 40. Women are affected almost twice as often as men. Epidemiological studies show that the prevalence of the disease increases with the distance from the equator and that there is no population at high risk for the disease between latitudes 40 and 40N. Vitamin D levels may play a role, as well as exposure to Epstein-Barr virus. Genetic predisposition results from twin studies, few family cases, and a strong association between the disease and specific HLA antigens [5] .
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International Journal of Advanced Research in Medicine 2021; 3(2): 91-94
E-ISSN: 2706-9575
P-ISSN: 2706-9567
IJARM 2021; 3(2): 91-94
Received: 19-05-2021
Accepted: 21-06-2021
Dimitrios Nikias
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Anastasios Kottaras
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Dimitrios Lytras
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Paris Iakovidis
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Andreas Fotios Tsimerakis
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Christos Kopsidas
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
Corresponding Author:
Dimitrios Nikias
Department of Physiotherapy,
Faculty of Health Sciences
International Hellenic
University - Alexander
Campus P.O. Box 141, 57 400
Sindos, Thessaloniki, Greece
The role of aerobic exercise in improving functioning
and treating the symptoms of individuals with
multiple sclerosis
Dimitrios Nikias, Anastasios Kottaras, Dimitrios Lytras, Paris Iakovidis,
Andreas Fotios Tsimerakis and Christos Kopsidas
DOI: https://doi.org/10.22271/27069567.2021.v3.i2b.222
Abstract
Multiple sclerosis (MS) is a progressive long-term neurological disorder of the central nervous system
(CNS) that directly affects the lives of individuals and their environment. Early intervention through
the systematic application of aerobic exercise can help to better treat the symptoms in people with MS
by improving their balance, quality of movement and reducing their functional limitations. The aim of
this review is to describe recent research data on the efficacy of this method in improving the
functioning and treatment of symptoms in people with MS. The Google Scholar and PubMed database
were searched in English and Greek with the following keywords: multiple sclerosis, aerobic exercise,
functional ability, rehabilitation. The review included 10 articles from clinical trials, systematic reviews
and books. Discussion - Conclusions: The application of aerobic exercise seems to have a positive
effect on the treatment of motor disorders in people with MS when compared to conventional
physiotherapy. The results of this review show that aerobic exercise two to three times a week for more
than six weeks is able to improve the functional level of people with MS.
Keywords: multiple sclerosis, aerobic exercise, functional ability, rehabilitation
Introduction
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). The
pathological damage that characterizes MS is the presence of areas with specific
demyelination that are scattered in the parenchyma and the space of the white matter of the
CNS [1]. Loss of myelin, the fat that insulates nerves, dramatically affects the rapid and
smooth travel along nerve pathways in the CNS. This myelin loss reduces the rate at which
stimuli propagate, affecting smooth, rapid, and coordinated movement. As a result, the
problems associated with MS range from mild to severe disability [2]. The physical, cognitive
and psychological consequences of MS often have a wide range, are varied and complex.
Because the disease progresses at a different rate over several decades, the needs of each
individual change over time, sometimes quite suddenly and unexpectedly. Effective disease
management therefore requires a long-term and preventive rehabilitation approach, with an
interdisciplinary team working with the patient and their family. Ideally this collaboration
starts at the time of diagnosis and progresses along with the disease [3]. Before the advent of
MRI, it was more difficult to diagnose MS, as the clinical picture may include a single
symptom or the symptoms may be mild and subside over a period of time [4].
MS is one of the most common neurological disorders, affecting approximately 300000
patients in the United States, with a higher incidence in young adults. Clinically, it is
determined by the involvement of different parts of the CNS at different times - provided
that other disorders causing multifocal central dysfunction have been ruled out. Initial
symptoms generally appear before the age of 55, with a maximum incidence between the
ages of 20 and 40. Women are affected almost twice as often as men. Epidemiological
studies show that the prevalence of the disease increases with the distance from the equator
and that there is no population at high risk for the disease between latitudes 40 and 40N.
Vitamin D levels may play a role, as well as exposure to Epstein-Barr virus. Genetic
predisposition results from twin studies, few family cases, and a strong association between
the disease and specific HLA antigens [5].
International Journal of Advanced Research in Medicine http://www.medicinepaper.net
~ 92 ~
Physiotherapy has been proven to help better treat motor
dysfunction in people with MS. The application of aerobic
exercises plays a very important role in improving the
ability to move and maintaining balance.
The aim of this review is to describe recent research data on
the efficacy of aerobic exercise in improving functional
ability in these patients.
Literature review
The Google Scholar and PubMed database were searched in
English and Greek with the following keywords: multiple
sclerosis, aerobic exercise, functional ability, rehabilitation.
The review included 10 articles from clinical trials,
systematic reviews and books. Below are their main
findings.
In their pilot study, Motl et al. [6] examined changes in gait
function associated with combined exercise training
consisting of aerobic, endurance, and balance activities in
people with MS who had recently had a gait impairment.
The study involved 13 participants with significant
disability due to MS (Expanded Disability Status Scale
(EDSS) = 4.0-6.0) completed the Multiple Sclerosis
Walking Scale-12, 2 trials of the Timed 25-Foot Walk, the
Timed Up & Go (TUG) test and the functional stimulation
profile score from 4 hiking tests on a treadmill (GaitRite),
before and after an 8-week training session. The training
program was designed by a physiotherapist and took place
three days a week under the supervision of an exercise
specialist. In terms of results, there were significant
improvements in the MS gait, the Timed 25-Foot Walk, the
TUG test and the functional stimulation profile scores.
These results suggest that a moderately intense,
comprehensive, combined exercise program represents a
rehabilitation strategy associated with improved gait
mobility in a small sample of people with MS who have
recently had a gait impairment.
Furthermore, Edwards and Pilutti [7] in their systematic
review showed that there is evidence for the benefits of
exercise in people with MS. However, these benefits have
been identified primarily in people with mild to moderate
disability. They conducted a systematic review of the
current literature on exercise in people with MS with severe
mobility disabilities. They searched four electronic
databases (PubMed, EMBASE, OvidMEDLINE and
PsychINFO) for related articles published by October 2016.
Data were analyzed using a descriptive approach and
summarized by how the exercise was performed
(conventional or adapted exercise training) and by outcome
(disability, fitness, physical function, symptoms and
involvement). Initially, 19 articles were included in the final
review. Five studies examined conventional exercise
training (aerobics and resistance) and 13 studies looked at
tailored exercises, including body-weight-supported
treadmill training (BWSTT), total-body recumbent stepper
training (TBRST) and electrical stimulation cycling
(ESAC). Regarding their findings, there is limited but
promising evidence of the benefits of exercise for people
with MS with severe mobility disabilities. Given the lack of
effective treatment strategies for managing long-term
disability accumulation, exercise can be considered as an
alternative approach.
Moreover, Halabchi et al. [8] through a systematic review
noted that proper exercise can cause remarkable and
significant improvements in various areas of cardiac
respiration (aerobic capacity), muscle strength, flexibility,
balance, fatigue, knowledge, quality of life and respiratory
function in patients with MS. Low to moderate intensity
aerobic exercise may improve aerobic capacity and reduce
fatigue in these patients with mild to moderate disability.
Flexibility exercises such as stretching muscles can reduce
spasticity and prevent future painful contractions. Balancing
exercises have beneficial effects on fall rates and better
balance. There are some general guidelines for
recommending exercise to the MS population. In general,
exercise should be considered a safe and effective means of
rehabilitation in patients with MS. Existing evidence
suggests that a supervised and personalized exercise
program can improve fitness, function and quality of life, as
well as modifiable disorders in MS patients.
Motl and Sandroff [9] emphasize that exercise is a behavioral
approach to the safe management of many of the functional,
symptomatic and qualitative consequences of MS.
Summarizing data from literature reviews and meta-
analyses, supplemented by recent individual studies, they
suggest that exercise training can yield small but significant
improvements in gait, balance, cognition, fatigue,
depression and quality of life in people with MS. Their
paper highlights the limitations of research on exercise
training and its implications and future research directions
while providing an overview of the promotion of exercise in
MS based on recent guidelines. Collectively, evidence for
the benefits of exercise suggests that time is ripe for its
promotion by healthcare providers, particularly neurologists,
as a central part of clinical care and management of MS
patients.
Pilutti et al. [10] provide a quantitative synthesis of
randomized controlled trials examining the effect of
exercise on symptomatic fatigue in people with MS. They
searched online databases (Web of Science, PubMed,
PsycInfo and Google Scholar) for articles published
between 1960 and October 2012 using the keywords
"fatigue" or "energy" or "mood" or "relaxation" and
"exercise" or "Physical activity" or "rehabilitation" or
"fitness" with "multiple sclerosis". They came up with 17
articles that included randomized controlled trials with 568
participants and that met the inclusion criteria and provided
enough data to calculate effect sizes (ESs, Cohen’s d). The
meta-analysis was performed using a meta-analysis software
program and a random effects model was used to calculate
the total ES, expressed as Hedge’s g. The main conclusion
they drew from the cumulative data was that exercise
training is associated with a significant small reduction in
fatigue among people with MS.
Platta et al. [11] provided a quantitative synthesis of
randomized controlled trials, which examined the effect of
exercise on muscle and cardiorespiratory capacity in people
with MS. Using the online databases PubMed, Google
Scholar and Web of Science, they searched for all the
relevant articles published up to October 2014. Exercise
or aerobics or strength training or resistance or
cardiorespiratory and multiple sclerosis were used as
keywords. The trials that were included examined the effect
of exercise on muscle and/or cardiorespiratory fitness
parameters. In total 20 articles were included. The meta-
analyses were performed using a random effects model to
calculate the total or average ES per fitness parameter.
Cumulative evidence suggests that exercise training is
associated with changes in muscle (small in size) and
International Journal of Advanced Research in Medicine http://www.medicinepaper.net
~ 93 ~
cardiorespiratory (moderate in size) fitness in people with
MS. Such an indication of size is important for clinical
research and practice by providing a substantiated estimate
of the true benefit of exercise to normal fitness.
Regarding guidelines, Dustine and Moore [2] suggest the
application of physical exercise as it does not seem to have
any effect on the prognosis or the development of MS.
However, exercise can temporarily improve fitness and
functional performance (e.g., strength, endurance, aerobic
capacity). It must be adapted to the symptoms of the disease
as these greatly affect its application. Therapeutic exercise
in people with MS should aim to maintain and where
possible improve the given level of joint mobility, muscle
strength and endurance and cardiorespiratory endurance.
Due to the fact that exhaustion is a common symptom, any
process that can increase energy through inproved efficiency
should be integrated into a well-balanced exercise program.
Specific aerobic exercises include cycling, walking and
swimming, which help maintain and/or increase aerobic
cardiovascular capacity and are applied for 30 minutes a day
for three days a week and the expected time for success is
four to six months.
Caution is suggested by Aminoff et al. [5], who argue that
although exercise and physiotherapy are indeed important,
excessive exercise should be avoided, especially during
periods of acute relapse. Fatigue is a serious problem for
many patients and sometimes responds to antamadine and
one of the antidepressants in the group of selective serotonin
reuptake inhibitors. Treatment of spasticity is often required,
as well as aggressive treatment of bladder and bowel
problems. Treatment for other aspects of advanced MS,
such as cognitive deficits, pain, tremor and disorder, is
generally less successful.
In their study, Kubsik-Gidlewska et al. [12] present a
rehabilitation strategy for MS based on the latest
developments in the field of physiotherapy. Publications on
the problem discuss a wide range of physiotherapy methods
that can be used to reduce the degree of disability and
alleviate the symptoms associated with the disease. The
complexity of the disease, the difficulty in determining the
appropriate treatment and a wide range of symptoms require
a comprehensive approach to the patient, which will include
both pharmacology and neuroprocessing. Rehabilitation,
which includes psychotherapy and symptomatic treatment,
is now considered the best form of treatment for MS. An in-
depth diagnostic assessment of functional status and
prognosis should be performed prior to initiating the
recovery process. The prognosis must take into account the
mental state, neurological state and awareness of the patient.
The MS physiotherapy program is based on a physiotherapy
gradation that requires a gradual transition from basic
movements to more complex ones until universal functions
are achieved. The most appropriate form of treatment is
functional rehabilitation in combination with natural
procedures. Recent reports indicate that aerobic training
should be included in the rehabilitation program.
Introduction of physical activity, regardless of the severity
of the disease, will reduce the negative effects of immobility
and, consequently, will increase the functional capabilities
of all body systems.
Lastly, Grazioli et al. [13] in their study note that loss of
balance and ability to walk are two of the main disorders of
MS, which leads to loss of autonomy, increased perception
of fatigue and severity of the disease in patients. Physical
activity has been shown to improve functional MS
disorders, but there is limited evidence of synergistic
efficacy of exercise training interventions that have both
resistance and aerobic focus in these patients. They assessed
the effect of a combined 12-week training intervention
(resistance and aerobic exercise) on balance, walking
ability, fatigue perception, quality of life and disease
severity in MS patients. Combined training was well
tolerated by patients and improved their quality of life, as
well as was reflected in improved walking and balance and
reduced depression, fatigue and disease severity. The results
of this study confirm the beneficial effects of physical
activity in these patients and support the use of a
combination of resistance training and aerobic exercise to
achieve functional and psychological therapeutic results.
Discussion and Conclusions
The results of this review show that the application of
aerobic exercise can significantly contribute to improving
the functional ability of people with MS. There is evidence
that applying aerobic exercise at least three times a week for
30 minutes for 4-6 months in combination with medication
improves the functioning of these patients [2,5]. Exercise
should be considered a safe and effective means of
rehabilitation in patients with MS. Evidence has shown that
a supervised and personalized exercise program can
improve fitness, function, quality of life and modifiable
disorders in MS patients [8]. There are general guidelines
that can be followed for prescribing exercise in this
population. These guidelines should be tailored to the needs,
abilities and preferences of the patient.
References
1. Oh J, Vidal-Jordana A, Montalban X. Multiple
sclerosis: Clinical aspects. Curr Opin Neurol.
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2. Dustine JL, Moore, Geoffrey E. ACSM’s Exercise
Management for Persons With Chronic Diseases and
Disabilities. 2nd ed. American College of Sports
Medicine 2003.
3. Lennon S, Ramdharry G, Verheyden G. Physical
Management for Neurological Conditions. 4th ed.
Elsevier 2018.
4. Martin, “Tink” S, Kessler M. Neurologic Interventions
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5. Aminoff, Michael J, Greenberg, David A, Simon,
Roger P. Clinical Neurology. 6th ed. McGraw Hill
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D, Sosnoff JJ. Combined training improves walking
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Article
Full-text available
Loss of balance and walking ability are two of the primary impairments in multiple sclerosis (MS), which leads to loss of autonomy, increased fatigue perception, and disease severity in patients. Physical activity has been shown to ameliorate MS functional impairments, but there is limited evidence of synergistic efficacy of exercise training interventions that have both a resistance and aerobic focus in these patients. We evaluated the effect of a 12-wk combined training intervention (resistance and aerobic exercise) on balance, walking ability, fatigue perception, quality of life, and severity of disease in patients with MS. The combined training was well tolerated by the patients and improved the quality of life of the patients as also reflected in the improvement in walking and balance ability as well as reduced depression, fatigue, and severity of disease. The results of this study confirm the beneficial effects of physical activity in patients with MS and support the use of a combination of resistance and aerobic exercise training to achieve functional and psychological therapeutic outcomes.
Article
Full-text available
Background Multiple sclerosis (MS) can result in significant mental and physical symptoms, specially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression. Patients with MS frequently decrease physical activity due to the fear from worsening the symptoms and this can result in reconditioning. Physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental symptoms without any concern about triggering the onset or exacerbation of disease symptoms or relapse. Main body Appropriate exercise can cause noteworthy and important improvements in different areas of cardio respiratory fitness (Aerobic fitness), muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function in MS patients. Aerobic exercise training with low to moderate intensity can result in the improvement of aerobic fitness and reduction of fatigue in MS patients affected by mild or moderate disability. MS patients can positively adapt to resistance training which may result in improved fatigue and ambulation. Flexibility exercises such as stretching the muscles may diminish spasticity and prevent future painful contractions. Balance exercises have beneficial effects on fall rates and better balance. Some general guidelines exist for exercise recommendation in the MS population. The individualized exercise program should be designed to address a patient’s chief complaint, improve strength, endurance, balance, coordination, fatigue and so on. An exercise staircase model has been proposed for exercise prescription and progression for a broad spectrum of MS patients. Conclusion Exercise should be considered as a safe and effective means of rehabilitation in MS patients. Existing evidence shows that a supervised and individualized exercise program may improve fitness, functional capacity and quality of life as well as modifiable impairments in MS patients.
Article
Purpose of review: Multiple sclerosis is a chronic, predominantly immune-mediated disease of the central nervous system, and one of the most common causes of neurological disability in young adults globally. This review will discuss the epidemiology, diagnosis, disease course, and prognosis of multiple sclerosis and will focus on recent evidence and advances in these aspects of the disease. Recent findings: Multiple sclerosis is increasing in incidence and prevalence globally, even in traditionally low-prevalence regions of the world. Recent revisions have been proposed to the existing multiple sclerosis diagnostic criteria, which will facilitate earlier diagnosis and treatment in appropriate patients. Classifying multiple sclerosis into distinct disease phenotypes can be challenging, and recent refinements have been proposed to clarify existing definitions. The prognosis of multiple sclerosis varies substantially across individual patients, and a combination of clinical, imaging, and laboratory markers can be useful in predicting clinical course and optimizing treatment in individual patients. Summary: A number of recent advances have been made in the clinical diagnosis and prognostication of multiple sclerosis patients. Future research will enable the development of more accurate biomarkers of disease categorization and prognosis, which will enable timely personalized treatment in individual multiple sclerosis patients.
Article
The aim of the study is to present a strategy of rehabilitation in multiple sclerosis on the basis of the latest developments in the field of physiotherapy. The publications on the problem discuss a wide range of methods of physiotherapy that can be used in order to reduce the degree of disability and alleviate the symptoms associated with the disease. The complexity of the disease, the difficulty in determining the appropriate treatment and a wide range of symptoms require a comprehensive approach to the patient which would include both pharmacology and neurorehabilitation. Rehabilitation, which includes psychotherapy and symptomatic therapy, is regarded nowadays as the best form of treatment for multiple sclerosis. An in-depth diagnostic assessment of functional status and prognosis should be carried out before the start of the rehabilitation process. The prognosis should take into account the mental state, the neurological status and the awareness of the patient. The kinesiotherapy program in multiple sclerosis is based on a gradation of physiotherapy which assumes a gradual transition from basic movements to more complex ones till global functions are obtained. The most appropriate form of treatment is functional rehabilitation combined with physical procedures. Recent reports indicate the need for aerobic training to be included in the rehabilitation program. The introduction of physical activities, regardless of the severity of the disease, will reduce the negative effects of akinesia, and thus increase the functional capabilities of all body systems.
Article
Introduction: There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment. Objective: To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability. Methods: Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation). Results: Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were included in the final review. Five studies examined conventional exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities including body-weight support treadmill training (BWSTT), total-body recumbent stepper training (TBRST), and electrical stimulation cycling (ESAC). Outcomes related to mobility, fatigue, and quality of life (QOL) were most frequently reported. Two of five studies examining conventional resistance exercise training reported significant improvements in physical fitness, physical function, and/or symptomatic and participatory outcomes. Nine of 13 studies examining adapted exercise training reported significant improvements in disability, physical fitness, physical function, and/or symptomatic and participatory outcomes. Conclusions: There is limited, but promising evidence for the benefits of exercise training in persons with MS with severe mobility disability. Considering the lack of effective therapeutic strategies for managing long-term disability accumulation, exercise training could be considered as an alternative approach. Further research is necessary to optimize the prescription and efficacy of exercise training for adults with MS with severe mobility disability.
Article
Exercise training represents a behavioral approach for safely managing many of the functional, symptomatic, and quality of life consequences of multiple sclerosis (MS). This topical review paper summarizes evidence from literature reviews and meta-analyses, supplemented by recent individual studies, indicating that exercise training can yield small but important improvements in walking, balance, cognition, fatigue, depression, and quality of life in MS. The paper highlights limitations of research on exercise training and its consequences and future research directions and provides an overview for promotion of exercise training in MS based on recent prescriptive guidelines. Collectively, the evidence for the benefits of exercise training in MS suggests that the time is ripe for the promotion of exercise by healthcare providers, particularly neurologists as a central part of the clinical care and management of MS patients.
Article
Objectives: To provide a quantitative synthesis of randomized controlled trials (RCT) examining the effect of exercise training on muscular and cardiorespiratory fitness in persons with MS. Data sources: Three electronic databases, Pubmed, Google Scholar and Web of Science were searched for all relevant articles published up until October 2014. Study selection: Keywords included "exercise" OR "aerobic" OR "strength" OR "resistance training" OR "cardiorespiratory" AND "multiple sclerosis". Trials examining the effect of exercise training on muscular and/or cardiorespiratory fitness parameters were included. Data extraction: The initial search yielded 1501 articles of which 62 were reviewed in detail and 20 RCTs met the inclusion criteria and provided enough data to compute effect sizes (ESs; Cohen d). The meta-analyses was conducted using Comprehensive Meta-Analysis software and a random-effects model was used to compute the overall or mean ES per fitness parameter. Data synthesis: The mean ES was 0.27 (SE=0.05, 95% CI=0.17-0.38, z=5.05, p< .001) for muscular fitness outcomes and 0.47 (SE=0.09, 95% CI=0.30-0.65, z=5.40, p< .001) for cardiorespiratory fitness outcomes. The weighted mean ES was not heterogeneous for muscular (Q=11.09, df=13, p=.60, I(2)=0.00) or cardiorespiratory (Q=7.83, df=9, p=0.55, I(2)=0.00) fitness outcomes. Conclusions: The cumulative evidence supports that exercise training is associated with changes in muscular (small in magnitude) and cardiorespiratory (moderate in magnitude) fitness outcomes in persons with MS. Such an indication of magnitude is important for clinical research and practice by providing an evidence-based estimate of the actual benefit that exercise training confers on physiological fitness.
Article
Objective To provide a quantitative synthesis of randomized controlled trials examining the effect of exercise training on symptomatic fatigue in persons with multiple sclerosis (MS).Methods Electronic databases (Web of Science, PubMed, PsycInfo, and Google Scholar) were searched for articles published between 1960 and October 2012 by using the key words "fatigue," OR "tiredness," OR "energy," OR "mood," OR "lassitude," AND "exercise," OR "physical activity," OR "rehabilitation," OR "fitness" WITH "multiple sclerosis." The initial search resulted in 311 articles, of which 74 were reviewed in detail and 17 met the inclusion criteria and provided enough data to compute effect sizes (ESs; Cohen d). The meta-analysis was conducted using a meta-analysis software program, and a random-effects model was used to calculate the overall ES, expressed as Hedge g.ResultsThe weighted mean ES from 17 randomized controlled trials with 568 participants with MS was 0.45 (standard error = 0.12, 95% confidence interval = 0.22-0.68, z = 3.88, p ≤ .001). The weighted mean ES was slightly heterogeneous (Q = 29.9, df = 16, p = .019).Conclusions The cumulative evidence supports that exercise training is associated with a significant small reduction in fatigue among persons with MS.
Article
The disabling consequences of multiple sclerosis (MS) emphasize the significance of developing physiologically relevant strategies for rehabilitation of function. This pilot study examined changes in walking function associated with combined exercise training consisting of aerobic, resistance, and balance activities in persons with MS who had recent onset of gait impairment. Thirteen participants with significant disability due to MS (Expanded Disability Status Scale range = 4.0-6.0) completed the Multiple Sclerosis Walking Scale-12, 2 trials of the Timed 25-Foot Walk, the Timed Up & Go, and functional ambulation profile score derived from 4 walking trials on an instrumented walkway (GaitRite) before and after an 8-week training period. The training program was designed by a physical therapist and was performed 3 days per week under the supervision of an exercise specialist. In week 1, the session was 15 minutes in duration (ie, 5 minutes of each mode of exercise), session durations were increased by approximately 5 minutes per week up to a maximum of 60 minutes in week 8 (ie, 20 minutes of each mode of exercise). There were significant improvements in Multiple Sclerosis Walking Scale-12 scores (Mpre = 56.0, Mpost = 46.7, P = 0.03, d = 0.56), Timed 25-Foot Walk (Mpre = 11.7, Mpost = 9.8, P = 0.004, d = 0.90) and Timed Up & Go (Mpre = 16.0, Mpost = 13.0, P = 0.01, d = 0.72) performance, and functional ambulation profile score (Mpre = 72.8, Mpost = 77.6, P = 0.02, d = 0.65). These results suggest that a moderately intense, comprehensive, combined exercise training program represents a rehabilitation strategy that is associated with improved walking mobility in a small sample of persons with MS who have recent onset of gait impairment.