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Abstract

For many years, patients with multiple sclerosis (MS) were advised to avoid exercise because of the risk of increased neurological impairment. This article reviews the literature related to MS and physical exercise. Physical exercise depends on patients' physiological tolerance and response to exercise. MS patients can exhibit dysfunction of cardiovascular adjustment accompanied by respiratory involvement, which can alter aerobic capacity. These abnormalities tend to increase with the neurological impairment. Muscle weakness is the consequence of not only altered central motor drive but also disuse. Several studies have shown the benefits of physical training, with improvements in aerobic capacity, gait parameters and fatigue, and an influence on quality of life. Regular aerobic physical activity is necessary to maintain the benefit of physical training.

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... in MS patients – effects on clinical parameters (Table 3) Impairment of MS patients like spasticity or paresis is primarily a consequence of disease progress (morphological changes), but it can be aggravated by reduced physical activity [14,26] . Exercise has been shown to improve various aspects of the physiological profile of MS patients; in particular, inactivity-related impairment can be alleviated by exercise [26]. ...
... in MS patients – effects on clinical parameters (Table 3) Impairment of MS patients like spasticity or paresis is primarily a consequence of disease progress (morphological changes), but it can be aggravated by reduced physical activity [14,26] . Exercise has been shown to improve various aspects of the physiological profile of MS patients; in particular, inactivity-related impairment can be alleviated by exercise [26]. However, recommendations on exercise for patients with MS have to face a number of limitations: Although there is a large number of studies on which recommendations have been based, many of these studies have limitations, including small sample sizes, lack of an appropriate control group, unblinded design, and failure to distinguish between different courses and stages of the disease. ...
... Importantly, it has to be ensured that the patient is not overstrained141516. Compared to healthy people MS patients have a reduced aerobic capacity [14,26,38], decreased muscle strength, retarded rate of muscle tension development, reduced muscle endurance and impaired balance [14,15,36,99100101. A relationship between gait speed and strength parameters has been postulated [102]. ...
Article
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Multiple sclerosis (MS) is the most common chronic inflammatory disorder of the central nervous system (CNS) in young adults. Depending on the underlying pathology, its localization and further characteristics the disease causes a wide spectrum of symptoms and disabilities. Up to date management of MS comprises both drug-based and non-drug approaches complementarily to reduce existing symptoms and to prevent sequelae, such as infections or orthopedic diseases. To improve the individual patient’s outcome substantially, it is necessary to adapt physical therapy like exercise and physiotherapy to the individual needs. However, high quality systematic data on physical therapy in MS, that support this process of customization, are rare. This chapter summarizes the current knowledge on the influence of physical activity and exercise on disease-related symptoms and physical restrictions in MS patients. Drug-based treatment strategies, cognitive training or other treatment strategies are not in the focus of interest in this chapter.
... Patients frequently reduce their activities due to their fear of symptoms exacerbation [13]. Limited activities increase disability,unfitness, mobility, quality of life (QOL),gait abnormalitiesand lack of stability and muscle strenght [14,15]. ...
... Decreased aerobic capacity and cardiorespiratory fitness, in expression of VO 2 maxor maximal oxygen consumption, among MS patients has been about 30% lower than the healthy controls. Respiratory dysfunction due to respiratory muscle weakness and external causes like muscle defect and tiredness are contributing factors in reducing aerobic fitness [14,[16][17][18]. ...
... HRQOL(Health-related quality of life) has diminished in MS patients. The reduced QOL may be related with deterioration of symptoms, walking and cognition in patients [14]. Stuifbergen (2006) studied the positive effects of regular exercises in general health, liveliness and function of patients [43]. ...
Article
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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.
... Low tolerance to exercise has been related to autonomic dysfunction and to reduced CV endurance, 216 especially in PwMS with moderate disability (EDSS > 6). 195 Reduced CV endurance was due to a decrease in the capacity of oxygen transport, 179 and may also be a consequence of decreased function of Resp muscles 195,217 (see Respiratory Dysfunction). Impairment and disability level have been reported as not influencing CV endurance. ...
... 218 Decreased muscle strength was related to muscle atrophy, with a lower number of type I fibers, shifting towards a greater proportion of type IIa and IIax fibers or an increase in the proportion of hybrid fibers 219 and reduced size of all types of fibers, which could be due to disuse, not excluding the possibility of neural lesion as the underlying cause. 217,219 Neural mechanisms could lead to a reduced ability to activate motor units, and to lower motor unit firing rates. 133 Decreased muscle endurance has been closely and positively related to a diminished VO 2 max. ...
... 180 Approximately 80% of PwMS had AD, leading to urinary, defecation, and genital function disorders. 217 Merkelbach and coworkers reported CV AD prevalence between 10% and 50%, and orthostatic intolerance, as much as 50%. 249 Clinical features. ...
Multiple sclerosis (MS) is a chronic, central nervous system, disabling disease. International Classification of Functioning and relevant generic and specific outcome measures are reported. Problems perceived by people with MS (PwMS) affect mobility, sight, continence, feeding, or cognitive impairment, depending on whether acute, chronic, or long-term disability was involved. The most common body function and structure impairments leading to disability and reported by health care professionals are fatigue, weakness, decreased fitness, sensory disorders, pain, upper motor neuron syndromes, ataxia and tremor, balance and postural control problems, gait pattern disorders, visual problems, and neurogenic lower urinary tract and bowel dysfunction; sexual, autonomic, neuropsychological, and neuropsychiatric impairment; dysarthrophonia, dysphagia, and respiratory and sleep disorders. The most frequently affected activities and relationships include mobility, domestic life, community and social activities, remunerative employment, interpersonal relationships, self-care, learning and applying knowledge, and economic life. Limitations in activities of daily life because of fatigue, pain, visual problems, incontinence, sexual and cognitive impairment, depressive disorders, sleep disorders, economic pressure, employment status, and lack of information have an impact on quality of life (QoL). Increased caregiving tasks, psychological burden, limitation in activities and participation, and reduced QoL have a profound influence on caregivers. This paper summarizes the perception of problems and needs, the disease's impact on functioning and QoL of PwMS, and the impact on their significant others and caregivers, according to health and social research.
... For many PwMS fatigue is a major debilitating symptom and they may feel they need to conserve energy. Conversely, a lack of PA, or inactivity, may contribute to an increased risk of comorbidities or obesity which are known to negatively affect disease progression in MS [9] and may also lead to deconditioning and muscle weakness [10]. Furthermore, PwMS generally have lower levels of quality of life (QOL) compared to the general population [11], and although the evidence is inconclusive [12,13], several studies have reported beneficial effects of PA on QOL in PwMS [14][15][16]. ...
... PwMS generally have lower rates of PA compared to the general population [7,48], even those with mild disability, [49] although evidence is emerging that PA is beneficial for PwMS regardless of level of disability [38,50]. Several RCTs have found PA to favorably affect level of disability [12,51], and a lack of PA may also negatively affect disease progression and characteristics in PwMS [9,10]. The current study design does not allow separating the effects that PA and disability have on each other but future longitudinal data of this cohort may provide further insights. ...
Article
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Background Multiple Sclerosis (MS) is a common neurodegenerative disease, which often has a devastating effect on physical and emotional wellbeing of people with MS (PwMS). Several studies have shown positive effects of physical activity (PA) on disability, health related quality of life (HRQOL), and other outcomes. However, many studies include only people with mild disability making it difficult to generalize findings to those with moderate or severe disability. This study investigated the associations between PA and HRQOL, relapse rate (RR), disability, and demographic variables in PwMS with varying disability. Methods Through online platforms this large international survey recruited 2232 participants with MS who completed items regarding PA, MS and other health characteristics. Results PwMS who were younger (p < .001), male (p = 0.006), and with lower body mass index (BMI) (p < .001) undertook more PA, which was associated with decreased disability (p < 0.001) and increased HRQOL measures (all p < 0.001). For the subsample of people with relapsing-remitting MS, PA was associated with a decreased RR (p = 0.009). Regression analyses showed that increased PA predicted clinically significant improvements in HRQOL while controlling for level of disability, age and gender. More specifically, increasing from low to moderate and to high PA increased estimated mean physical health composite from 47.7 to 56.0 to 59.9 respectively (25.6% change), mental health composite from 60.6 to 67.0 to 68.8 (13.5% change), energy subscale from 35.9 to 44.5 to 49.8 (38.7% change), social function subscale from 57.8 to 66.1 to 68.4 (18.3% change), and overall QOL subscale from 58.5 to 64.5 to 67.7 (15.7% change). Conclusions For PwMS, regardless of disability level, increased PA is related to better HRQOL in terms of energy, social functioning, mental and physical health. These are important findings that should be taken into consideration by clinicians treating PwMS.
... Keeping patients active increases their quality of life 26 and benefits them in the long term by keeping them in better physical shape and preserving muscle strength and flexibility. [27][28][29][30] In combination with traditional treatment strategies, preventative lifestyle changes will likely ease the management of the disease, better the long-term prognosis, and decrease the number of injuries which could occur in MS patients. ...
... Supervised exercise programs may help reduce injury rates and enhance quality of life. [26][27][28][29][30] A Cochrane Database review published in 2005 indicated that exercise therapy in MS patients could improve stamina, muscle strength, overall mobility, and potentially mood in some cases. In addition, the Cochrane review found no negative effects of exercise on MS patients. ...
Article
Background Because of the high degree of disability in multiple sclerosis (MS) patients, minimizing injury occurrence is essential for preserving quality of life. Objectives By documenting the incidence of particular injuries, establishing relative risks of particular injuries in different subsets of MS patients and analyzing when the injuries occurred following diagnosis, we aim to provide information to encourage injury prevention recommendations and to provide preliminary data for further clinical research. Methods This study utilized a questionnaire consisting of 40 fill-in-the-blank or multiple choice questions. It was administered to previously diagnosed MS patients at office visits, infusion center visits, hospital stays, MS clinic visits and MS support groups. Results The years following definite MS diagnosis with the highest injury rates (injuries/people years lived) were 25 years or more (.0594 injuries/year, 95% CI [0.0771 - 0.0449]). In addition, people below the age of 40 have nearly a doubled risk of injury compared to people above the age of 40 (p= .033). Primary progressive MS patients had the greatest past incidence of fractures, 55.6% (5/9) (p=0.033). Patients reported that only 17.4% (19/109) of injuries occurred during exercise. Conclusions Overall, risk factors for injury include male gender, living longer with MS, being younger and having the diagnosis of primary progressive MS. Patient education, along with specific treatments and regimented physical activity, can lead to a more robust and injury free lifestyle in this patient population.
... It was found that, using validated self-report measures, the meditation group had significant improvements in QOL and significantly lower rates of fatigue (MFIS), depression (CES-D), and anxiety (STAI) when compared to the control group [29] after intervention and at a six-month followup . This trial was soundly constructed and provides reliable evidence that meditation may have a beneficial effect on QOL and mental health-related comorbidities [43]. The major limitation of the study was the lack of a sham control group, which meant that the " self-efficacy effect " may have influenced the results [44]. ...
Article
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Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.
... The comparison of MVC and muscle recovery between those with CFS and those with MS is innovative to our knowledge and reveals the interesting finding that despite similar activity patterns, CFS patients were weaker and recovered slower. Given the etiology of MS, weakness is common and is the consequence of altered central motor drive, atrophy exceeding that observed with short-term disuse and approaching that reported in spinal cord injury, fewer type I fibers, smaller fibers of all types with reduced enzyme activity, etc. (for review, see [48]). Nevertheless, CFS patients exhibited lower isometric muscle strength and slower recovery, although the pattern of recovery was equal in all groups. ...
Article
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The current study had two objectives. (1) to compare objective and self-report measures in patients with chronic fatigue syndrome (CFS) according to the 1994 Center for Disease Control (CDC) criteria, patients with multiple sclerosis (MS), and healthy controls, and (2) to contrast CFS patients who only fulfill CDC criteria to those who also fulfill the criteria for myalgic encephalomyelitis (ME), the 2003 Canadian criteria for ME/CFS, or the comorbid diagnosis of fibromyalgia (FM). One hundred six participants (48 CFS patients diagnosed following the 1994 CDC criteria, 19 MS patients, and 39 healthy controls) completed questionnaires assessing symptom severity, quality of life, daily functioning, and psychological factors. Objective measures consisted of activity monitoring, evaluation of maximal voluntary contraction and muscle recovery, and cognitive performance. CFS patients were screened whether they also fulfilled ME criteria, the Canadian criteria, and the diagnosis of FM. CFS patients scored higher on symptom severity, lower on quality of life, and higher on depression and kinesiophobia and worse on MVC, muscle recovery, and cognitive performance compared to the MS patients and the healthy subjects. Daily activity levels were also lower compared to healthy subjects. Only one difference was found between those fulfilling the ME criteria and those who did not regarding the degree of kinesiophobia (lower in ME), while comorbidity for FM significantly increased the symptom burden. CFS patients report more severe symptoms and are more disabled compared to MS patients and healthy controls. Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients.
... Troubles de l'adaptation à l'effort [32][33][34][35] Différentes études ont montré une capacité aérobie plus faible chez les sujets atteints de SEP avec une consommation maximale d'oxygène (VO2 max), diminuée lors des épreuves d'effort, en lien pour partie à des facteurs périphériques comme la faiblesse musculaire ou la fatigue. Une atteinte pulmonaire peut altérer l'adaptation à l'effort en rapport avec une altération de la commande des muscles respiratoires. ...
... In fact, 64 % of patients referred some differences in PA practice after the disease diagnosis, in particular because of less physical resistance, mood disorders and MS treatments. It is noteworthy that MS patients could have reduced walking resistance and a weak cardiorespiratory function, secondary to deconditioning, cardiovascular autonomic dysfunctions and altered respiration control [20]. The great energetic consumption during walking is responsible for general and local leg fatigability. ...
Article
Multiple sclerosis (MS) is a long-lasting neurological disease with onset in young adult age. Patients with MS are less active than healthy people, and their sedentary lifestyle might lead to secondary diseases or worsening of symptoms, disability and quality of life. In the study, we evaluated the attitude of physical activity (PA) of a group of MS patients and the differences in practice PA before and after the diagnosis. A randomly recruited group of patients with MS fulfilled a questionnaire about their attitudes towards PA before the onset and after the diagnosis of the disease. Clinical and demographic data were recorded. Out of 118 patients, 37 % practiced PA only before the diagnosis, 9 % only after and 52 % during both periods. After the diagnosis, 64 % of participants noted some negative differences in PA, in particular less physical resistance and worsening of symptoms, and 38 % stopped PA. However, patients referred benefits from PA after diagnosis. Individual exercises rather than group activities were preferred after diagnosis. Only 26 % of patients knew that adapted PA existed and the differences between adapted PA and classic physiotherapy. We observed a reduction in the practice of PA in patients after the diagnosis of MS, in particular for disease-related reasons. Nevertheless, active patients referred benefits from PA. It is important to know the point of view of patients towards developing individualized training programs. In this way, it could be possible to achieve more benefits from PA and reduce the negative effects.
... One concern with training muscles in MS was the possi- bility that the weak and diseased muscles may not be able to adapt to training stimuli and that training exercises might increase weakness and fatigue [89]. However, during recent years, it has been increasingly acknowledged that exercise benefits MS patients [89,90]. In general, the res- piratory muscles can be trained for strength or endurance, with the training outcome being related to the training regimen [91e93]. ...
... It is frequently stated in the literature that the VO 2max is impaired in PwMS [3,64], despite no studies summarizing the existing knowledge. The cross-sectional results of the present review, covering VO 2max measurements from 40 studies on PwMS, reveal that healthy controls achieve significantly higher VO 2max values compared with PwMS. ...
Article
Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS. The objectives of this study were to (1) systematically review the psychometric properties of the VO2max test; (2) systematically review the literature on VO2max compared with healthy populations; (3) summarize correlates of VO2max; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO2max in PwMS. A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity (VO2max) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. The psychometric properties of the VO2max test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO2max. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO2max testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having low-to-mild disability, and an ∼10 % change between two tests performed on separate days can be considered the smallest reliable change (with 95 % certainty) in VO2max in PwMS. The average body-weight-adjusted VO2max was significantly lower in PwMS (25.5 ± 5.2 mL·kg(-1)·min(-1)) compared with healthy controls (30.9 ± 5.4 mL·kg(-1)·min(-1)). The analysis of VO2max correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO2max by as much as 3.5 mL·kg(-1)·min(-1). A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits.
... Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease and is associated with reduced physical capacity and quality of life (Qol) [1,2]. Today, it is known that physical exercise does not lead to relapse or a faster progression of the disease but decreases fatigue and improves fitness, Qol [3][4][5][6][7][8], and walking ability in particular walking speed and endurance [9]. Despite these facts, patients with MS have been reported to undertake less sporting activity than the normal population [10], resulting in reduced physical capacity [11]. ...
Article
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Background: The aim of this prospective randomized controlled trial was to investigate if a short-term endurance or combined endurance/resistance exercise program was sufficient to improve aerobic capacity and maximum force in adult patients (18-65 years) with multiple sclerosis (MS). Methods: All patients performed a three-month exercise program consisting of two training sessions per week, lasting 40 min each, with moderate intensity. All patients had a maximum value of 6 (low to moderate disability) on the Expanded Disability Status Scale (EDSS). One group (combined workout group (CWG); 15 females, 4 males) completed a combined endurance/resistance workout (20 min on a bicycle ergometer, followed by 20 min of resistance training), while the other group (endurance workout group (EWG); 13 females, 5 males) completed a 40 min endurance training program. Aerobic capacity was assessed as peak oxygen uptake, ventilatory anaerobic threshold, and workload expressed as Watts. Maximum force of knee and shoulder extensors and flexors was measured using isokinetic testing. Quality of life was assessed with the SF-36 questionnaire, and fatigue was measured using the Modified Fatigue Impact Scale. Results: Both training groups increased in aerobic capacity and maximum force. EWG, as well as CWG, showed improvement in several subscales of the SF-36 questionnaire and decrease of their fatigue. Conclusion: A short exercise intervention increased both aerobic capacity and maximum force independent of whether endurance or combined endurance/resistance workouts were performed.
... However, there is now strong evidence indicating that exercise does not cause prolonged or permanent worsening of MS symptoms. 24 On the contrary, exercise can often result in improvements in a range of MS symptoms, 1,25 and no adverse effects of strength exercise in the MS population have been documented in the literature. ...
Research
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Evidence based review of strength and cardiovascular deficits experienced by people with MS and the associated assessment and treatment strategies.
... There is a low confirmation for the efficacy of person therapeutic agents [112,113]. The exercise and psychology therapy gave good results in MS patients [114,115], and psychology therapy specially is effective in this matter [116]. ...
Article
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Multiple sclerosis (MS) is the most famous autoimmune disease attacking the central nervous system. It attacks people from age 20–50 years old and the females' attacks double than males' attacks. MS is an autoimmune disease affecting principally the central nervous system that cause nerve sheath demyelination followed by axon damage and paralysis. MS symptoms include muscle weakness, weak reflexes, muscle spasm, difficult in move, miss-coordination and unbalance with others. There are many factors may be responsible for MS: microbial, viral, smoking, stress, environmental toxins, contaminated diet, and gout. MS is wide spread in the populations in North Europe and this related to lack of vitamin D due to decrease of sunlight exposure. MS biomarkers include nitric oxide, interleukin-6, nitric oxide synthase, fetuin-A and osteopontin. MS is not a genetic disease where MS occurs when human leukocyte antigen system related genes are changed in chromosome 6. The physiology of MS is monitored by activation of immune-inflammatory, oxidative, and nitrosative stress pathways. MS is including two main steps: (1) myelin sheath destruction and formation of lesions and, (2) inflammation. Four types of MS can be distinguished: relapsing-remitting, primary progressive, secondary progressive and progressive relapsing. Nine treatments have been accepted for relapsing-remitting MS type: interferon β-1a, interferon β-1b, mitoxantrone, natalizumab, glatiramer acetate, fingolimod, dimethyl fumarate, teriflunomide, and alemtuzumab, however, the only treatment used is mitoxantrone for progressive MS but many of MS treatments side effects are recorded. Complementary treatments also used in MS treatments such as: vitamin D, Yoga, medicinal plants, oxygen therapy, acupuncture and reflexology.
... Regular exercise and physical activity are decisive factors in a person's quality of life by sustainably improving health and well-being and preventing diseases at all stages of life. Exercise has been shown to improve various aspects of the physiological profile of MS patients; in particular, inactivity-related impairment can be alleviated by exercise [16]. ...
Article
Backround: The aim of our study is to examine effects of aerobic and Pilates exercises on disability, cognition, physical performance, balance, depression and fatigue in relapsing-remitting Multiple Sclerosis (MS) patients as compared to healthy controls. Methods: The subjects were divided as aerobic exercise (n = 26), Pilates (n = 9), and the healthy control group (n = 21). We used MSFC, physical performance, Berg balance scale, Beck depression scale, fatique impact scale. All evaluations were performed before and after exercise training. Results: There are statistically meaningful differences between Nine hole testing, PASAT 3, physical performance and fatique impact scale before and after aerobic exercise. Also we found significant difference for physical performance in the Pilates group. There are no significant differences in measures of fatique impact scale and depression between aerobic exercise group and the healthy controls after exercise. We found significant differences between Pilates and control group's after measurements except depression. There were significant differences between the Pilates and aerobic group for cognitive tests in favor of the Pilates group. Conclusion: Aerobic exercise and clinical Pilates exercises revealed moderate changes in levels of cognitive, physical performance, balance, depression, fatigue in MS patients.
... There is little confirmation for the efficacy of these therapeutic agents in MS patient [112,113] . The exercise and psychology therapy gave good results in MS patients [114,115] , and psychology therapy specially is effective in this matter [116] . ...
Article
Full-text available
Multiple sclerosis (MS) is the most famous autoimmune disease attacking the central nervous system. It attacks people from age 20–50 years old and the females' attacks double than males' attacks. MS is an autoimmune disease affecting principally the central nervous system that causes nerve sheath demyelination, followed by axon damage and paralysis. MS symptoms include muscle weakness, weak reflexes, muscle spasm, difficulties in movement and unbalance. Many factors may be responsible for MS: microorganism, virus, smoking, stress, environmental toxins, contaminated diet and gout. MS is widely spread in the population in North Europe and this is related to lack of vitamin D due to decrease of sunlight exposure. MS biomarkers include nitric oxide, interleukin-6, nitric oxide synthase, fetuin-A and osteopontin. MS is not a genetic disease (not transferred from parents into next generations) but MS appears when leukocyte antigen system-related genes are changed in human chromosome 6. The physiology of MS patients is controlled by numbers of biological processes such as activation of immune-inflammatory, oxidative and nitrosative stress pathways. MS includes two main steps: (1) myelin sheath destruction and formation of lesions and, (2) inflammation. Four types of MS can be distinguished: relapsing-remitting, primary progressive, secondary progressive and progressive relapsing. Nine treatments have been accepted for relapsing-remitting MS type: interferon β-1a, interferon β-1b, mitoxantrone, natalizumab, glatiramer acetate, fingolimod, dimethyl fumarate, teriflunomide, and alemtuzumab. However, the only treatment used is mitoxantrone for progressive MS with many side effects. Complementary treatments are also used in MS treatments such as vitamin D, Yoga, medicinal plants, oxygen therapy, acupuncture and reflexology.
... The functional symptoms that patients with multiple sclerosis (pwMS) usually present with, along with a usual lower level of physical activity compared to healthy controls [7], contribute to increased disability and poorer quality of life [8,9]. ...
Article
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Background and Objectives: Multiple sclerosis (MS) is a disease that manifests with varied neurological symptoms, including muscle weakness, especially in the lower extremities. Strength exercises play an important role in the rehabilitation and functional maintenance of these patients. The individualized prescription of strength exercises is recommended to be based on the maximum force determined by the one-repetition maximum (1RM), although to save time and because it requires less equipment, it is often determined by the maximum voluntary isometric contraction (MVIC). The purpose of this work was to study, in patients with MS (pwMS), the reliability of MVIC and the correlation between the MVIC and 1RM of the knee extensors and to predict the MVIC-based 1RM. Materials and Methods: A total of 328 pwMS participated. The study of the reliability of MVIC included all pwMS, for which MVIC was determined twice in one session. Their 1RM was also evaluated. The sample was randomized by MS type, sex, and neurological disability score into a training group and a testing group for the analysis of the correlation and prediction of MVIC-based 1RM. Results: MVIC repeatability (ICC, 2.1 = 0.973) was determined, along with a minimum detectable change of 13.2 kg. The correlation between MVIC and 1RM was R2 = 0.804, with a standard error estimate of 12.2 kg. The absolute percentage error of 1RM prediction based on MVIC in the test group was 12.7%, independent of MS type and with no correlation with neurological disability score. Conclusions: In patients with MS, MVIC presents very good intrasubject repeatability, and the difference between two measurements of the same subject must differ by 17% to be considered a true change in MVIC. There is a high correlation between MVIC and 1RM, which allows estimation of 1RM once MVIC is known, with an estimation error of about 12%, regardless of sex or type of MS, and regardless of the degree of neurological disability.
... There are several different physical exercises that can induce a benefit in MS patients. For example, it has been shown as aerobic training protocol, consisting of 3 weekly sessions a cycloergometer, induced a 22% improvement in VO2max (Gallien et al., 2007). In another study it was shown as 8 weeks of aerobic dance, induced an improvement in the lipid profile, particularly on LDL cholesterol reduction and HDL cholesterol increase, in women with relapsingremitting multiple sclerosis (RRMS) (Monazamnezhad et al., 2015). ...
... One of the most commonly used therapies used to treat fatigue is aerobic training. Studies aimed at assessing the effect of applying aerobic exercise to reduce fatigue in MS patients show different results [2,15,[26][27][28]. Rasova et al. [15] pointed to the positive impact of training on fatigue perceived by MFIS among patients enrolled with disability at EDSS £6.5. ...
Article
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Background The objective of this study was to evaluate the effect of a rehabilitation program in changing the perception of fatigue in patients with multiple sclerosis. Material/Methods The study involved 65 respondents/patients with clinically confirmed multiple sclerosis (54 women, 11 men, average age 46.49 years). The evaluation of the effects of fatigue on the physical, psychological, and psychosocial aspects of life was assessed using the Modified Fatigue Impact Scale (MFIS). To test the effectiveness of the neurorehabilitation program, we enrolled 2 groups: the experimental group (EG, n=32, 29 women, 3 men, Expanded Disability Status Scale (EDSS) 4.8 average, SD±1.77, min. 1.5 max 8.0) participated in the intervention and rehabilitation program over a period of 12 weeks and the control group (CG, n=33, 25 women, 8 men. EDSS average 5.12±1.74 SD, min. 2.0 max. 8.0). Each group of patients was divided into 3 sub-groups according to the severity of EDSS: a) 1–3.5, b) 4–6, and c) 6.5–8. For the statistical evaluation of the significance of the observed changes, the MANOVA/ANOVA model was used. Results Between the input and output assessment of the MFIS individual areas questionnaire between the EG and the CG, there existed a statistically significant in the physical area (p<0.000), psychological area (p<0.000), and psychosocial area (p=0.002). Conclusions Our results support the importance of an active approach in patients with multiple sclerosis using individualized rehabilitation intervention programs.
... Limited PAs may be detrimental to disability progression, mobility, quality of life, gait performances, stability, and muscle strength [55,56]. Instead, exercise therapy has proven to improve motor impairment [57] and has positive influence on symptoms management through beneficial effects on fatigue, spasticity, mobility, depression, and pain [58]. ...
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Multiple sclerosis (MS) is the most common neurological disorder in young adults. The prevalence of walking impairment in people with MS (pwMS) is estimated between 41% and 75%. To evaluate the walking capacity in pwMS, the patient reported outcomes (PROs) and performance-based tests (i.e., the 2-minute walk test, the 6-minute walk test, the Timed 25-Foot Walk Test, the Timed Up and Go Test, and the Six Spot Step Test) could be used. However, some studies point out that the results of both performance-based tests and objective measures (i.e., by accelerometer) could not reflect patient reports of walking performance and impact of MS on daily life. This review analyses different motion sensors embedded in smartphones and motion wearable device (MWD) that can be useful to measure free-living walking behavior, to evaluate falls, fatigue, sedentary lifestyle, exercise, and quality of sleep in everyday life of pwMS. Caveats and limitations of MWD such as variable accuracy, user adherence, power consumption and recharging, noise susceptibility, and data management are discussed as well.
... Having a chronic systemic disease like MS may lead to muscle inactivity. Additionally, accompanying cardiovascular and pulmonary dysfunctions, systemic inflammation triggering hypoxia and oxidative stress and drugs such as corticosteroids may contribute to muscle disuse (6). ...
... Received 5 January 2018; Received in revised form 4 October 2018; Accepted 12 November 2018 patients experience e.g. muscle weakness and atrophy, could be considered as a consequence of inactivity and not a result of the disease per se (Dalgas, Stenager, & Ingemann-Hansen, 2008), it has been demonstrated that exercise can reduce inactivity-related impairments (Gallien et al., 2007). Therefore, it seems logical to speculate that exercise may induce clinically significant improvements in MS patients as well as benefits in their quality of life. ...
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Patients with multiple sclerosis experience many complications that gradually lead them to comorbidity and disability. Exercise could prevent and ameliorate the symptoms that comorbidity or inactivity generate. However, until recently it was suggested that multiple sclerosis patients should not participate in exercise training programs because these patients are characterized by thermoregulatory failure and the heat stress due to physical work could exacerbate the disease symptoms. Furthermore, taken into account that 60–80% of the multiple sclerosis patients present adverse clinical symptoms when their body temperature is increased (not only due to physical working but even when immerse in hot water or by exposure to infrared lamps or to the sun), the need for the development of treatment strategies to overcome the thermoregulatory problem in these patients is crucial. Given that pre-cooling has been proposed as an effective method, the aim of this systematic review is to discuss the current knowledge for the effects of cooling therapy on the functional capacity of multiple sclerosis patients. The relevant literature includes many articles, but only a handful of studies published thus far have used a cooling intervention in multiple sclerosis patients and have examined the effects of pre-cooling on functional capacity. These studies used active cooling methods, namely garments or other material that are cooled by circulating liquid through a tube, as well as passive, cooling methods. Passive cooling methods include passive cooling garments or other material namely garments that have ice or gel packs inside them. Overall, the results of all the studies analysed in this review demonstrated that pre-cooling therapy can prevent the symptom worsening due to increased body temperature in multiple sclerosis patients without causing adverse effects. Therefore, such strategies could serve as a complimentary therapeutic approach in multiple sclerosis patients.
... 20,23,25,30,45,47,[49][50][51][52][53] In general, individuals with MS exhibit lower V_O 2peak and V_O 2max compared with the general population. 74 Previous studies suggest that these lower values are mainly due to the decreased level of daily activity 75 and not necessarily caused by a problem at the physiological level. Therefore, Feltham et al 16 affirm that adaptations at the cardiovascular level in patients with MS are similar to the healthy population. ...
Article
The study was preregistered in the International Prospective Register of Systematic Review (PROSPERO) with the following registration number: CRD42020199266. Objectives To evaluate the benefits of aerobic training (AT) programs on cardiorespiratory fitness, functional capacity, balance, and fatigue in people with MS and to identify the most optimal dosage of AT programs for people with MS via a systematic review with meta-analysis. Data sources Two electronic databases were searched until March 2020 (PubMed-Medline and Web of Science). Study selection Studies examining the effect of AT program on cardiorespiratory fitness, functional capacity, balance, and fatigue were included. Data extraction After applying the inclusion and exclusion criteria, 43 studies were included. A total sample of 1070 people with MS [n=680 AT group; n=390 control group (CG)] were analyzed. Data synthesis AT group shows a significant increase in cardiorespiratory fitness [Standardized Mean Difference (SMD)=0.29, p=0.002], functional capacity (Timed Up and Go Test: SMD=-1.14, p<0.001; gait speed: SMD=-1.19, p<0.001 and walking endurance: SMD=0.46, p<0.001), and balance (SMD=3.49, p<0.001) after training. The fatigue perception also decreased (SMD=-0.45, p<0.001). However, no significant differences were observed when compared to the CG in either cardiorespiratory fitness (0.14, p=0.19) or fatigue perception. Nevertheless, significant differences between AT group and CG were observed in balance (p=0.02), gait speed (p=0.02) and walking endurance (p=0.03), favouring the participants who performed AT. Regarding the subgroup analysis, no significant differences were observed between subgroups in any of the variables studied except for gait speed, in which a greater increase in post-training was observed when AT program applied the continuous method (χ2=7.75, p=0.005) and the exercises were performed by walking (χ2=9.36, p=0.002). Conclusions Aerobic training improves gait speed, walking endurance and balance. Cardiorespiratory fitness and fatigue perception also improved after AT, but no differences were found with CG. In addition, subgroup analysis suggested that training using continuous and walking methods could optimize gait speed.
... There are several different physical exercises that can induce a benefit in MS patients. For example, it has been shown as aerobic training protocol, consisting of 3 weekly sessions a cycloergometer, induced a 22% improvement in VO2max (Gallien et al., 2007). In another study it was shown as 8 weeks of aerobic dance, induced an improvement in the lipid profile, particularly on LDL cholesterol reduction and HDL cholesterol increase, in women with relapsingremitting multiple sclerosis (RRMS) (Monazamnezhad et al., 2015). ...
Article
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RESUMEN Introducción: Un estilo de vida poco saludable tendría influencia negativa en la evolución de la esclerosis múltiple (EM). La pandemia de Covid-19 ha producido cambios que podrían haber modificado el mismo. Los objetivos fueron evaluar aspectos del estilo de vida de personas con EM (pcEM) integrantes de una asociación de pacientes de Argentina, previo y durante la pandemia, las causas de éste y si recibieron consejos médicos sobre el tema. Sujetos y métodos: Estudio observacional, pcEM fueron convocadas a través de una asociación de pacientes para responder encuestas on line en noviembre de 2019 y octubre 2020. Se recolectaron datos demográficos, de la enfermedad, talla, peso, tabaquismo, alimentación, actividad física, consumo de alcohol y sobre la atención médica. Resultados: 208 pcEM. Mujeres: 76,4%. 43,76 años (+/- 10,7). Cumple con la actividad física recomendada40,4%, 5 porciones de frutas y verduras diarias 13,9%, tabaquismo 24,5%, consumo de alcohol de riesgo 12,5%, sobrepeso + obesidad 53,4%. En pandemia disminuyó el tabaquismo (24,9% vs 20% p=0.004), aumentó el peso (BMI=26,1 vs 27,4 p=0,001) y disminuyó la actividad física (39,3% vs 31,5% p=0,016). Recibió regularmente consejos sobre ejercicio físico el 54,3%, dieta saludable 32,4%, cesación tabáquica 33,3%. Conclusiones: Un importante porcentaje de las pcEM presentan aspectos del estilo de vida no saludables. En pandemia se observó, aumento de peso, aumento del sedentarismo y disminución del tabaquismo. No se realizaron frecuentemente los consejos sobre estilo de vida. Son necesarios nuevos estudios para evaluar cómo mejorar el estilo de vida y su implicancia en la evolución y la calidad de vida.
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Riassunto La sclerosi multipla è una malattia infiammatoria del sistema nervoso centrale che causa disabilità. Accanto alla gestione neurologica e all’istituzione di trattamenti di fondo, la gestione rieducativa occupa un posto a pieno titolo nella gestione della disabilità, qualunque sia lo stadio della malattia. Tale gestione rieducativa varierà in funzione dello stadio evolutivo, spaziando dall’educazione terapeutica all’attuazione di ausili umani e tecnici, passando per protocolli più attivi, in particolare di rinforzo muscolare e di riallenamento allo sforzo, in funzione dello stadio evolutivo della malattia.
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Abstract This research aims to investigate the direct and indirect effects of physical training on psychological health in a sample of individuals with Multiple Sclerosis (MS). Thirty-five women affected by relapsing-remitting MS, with a mean age of (40 ± 5) years and an Expanded Disability Status Scale (EDSS) score ranging between 0 and 3, participated in the study. After baseline tests, in accordance with pairing techniques, participants were assigned to an experimental (EG) and a control group (CG). The EG attended a 12-week combined aerobic and strength program. Those in the EG and the CG were homogeneous at baseline and were treated similarly except for the intervention. Participants of both groups were tested before and after the intervention with the following instruments: 1. Modified Fatigue Impact Scale (MFIS); 2. Beck Depression Inventory scale (BDI); 3. Multiple Sclerosis Quality of life–54 (MSQOL-54). Data was analyzed with non-parametric tests for unpaired samples, linear regression and mediation analysis. The results showed: (a) the benefits of physical training on the perception of fatigue, depression, social activity and Quality of Life (QoL) in the EG; (b) the role of fatigue as a mediator of the relationship between participation in physical training and depression, social activity and QoL. Findings suggested the effectiveness of a combined aerobic and strength training for the improvement of psychological aspects in women affected by MS and the mediation role of fatigue in such a relationship.
Article
Background: Effective management of multisymptomatic chronic diseases such as multiple sclerosis (MS) requires a multimodal, interdisciplinary approach. At MS clinics, numerous healthcare specialties are coordinated to provide patients with quality clinical care for all aspects of their disease. Settings and resource availability may vary between countries. Four specific specialty services from different EU countries are examined in more detail. Summary: The multidisciplinary neurorehabilitation team in Rennes, France, provides specialized consultations (e.g. spasticity, urodynamic unit, devices), inpatient and outpatient intensive rehabilitation programs and therapeutic education. Management approaches are based on a patient's level of impairment as assessed by the Expanded Disability Status Scale. In Girona, Spain, neuropsychologists perform assessments as part of the neurological protocol for all patients with MS. Depending on the level of impairment and patients' characteristics (e.g. working or not working), cognitive deficits may be treated at home or at a neurorehabilitation center. In Barcelona, Spain, neuro-ophthalmologists are involved in the differential diagnosis and follow-up care of MS patients with visual disturbances; particular attention is given to patients' vision-related quality of life. Pain specialists at the Marianne Strauß Klinik in Berg, Germany, have developed a system for classifying MS pain syndromes and differentiating MS-related pain from non MS-related pain. Chronic pain management involves numerous disciplines and requires active engagement by patients in developing treatment plans. Key Messages: MS affects several body systems and patients invariably require specialized interdisciplinary support. Insight into services provided by various specialties and their fit within multidisciplinary care models at MS centers may facilitate the design or refinement of care models in other locations.
Article
Resumen La esclerosis múltiple es una enfermedad inflamatoria del sistema nervioso central evolutiva responsable de una discapacidad. Junto al tratamiento neurológico y el establecimiento de tratamientos de fondo, la rehabilitación ocupa un lugar esencial en el tratamiento de la discapacidad, sea cual sea el estadio de la enfermedad. Esta rehabilitación es variable en función del estadio evolutivo y va desde la educación terapéutica hasta la puesta en marcha de ayudas humanas y técnicas, pasando por protocolos más activos, en particular de refuerzo muscular y entrenamiento para el esfuerzo, en función del estadio evolutivo de la enfermedad.
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Background At the time of publication of the most recent National Institute for Health and Care Excellence (NICE) guidance [technology appraisal (TA) 32] in 2002 on beta-interferon (IFN-β) and glatiramer acetate (GA) for multiple sclerosis, there was insufficient evidence of their clinical effectiveness and cost-effectiveness. Objectives To undertake (1) systematic reviews of the clinical effectiveness and cost-effectiveness of IFN-β and GA in relapsing–remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and clinically isolated syndrome (CIS) compared with best supportive care (BSC) and each other, investigating annualised relapse rate (ARR) and time to disability progression confirmed at 3 months and 6 months and (2) cost-effectiveness assessments of disease-modifying therapies (DMTs) for CIS and RRMS compared with BSC and each other. Review methods Searches were undertaken in January and February 2016 in databases including The Cochrane Library, MEDLINE and the Science Citation Index. We limited some database searches to specific start dates based on previous, relevant systematic reviews. Two reviewers screened titles and abstracts with recourse to a third when needed. The Cochrane tool and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Philips checklists were used for appraisal. Narrative synthesis and, when possible, random-effects meta-analysis and network meta-analysis (NMA) were performed. Cost-effectiveness analysis used published literature, findings from the Department of Health’s risk-sharing scheme (RSS) and expert opinion. A de novo economic model was built for CIS. The base case used updated RSS data, a NHS and Personal Social Services perspective, a 50-year time horizon, 2014/15 prices and a discount rate of 3.5%. Outcomes are reported as incremental cost-effectiveness ratios (ICERs). We undertook probabilistic sensitivity analysis. Results In total, 6420 publications were identified, of which 63 relating to 35 randomised controlled trials (RCTs) were included. In total, 86% had a high risk of bias. There was very little difference between drugs in reducing moderate or severe relapse rates in RRMS. All were beneficial compared with BSC, giving a pooled rate ratio of 0.65 [95% confidence interval (CI) 0.56 to 0.76] for ARR and a hazard ratio of 0.70 (95% CI, 0.55 to 0.87) for time to disability progression confirmed at 3 months. NMA suggested that 20 mg of GA given subcutaneously had the highest probability of being the best at reducing ARR. Three separate cost-effectiveness searches identified > 2500 publications, with 26 included studies informing the narrative synthesis and model inputs. In the base case using a modified RSS the mean incremental cost was £31,900 for pooled DMTs compared with BSC and the mean incremental quality-adjusted life-years (QALYs) were 0.943, giving an ICER of £33,800 per QALY gained for people with RRMS. In probabilistic sensitivity analysis the ICER was £34,000 per QALY gained. In sensitivity analysis, using the assessment group inputs gave an ICER of £12,800 per QALY gained for pooled DMTs compared with BSC. Pegylated IFN-β-1 (125 µg) was the most cost-effective option of the individual DMTs compared with BSC (ICER £7000 per QALY gained); GA (20 mg) was the most cost-effective treatment for CIS (ICER £16,500 per QALY gained). Limitations Although we built a de novo model for CIS that incorporated evidence from our systematic review of clinical effectiveness, our findings relied on a population diagnosed with CIS before implementation of the revised 2010 McDonald criteria. Conclusions DMTs were clinically effective for RRMS and CIS but cost-effective only for CIS. Both RCT evidence and RSS data are at high risk of bias. Research priorities include comparative studies with longer follow-up and systematic review and meta-synthesis of qualitative studies. Study registration This study is registered as PROSPERO CRD42016043278. Funding The National Institute for Health Research Health Technology Assessment programme.
Article
Riassunto L’implementazione di un programma di riallenamento allo sforzo e, più specificamente, di allenamento di resistenza è un elemento chiave nella gestione della riabilitazione dei pazienti affetti da sclerosi multipla. Una prova da sforzo permette di determinare le capacità cardiorespiratorie dei pazienti per personalizzare il programma di riallenamento allo sforzo. I programmi di riallenamento allo sforzo continui sono pianificati a un’intensità del 50-70% della potenza aerobica massima per 30 minuti. In assenza di una prova da sforzo, sono proposti sulla base di una frequenza cardiaca bersaglio calcolata a partire dalla frequenza cardiaca massimale teorica o sulla scala di percezione dello sforzo di Borg. Accanto ai programmi continui, stanno emergendo programmi intermittenti e combinati, senza che, attualmente, esistano raccomandazioni. Le modalità di riallenamento allo sforzo sono personalizzate, adattate alle capacità fisiche del paziente. I benefici del riallenamento allo sforzo sono molteplici: miglioramento delle capacità cardiorespiratorie, della forza, della deambulazione e della riduzione della fatica e miglioramento della qualità di vita. Questo articolo precisa gli effetti del riallenamento allo sforzo e definisce le modalità di questi programmi, per consentirne l’implementazione nella gestione rieducativa dei pazienti affetti da sclerosi multipla, in un centro di rieducazione o in studio privato.
Article
Resumen La implementación de programas de readaptación al esfuerzo, y más específicamente el entrenamiento de resistencia, es un elemento clave en el tratamiento rehabilitador de los pacientes con esclerosis múltiple. Se efectúa una prueba de esfuerzo para determinar la capacidad cardiorrespiratoria del paciente con el fin de personalizar el programa de readaptación al esfuerzo. Los programas de readaptación al esfuerzo continuos están programados al 50-70% de la potencia máxima aeróbica durante 30 minutos. A falta de una prueba de esfuerzo, se proponen basándose en una frecuencia cardíaca objetivo calculada a partir de la frecuencia cardíaca máxima teórica o en la escala de percepción subjetiva del esfuerzo de Borg. Además de los programas continuos, están surgiendo programas intermitentes y combinados sin recomendaciones actuales. Las modalidades de readaptación al esfuerzo son personalizadas, adaptadas a las capacidades físicas del paciente. Los beneficios de la readaptación al esfuerzo son múltiples: mejora de la capacidad cardiorrespiratoria, de la fuerza, de la marcha, reducción de la fatiga y mejora de la calidad de vida. En este artículo se especifican los efectos de la readaptación al esfuerzo y se definen las modalidades de estos programas, para que puedan utilizarse en la rehabilitación y readaptación de pacientes con esclerosis múltiple, en centros de rehabilitación o en consultorios privados.
Article
This study aims to investigate the effects of a physical exercise programme on psychological health of subjects with Multiple Sclerosis (MS), analysing the direct effects of physical exercise on quality of life (QoL) and on depression, and the moderating effects of the disability level in the relationship between physical training and psychological variables. Thirty-one women affected by relapsing-remitting MS, with a mean age of 40 years (SD=5; min=22; max=50) and a level of disability measured by the Expanded Disability Status Scale (EDSS) of 2.0, were involved in the study. The study’s participants were assigned, according to pairing techniques, to an experimental (EG), or a control group (CG), homogeneous at the baseline for interesting variables. The EG attended a physical training programme for 12 weeks, twice a week, based on aerobic and strength exercise; while, the CG maintained the normal routine. The physical training showed positive effects on depression (β=-.77, p<.0001) and QoL (β=.65, p<.0001). The disability level resulted as the moderator of relationship between the participation to physical exercise and the psychological variables.
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The aim of the present study was to investigate the effect of ten-week combined training on stable and unstable surfaces on muscle strength and functional capacity in patients with multiple sclerosis. 30 patients were divided into two exercise groups and a control group. The results showed that there were significant improvements for all outcome measures in both exercise groups. Exercise group in unstable surface showed significantly larger improvement in muscle strength and 5-time sit-to-stand test and Stair- climbing test than exercise group in stable surface and control group. According to research findings, exercise in stable and unstable surfaces resulted in considerable improvements in isometric muscle strength and functional capacity in patients with multiple sclerosis.
Article
Introduction Disturbances associated with Multiple Sclerosis (MS) can be due to the pathologic process of the disease or insufficient physical fitness. The benefits of exercise in improving cardiopulmonary fitness have been demonstrated in animal studies and also clinical trials on cardiovascular patients and healthy human cases; however, its effectiveness in people with MS(pwMS) is still unknown. people with MS often engage in rehabilitation programs for exercise tolerance improvement. Therefore, it is necessary to investigate the effect of this specific intervention on cardiopulmonary fitness of these patients. The present study intended to illustrate the etiology of exercise intolerance in pwMS and also the effects of exercise on these etiological factors. Methods and Results The present interventional study included 21 female patients suffering from Relapsing-Remitting MS (RR-MS) who had a mean age of 35±5.18 years and the Expanded Disability Status Scale (EDSS) scores of 1 to 4. All the participants underwent Cardiopulmonary Exercise Testing (CPET) on an ergometer pre- and post-intervention. The intervention included 18 sessions of endurance training using a stationary bicycle with an intensity of 70% of the peak Heart Rate (HR) or 60% of the peak VO2 (Volume of oxygen consumption) under the supervision and cardiac monitoring. A total of 24 variables, including the parameters cardiopulmonary fitness (aerobic fitness), were investigated. Also, all the maximal variables were analyzed in the same RER(Respiratory Exchange Ration) (a mean RER of 0.92) pre- and post-intervention. According to the results, a total of 17 variables out of 24 study variables had significant changes (P<0.05). Conclusion The present study showed that even a short, 6-week course of aerobic exercise could change the peak HR and VO2, improving the cardio pulmonary fitness in these patients. This indicates the adaptation of the cardiopulmonary system to exercise in pwMS. In other words, these cardiopulmonary fitness variables improvement due to exercise demonstrates that this pathology is not merely caused by the MS-induced Central Nervous System (CNS) involvement and can be improved by improving cardiopulmonary fitness.
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Background: Multiple sclerosis is a disease of the central nervous system (CNS) that results in many symptoms, including balance deficits, mobility limitation, spasticity, fatigue and an impaired quality of life. Type of study: A controlled study. Methods: A sample of 20 MS patients (mean of age of 36.75 years) with Expanded Disability Status Scale scores (EDSS) of 1.0 to 4.0, were randomly assigned to an exercise training group and control group, respectively. The intervention consisted of 8 weeks (24 sessions) of treadmill training (30 minutes), at 40 - 75% of age-predicted maximum heart rate for the training group. The control group followed their own routine treatment programme. Balance, speed and endurance of walking, quality of life and fatigue were measured by Berg Balance scores, time for 10m walking and distance in 2min walking, Fatigue Severity Scale (FFS), and Multiple Sclerosis Quality of Life-54 questionnaire (MSQOL-54) were conducted. Results: Comparison of results indicated that pre- and post intervention produced significant improvements on the balance score (p= 0.001), 10m times (p= 0.001), walking endurance (p= 0.007), and FFS (p= 0.04) and some of MSQOL-54 scale scores (physical function, pain, energy, health perception and physical health) in the training group. No changes were observed for the control group regarding the balance score, the 10m timed walk, fatigue, and none of MSQOL-54 scale scores, but there was a significant decrease in the 2min distance (p=0.015) in this group. Conclusion: These results suggest that treadmill training improved balance and walking capacity, fatigue and quality of life in people with mild to moderate MS.
Article
Muscle weakness is a main factor of neurological impairment in several diseases such as multiple sclerosis, cerebral palsy and stroke patients. Several studies have stressed that, in such a situation, muscle strength training results in functional improvement. Reliable and reproducible, isokinetic evaluation can quantify a motor deficit and guide the muscle groups through strength training. When the quadriceps suffer a level of decifiect, which causes one to reduce the speed at which they walk, as aresult the hamstring muscles will weaken causing a greater disability. Isokinetic strengthening of the muscle groups with no consequence on spasticity, provides significant functional results. In multiple sclerosis, regular muscule strengthening allows the patient to maintain or even improve functional levels, making isokinetic strengthening relevant. After an isokinetic evaluation, the patient's deficits are taken into consideration and a protocol of rehabilitation, which usually includes strength training, is defined. Three protocols are identified. The first one involves the recurvatum of the knee, the second involves strengthening the quad-riceps and the third focuses on hip flexors. This type of isokinetic training, which is associated with a standard multidisciplinary approach, possesses an important functional interest including: transfer, climb and descent of staircases, and improving gait (speed, quality and endurance). However, due to the evolution of the disease, regular follow-up visits are important and necessary.
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This study was designed to 1) determine whether isokinetic dynamometry is appropriate and safe for ambulatory patients with multiple sclerosis and 2) describe the idiosyncrasies the patients with multiple sclerosis exhibited during testing. Ten patients with multiple sclerosis and 20 healthy subjects were matched for age, sex, and weight. The isokinetic peak torque and endurance measurements of knee extensor and knee flexor muscles were recorded at selected angular velocities ranging from 0 to 275 degrees/sec and extensor:flexor muscle strength ratios were calculated. Statistical analysis (t tests) revealed that both the extensor and flexor muscle peak torque values for patients with multiple sclerosis were significantly lower than those for healthy subjects at all angular velocities (p less than .005 to p less than .001), and yet were similar in shape and slope. Mean extensor:flexor ratios for healthy subjects and for patients with multiple sclerosis were not significantly different at 70, 190, and 230 degrees/sec. Individual chart recordings identified any contractile difficulties or increased contraction time. Isokinetic testing is judged to be a safe and reliable form of objective neuromuscular testing for ambulatory patients with multiple sclerosis.
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Patients with multiple sclerosis (MS) show a poor exercise tolerance. A reduction in respiratory muscle strength has also been reported. The purpose of this study was to evaluate whether reduction in exercise tolerance was related to respiratory muscle dysfunction. Twenty four multiple sclerosis patients (mean +/- SD age: 48 +/- 9 yrs, duration of illness 12.2 +/- 6 yrs, severity of illness as assessed by Expanded Disability Scale Score (EDSS) 5.3 +/- 2), underwent detailed evaluation of lung function tests, arterial blood gas analysis, respiratory muscle strength and endurance, and exercise test on an arm ergometer. Sixteen of the 24 patients were able to perform the exercise test (Group I), whilst the other eight were not (group II). Arterial blood gases and lung function tests were normal for both groups. Respiratory muscle strength as assessed both by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was significantly reduced (MIP 18-76 cmH2O; MEP 16-82 cmH2O) compared to predicted values. Inspiratory muscle endurance time was significantly reduced in Group II in comparison to Group I (247 +/- 148 vs 397 +/- 154 s, respectively). Both MIP and MEP were significantly related to inspiratory muscle endurance time. Endurance time, MIP and MEP were inversely significantly related to duration of illness, whilst only endurance time was significantly related to Expanded Disability Scale Score.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although physical rehabilitation is commonly administered to MS patients, its efficacy has not been established. We assessed the efficacy of an inpatient physical rehabilitation program on impairment, disability, and quality of life of MS patients with a randomized, single-blind, controlled trial. Fifty ambulatory MS patients were assigned to 3 weeks of inpatient physical rehabilitation (study treatment) or exercises performed at home (control treatment). Patients were evaluated at baseline and at 3, 9, and 15 weeks by a blinded examining physician. No changes in impairment occurred in either group, as measured by the Expanded Disability Status Scale. At the end of the intervention the study group improved significantly in disability, as assessed by the Functional Independence Measure (FIM) motor domain, compared with controls (p = 0.004), and the improvement persisted at 9 weeks (p = 0.001). The effect size statistic was usually large or moderate in all scale scores of the FIM motor domain at 3 weeks and moderate to fair thereafter. The study group also improved in overall health-related quality of life profile compared with controls; however, the difference was significant only for the mental composite score at 3 (p = 0.008) and 9 weeks (p = 0.001). Despite unchanging impairment, physical rehabilitation resulted in an improvement in disability and had a positive impact on mental components of health-related quality of life perception at 3 and 9 weeks.
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Multiple sclerosis (MS) patients of an inpatient rehabilitation program have been randomly assigned to an exercise training (MS-ET) or nontraining group (MS-NI). Before and after 4 weeks of aerobic exercise training, a graded maximal exercise test with measurement of gas exchange and a lung function test was administered to all 26 patients fulfilling the inclusion criteria. Activity level, fatigue and health perception were measured by means of questionnaires. Twenty-six healthy persons served as control group and were matched in respect of age, gender and activity level. Training intervention consisted of 5x30 min sessions per week of bicycle exercise with individualised intensity. Compared with baseline, the MS training group demonstrated a significant rightward placement of the aerobic threshold (AT) (VO2+13%; work rate [WR])+11%), an improvement of health perception (vitality+46%; social interaction+36%), an increase of activity level (+17%) and a tendency to less fatigue. No changes were observed for the MS-NI group and the control groups. Maximal aerobic capacity and lung function were not changed by either training or nontraining in all four groups. Overall compliance to the training program was quite low (65%), whereas incidence of symptom exacerbation by physical activity has been lower than expected (6%).
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This pilot study investigated whether 4 weeks of aerobic treadmill training in individuals with multiple sclerosis (MS) improved mobility and reduced fatigue. Individuals with MS were recruited to this prospective, randomised controlled trial. Individuals were assessed at baseline, week 7 and 12 with a 10 metre timed walk, a 2 minute walk, the Rivermead Mobility Index, and the Fatigue Severity Scale. After a pre-assessment familiarisation session and a baseline assessment, individuals were randomly allocated to an initial intervention or delayed intervention group. Treadmill training consisted of 4 weeks of supervised aerobic exercise delivered weeks 3-6 in the immediate group and 8-11 in the delayed group. Of the initial 19 recruits, 16 individuals completed the study. There was a significant difference in walking endurance between the delayed and immediate groups at baseline (p<0.05). On reassessment in week 7, decreases in 10 metre walk time were found in both groups, which was significant in the immediate group (p<0.05). The 2 minute walk distance significantly increased in both groups (p<0.05). In the training group, reassessed at week 12 after training ceased, there was a return towards baseline scores. No significant changes in fatigue scores were found. This study showed that in individuals with MS, aerobic treadmill training is feasible and well tolerated. Walking speed and endurance increased following training with no increase in reported fatigue. Detraining occurred in the period following training. A larger randomised clinical trial is warranted.
Article
The purpose of this study was to examine maximal aerobic exercise capacity in nine persons with MS (Kurtzke 1-4; M age 40) matched on gender age height weight and lifestyle to nine nondisabled control subjects (M age 38). Tests of maximal aerobic capacity were performed using a specially designed recumbent leg ergometer on land and in water. Maximal oxygen uptake (V̇(2max)) was significantly lower for the MS group than the control group under both environmental conditions. In addition there was no significant difference in V̇(2max) in each environment for either group. Initial examination of group means for cardiovascular responses during submaximal exercise appeared similar but individual data revealed a blunted heart rate (HR) response to increased work rate by several subjects with MS. Consequently the use of submaximal HR and work rate data to predict V̇(2max) resulted in overprediction in a large number of individuals with MS. Perception of stress appeared to be greater during the land test than the water test for the MS group a phenomenon which was not seen in the non-MS group. The results of this study illustrate some individuals with MS are capable of performing maximal aerobic exercise without immediate or latent side-effects. Consideration must be given to the possibility that persons with a greater level of physical impairment may not be as capable as the present sample. Modification and adjustments to the present protocol and mode of ergometry may be necessary. The presence of lower-extremity impairment may play a significant role in preventing a maximal exercise effort during leg cycling for some individuals for whom the utilization of other modes of ergometry may be more appropriate for exercise testing and/or training.
Article
A questionnaire study on sexual problems occurring with multiple sclerosis (MS) was carried out with 217 patients who had previously participated in the University of Washington Multiple Sclerosis Project. More than one-half of the participating subjects were ambulatory without aids and nearly 75% did not use a wheelchair. Sexual dysfunction was reported by 56% of the women and 75% of the men. Among the women, the most commonly occurring sexual symptoms (in decreasing order of frequency) were fatigue, decreased sensation, decreased libido, decreased frequency or loss of orgasm and difficulty with arousal. Men reported the most common problem was erectile dysfunction, followed by decreased sensation, fatigue, decreased libido, and orgasmic dysfunction. Although loss of mobility, weakness and depression are not significantly associated with sexual dysfunction, spasticity and bladder dysfunction appear to be associated. However, even where these symptoms were absent, sexual dysfunction was perceived in at least 50% of the cases. The data indicate that sexual dysfunction can be anticipated in at least 50% of the women and about 75% of the men affected by MS, regardless of mobility level. It is most likely to occur in patients with spasticity and bladder dysfunction.
Article
Objective. – To assess the benefit of a program of rehabilitation involving eccentric isokinetic muscle strengthening for hamstrings of patient with multiple sclerosis.Patients and Methods. – A total of 28 patients with multiple sclerosis and abnormalities when walking who underwent a program of rehabilitation involving eccentric isokinetic muscle strengthening associated with classical neurological rehabilitation. Assessment was by use of an isokinetic test, clinical examination and score on a visual analog scale (VAS) about quality of walking at the beginning and end of the rehabilitation program and three months later. The rehabilitation program involved eccentric isokinetic exercises during 12 sessions.Results. – Patients with multiple sclerosis and difficulty walking showed weak hamstrings on manual muscular testing. After 12 sessions of isokinetic eccentric rehabilitation, hamstring and quadriceps strength increased, VAS score increased, and recurvatum of the knee improved in 26 cases. Three months later, the score for quality of walking remained the same, but that for strength returned to a previous level.Conclusion. – Hamstring strength in patients with multiple sclerosis can be improved without complication with use of eccentric isokinetic rehabilitation. This is an interesting way to improve the quality of walking in these patients.
Article
Introduction. – Multiple sclerosis (MS) is a neurological disease of the central nervous system that most often affects young people. It is characterized by various debilitating symptoms. The aim of this study was to assess physical activities in patients with MS and how these affect their quality of life.Methods. – Forty-five patients were questioned about their physical activities. The following were taken into account: the characteristics of MS within each patient, the level of disease severity (EDSS score) and the quality of life (on the SEP-59 questionnaire).Results. – Fifteen patients had to give up a physical activity because of their illness but more so due to ataxia, fatigue and muscular weakness. Fifteen patients take part in a physical activity, the principal motivation being for their personal well-being. The mean EDSS was 4.2. Answers on the SEP-59 revealed found that patients with MS who took part in a physical activity had significantly better well-being in general.Discussion and conclusion. – Physical activities seem to improve the quality of life of patients with MS who, in general, already have a poor quality of life in relation to the general population. Knowing that muscular function is improved through exercise in patients with an EDSS less than 6, it would seem advantageous for them to take part in a regular physical activity.
Article
Although the role of aerobic exercise in multiple sclerosis (MS) is often debated, there has been little academic study in this important area. We performed a controlled study on the role of cardiovascular fitness in 50 people with clinically definite MS (25 subjects and 25 controls). The study was organized to allow each participant ample opportunity to achieve fitness. The results indicate that, despite popular medical opinion, aerobic exercise, when performed appropriately, does not increase disability; rather, there was a modest (10%) increase in fitness, which was measured as work load achieved. Low-disability individuals tend to become fit more easily than high-disability ones. Future investigations of the role of fitness on the course of MS and the quality of life of those with the disease are clearly indicated.
Article
Twenty‐three individuals with multiple sclerosis (MS) participated in a 6‐month exercise training program; 11 ambulatory (AMB) and 8 semi‐ambulatory (SEMI). Four persons with MS served as non‐exercising controls (C). A test of maximal aerobic power (VO2max) was administered at baseline to all subjects. AMB and SEMI subjects exercised on alternating days for 30 minutes, at 55‐60% VO2max using either a commercially available recumbent or upright combination leg/arm bicycle ergometer. At the end of 12 and 24 weeks, exercising subjects were re‐evaluated. The C group was only re‐evaluated at 24 weeks. The results show that the AMB and SEMI groups experienced a +20% and +5% improvement in VO2max, respectively. The C group averaged a 12% decline in VO2max during the 6 months. These data demonstrate the possibility that although exercise improves cardiovascular fitness of some persons with less severe MS, this beneficial response may not apply to the more severely impaired patient. Nevertheless, improved cardiovascular health at any level may enhance the overall rehabilitation outcome of many individuals in this patient population.
Article
Urinary troubles are frequently observed in people suffering from multiple sclerosis, and are responsible for major impairment. We have studied the clinical and urodynamic findings in such patients and have tried to define the risk factors for incontinence and upper urinary tract infections, which are the main complications. One hundred and fifty patients with clinically confirmed multiple sclerosis were examined in our urodynamic laboratory. All the patients presented urinary problems. A full urological report was obtained in all the cases. Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunction. Women with low maximal uretral pressure were particularly prone to incontinence, which occurred in 69% of our patients. Pyelonephritis were favored by a post voiding residual urine greater than 30% of the functional detrusor capacity, and especially concerned the male population.
Article
Objective. – To evaluate the impact of rehabilitation on balance, gait and strength in inpatients with multiple sclerosis (MS).Methods. – Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation. Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an isokinetic dynamometer at 60°/s speed. The functional independence measure (FIM) was also applied before and after rehabilitation.Results. – After rehabilitation, patients showed significant improvement in balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values. Absolute values of gait speed and strength parameters were related as were improvement in velocity speed and the higher hamstrings.Conclusion. – The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.
Article
The effects of the modifications of temperature are well known in patients affected by multiple sclerosis (MS). They are variable and can influence daily living. This sensibility can be used in the management of the disabilities.Method. – An epidemiological study was realized on a cohort of 191 patients suffering from MS referred to the MS clinic of Rennes (France). All the patients were questioned about the influence of heat and cold on their clinical symptoms (fatigue spasticity, walking disorders, vision, …). Correlations with the main clinical characteristics were studied.Population. – One hundred ninety-one patients, 129 women and 62 men with an average age of 47.6 ± 10 years were interviewed. Average score EDSS was of 5.2 ± 1.5. The mean duration of MS was 13.5 ± 10 years.Results. – One hundred forty-seven patients (77%) reported a sensibility to the temperature. Heat deteriorated function in 104 cases and 82 patients improved with cold. Paradoxically 20 patients reported to be deteriorated with cold and 19 improved with heat. Fatigue and walking were the most sensitive to temperature fluctuations. No particular clinical profile could be established. Fifty percent of the patients used this sensibility with therapeutic aim in everyday life.Discussion. – The clear influence of temperature fluctuations on the clinical symptom was confirmed in this study. However, there is a great variability from one patient to another. Different hypotheses have been evoked to explain this phenomenon. The most likely is an influence on the nervous specific conductivity. In routine practice cold physiotherapy will be proposed on case by case basis and still has an interesting place in the rehabilitation management.
Article
A quantitative assessment of muscle strength in ambulatory subjects with multiple sclerosis (MS) is required to follow up these patients, to understand the biomechanism of their troubles, and to assess different therapeutic protocols.MethodAn isokinetic dynamometer (Cybex II®) was used to evaluate the concentric knee flexor and extensor peak torques values in 20 ambulatory patients with MS, at speed of 60°/s and 180°/s. Thirteen patients, whose neurological state seemed to be stable, have been tested 1.5 month later.ResultsIt is possible to use isokinetic dynamometer to evaluate muscle strength in subjects with MS. The reproductibility is good within 20%. These tests can show up muscle deficits that were not clinically evident. They can help chosing the adapted treatment, following up the patients and assessing the efficiency of rehabilitation protocols.
Article
This study quantified the effects of an aquatic exercise program on muscular strength, endurance, work, and power of patients with multiple sclerosis. Ten individuals with a mean age of 40 years participated in a 10-week aquatic exercise program. Two types of isokinetic dynamometers were used to assess the muscular variables studied. A Cybex II dynamometer was used to measure peak torque, work, and fatigue in the knee flexor and extensor muscles and a biokinetic swim bench was used to measure muscular force, work, fatigue, and power in the upper extremities. Five velocity settings were selected for each of three testing trials (pretrial, midtrial, and posttrial). For the lower extremities, analysis of variance indicated a significant improvement of peak torque for knee extensor muscles from the pretrial to midtrial (p less than .05). Peak torque values from pretrial to midtrial for knee flexors and from midtrial to posttrial for both the knee extensor and flexor muscles indicated a nonsignificant difference at each velocity studied. Fatigue and work values in the lower extremities improved significantly between the pretrial and posttrial (p less than .05). For the upper extremities, an analysis of variance indicated a significant increase in all force measurements from pretrial to posttrial (p less than .05). Power and total work values also improved significantly (p less than .05). No significant difference in fatigue measurements for the upper extremities was found. The results of this investigation indicated that an aquatic exercise program may induce positive changes in muscular strength, fatigue, work, and power in patients with multiple sclerosis.
Article
Muscle weakness, studied in 4 patients with multiple sclerosis (MS), was compared with values from normal subjects. Twitch occlusion showed that normal subjects could activate their muscles maximally, but patients rarely achieved greater than 60% activation. In both groups, motoneuron firing rates increased linearly with force. Consistent with the reduced level of activation, MCV firing rates in MS muscles rarely exceeded 17 Hz (compared with approximately 24 Hz for normals). However, for right and left muscles of one patient, mean maximum firing rates were 14.2 +/- 2 Hz and 8.0 +/- 2 Hz, but her muscles, could be activated to levels greater than 92% and 60%, respectively. This patient's ability to achieve higher than expected forces at low firing rates was probably due to her slow muscle contractile speeds, especially 1/2-relaxation time (75 to 115 ms, cf. approximately 60 ms for normals), and high twitch/tetanus ratio (0.4, cf. 0.2).
Article
Respiratory complications occur in advanced multiple sclerosis (MS) but may also complicate acute relapses earlier in the disease. We present 19 patients with MS who developed respiratory complications at a mean of 5.9 (range 1–12) yrs after the onset of neurological symptoms. Fourteen patients developed severe respiratory insufficiency presenting with a combination of reduced forced vital capacity (FVC), hypoxaemia or hypercapnia (12 patients) and respiratory arrest (four patients). Two patients presented with apneustic breathing, one with paroxysmal hyperventilation, one with obstructive sleep apnoea and one with bulbar weakness leading to aspiration pneumonia. Respiratory muscle weakness was a major factor in 14 patients (predominantly diaphragm involvement in six), bulbar weakness in seven patients, impaired voluntary control in three and impaired automatic control in three. Twelve patients received mechanical respiratory support of whom seven have subsequently died The methods of support used were intermittent positive pressure ventilation (nine patients), iron lung (three), cuirass (two) and rocking bed (one) Six patients were maintained on respiratory support until they died after intervals varying from 24 h to 6 yrs (mean 17.7 mths). Five patients received temporary ventilation for between 6 d and 42 d: of these four remain alive at up to 4 yrs and one died after 16 yrs. One patient remains on domiciliary nasal intermittent positive pressure ventilation (IPPV) after 1 yr
Article
In this study blood pressure (BP) and heart rate (HR) responses to standing and HR responses to deep breathing were assessed in 34 patients with clinically definite multiple sclerosis (MS) and 63 healthy subjects. Normal ranges, which were clearly age related for both HR responses, were obtained. The BP response to standing was abnormal in 13% of the MS patients, these patients demonstrating significant postural hypotension. The HR response to standing was abnormal in 28% of the MS patients, with a normal initial increase in heart rate and a significantly reduced reflex bradycardia. On deep breathing 36% of MS patients showed abnormal HR changes. The resting HR did not differ between both groups. Abnormalities of one or more tests were found in 53% of the MS patients. No relationship was found between abnormal cardiovascular autonomic responses and the symptoms, duration, severity and progression of the disease. Based on clinical and magnetic resonance imaging findings no indications were found for localisation of the autonomic disturbances in the brainstem. It is suggested that at least a part of the cardiovascular autonomic lesions in MS is located outside the brainstem, i.e. in supramedullary reflex pathways or in the spinal cord.
Article
Fatigue of tibialis anterior (TA) was induced by repetitive electrical stimulation. Using this test, patients with upper motor neuron muscle weakness owing to multiple sclerosis (MS) and injuries to the spinal cord showed greater fatigability of their TA muscles, suggesting that the muscle fiber population changed toward that typical of fatigable motor units. During repetitive stimulation, in addition to the decrement in tension there was an increase in half-relaxation time of tetanic contractions at 40 Hz in both subjects and patients. The increase in half relaxation during repeated activity was greater in patients with MS and spinal cord injury than in healthy subjects, suggesting that the long-term inactivity affected the efficiency of the Ca2+ uptake mechanism of their muscle fibers. Thus long-term inactivity of patients with upper motoneuron dysfunction leads to increased fatigability of their muscles and exaggerates the slowing of muscle relaxation after prolonged exercise.
Article
To determine whether patients with MS had abnormalities of autonomic cardiovascular functions, we evaluated 22 MS patients and 20 control subjects with a battery of six standardized tests. The two groups differed on three tests: heart rate and blood pressure responses to standing, and the cold-face test. One-half of the MS patients had abnormalities on two or more tests, but individual patients showed diverse abnormality patterns. Abnormalities of neural cardiovascular regulation are frequent in MS patients and show a heterogeneous pattern, consistent with scattered plaques.
Article
In 21 patients with multiple sclerosis and 20 healthy controls, the following tests of autonomic function were examined: (1) variation in heart rate during deep breathing, (2) the variations in heart rate and systolic blood pressure during a standardised Valsalva manoeuvre, (3) the changes in heart rate and systolic blood pressure during arm ergometry starting at 30 W with increments of 20 W every 3 min. In the control subjects the maximum variation in heart rate from inspiration to expiration was greater than 16 beat/min (range 17-43). In patients with multiple sclerosis, five had a maximum variation in heart rate of less than 13 beat/min which was considered as the lower limit of normal. The Valsalva ratio in the control subjects ranged from 1.33-3.24. Four patients had Valsalva ratios of less than 1.30. In patients with multiple sclerosis the heart rate and systolic blood pressure responses to exercise were attenuated significantly in four and seven subjects respectively. It is concluded that a significant number of patients with multiple sclerosis show evidence of autonomic dysfunction involving the cardiovascular system.
Article
One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
Article
To determine whether skeletal muscle oxidative metabolism is impaired in multiple sclerosis (MS), phosphorus magnetic resonance spectroscopy was used to measure the rate of intramuscular phosphocreatine (PCr) resynthesis following exercise in MS and controls. Thirteen MS patients underwent intermittent isometric tetanic contractions of the dorsiflexor muscles elicited by stimulation of the peroneal nerve. Eight healthy control subjects performed voluntary isometric exercise of the same muscles. During exercise, there were no differences between groups in the fall of either PCr or pH. However, the half-time (T1/2) of PCr recovery following exercise was significantly longer in MS (2.3 +/- 0.3 min) compared to controls (1.2 +/- 0.1 min, P < 0.02). These data provide evidence of slowed PCr resynthesis following exercise in MS, which indicates impaired oxidative capacity in the skeletal muscle of this group. This finding suggests that intramuscular changes consistent with deconditioning may be important in the altered muscle function of persons with MS.
Article
Multiple sclerosis (MS) is a neurological disease characterized by a variety of potentially debilitating symptoms. The manner in which the disease affects each individual is unique; however, many individuals with MS have a normal life expectancy and remain ambulatory throughout their lives. Very little research has focused on understanding how MS affects basic physiologic responses during exercise. Four general topics have been addressed: autonomic control of heart rate (HR) and arterial blood pressure (BP), cardiorespiratory fitness, skeletal muscle function, and symptom instability under thermal stress. Abnormalities in cardiovascular reflexes have been observed in some MS individuals during quiescent testing; however, HR and BP responses during exercise have not confirmed such findings. Deficits in cardio-respiratory fitness appear to be present in moderately impaired individuals, which are not always present in minimally impaired persons. Similarly, abnormalities in skeletal muscle function have been reported in some individuals with MS, while absent in others. Training appears to improve both cardiorespiratory fitness and skeletal muscle function. Findings appear to be indirectly influenced by the level of physical impairment of the experimental sample. This factor needs to be considered in sample selection, as well as in analyzing and reporting data. Elicitation of symptoms in response to thermal stressors has been documented by several investigators using unreliable techniques to measure core temperature. The use of more valid methods during rest and exercise have not confirmed the relationship between symptoms and core temperature changes. It may be that thermal sensitivity, although typically reported by most MS individuals, is a symptom that is very unique to each individual and sample selection may have indirectly contaminated results in past research. Considerations for future research are discussed.
Article
Fifty-four multiple sclerosis (MS) patients were randomly assigned to exercise (EX) or nonexercise (NEX) groups. Before and after 15 weeks of aerobic training, aspects of fitness including maximal aerobic capacity (VO2max), isometric strength, body composition, and blood lipids were measured. Daily activities, mood, fatigue, and disease status were measured by the Profile of Mood States (POMS), Sickness Impact Profile (SIP), Fatigue Severity Scale (FSS), and neurological examination. Training consisted of 3 x 40-minute sessions per week of combined arm and leg ergometry. Expanded Disability Status Scale (EDSS) scores were unchanged, except for improved bowel and bladder function in the EX group. Compared with baseline, the EX group demonstrated significant increases in VO2max, upper and lower extremity strength, and significant decreases in skinfolds, triglyceride, and very-low-density lipoprotein (VLDL). For the EX group, POMS depression and anger scores were significantly reduced at weeks 5 and 10, and fatigue was reduced at week 10. The EX group improved significantly on all components of the physical dimension of the SIP and showed significant improvements for social interaction, emotional behavior, home management, total SIP score, and recreation and past times. No changes were observed for EX or NEX groups on the FSS. Exercise training resulted in improved fitness and had a positive impact on factors related to quality of life.
Article
The purpose of this study was to determine whether patients with multiple sclerosis (MS) would show attenuated heart rate and/or pressor responses to isometric handgrip exercise. Patients with MS (30 males, 74 females, aged 23-61 yr) and control subjects (9 males, 16 females, aged 25-47 yr) performed isometric handgrip exercise at 30% of maximal voluntary contraction (MVC) to fatigue. Systolic, diastolic, and mean arterial pressure (MAP) increased linearly in both groups, but were significantly lower (P < 0.05) in patients with MS at 20%, 40%, 60%, 80%, and 100% of exercise duration. Mean change in MAP at fatigue was +47.9 mm Hg for controls and +28.2 mm Hg for patients with MS, with 18 patients with MS between -6 mm Hg and +15 mm Hg. Heart rate increased normally in patients with MS. To predict change in MAP at fatigue in patients with MS, stepwise regression analysis using six variables yielded an R2 of 0.26. These data suggest that in some patients MS lesions exist in areas of autonomic cardiovascular control that result in attenuated pressor responses to exercise. In 17% of patients tested, attenuation was profound. Data also suggest an abnormal dissociation between the heart rate and pressor response to static work in patients with MS.
Article
Regular exercise and physical activity can minimize deconditioning and assist individuals with multiple sclerosis (MS) to maintain function at optimal levels. The purpose of this study was to explore the relationship of physical activity to social, mental and physical health and well-being in persons with MS. A convenience sample of 37 persons with MS completed the Human Activity Profile and the Medical Outcomes Study Short-Form Health Survey (SF36). Activity levels in persons with MS were much lower than norms reported for other groups of healthy adults and adults with a variety of chronic conditions. Higher activity scores were associated with higher scores on the measures of physical functioning and general health. The subgroup of persons who reported engaging in regular exercise had significantly higher scores on the measure of physical functioning than those who did not exercise. Additional research is needed to investigate barriers and facilitators of physical activity for persons with MS and whether increasing activity may have synergistic effects with other therapies.
Article
This study examined functional, biochemical, and morphological characteristics of skeletal muscle in nine multiple sclerosis (MS) patients and eight healthy controls in an effort to ascertain whether intramuscular adaptations could account for excessive fatigue in this disease. Analyses of biopsies of the tibialis anterior muscle showed that there were fewer type I fibers (66 +/- 6 vs. 76 +/- 6%), and that fibers of all types were smaller (average downward arrow26%) and had lower succinic dehydrogenase (SDH; average downward arrow40%) and SDH/alpha-glycerol-phosphate dehydrogenase (GPDH) but not GPDH activities in MS vs. control subjects, suggesting that muscle in this disease is smaller and relies more on anaerobic than aerobic-oxidative energy supply than does muscle of healthy individuals. Maximal voluntary isometric force for dorsiflexion was associated with both average fiber cross-sectional area (r = 0.71, P = 0.005) and muscle fat-free cross-sectional area by magnetic resonance imaging (r = 0.80, P < 0. 001). Physical activity, assessed by accelerometer, was associated with average fiber SDH/GPDH (r = 0.78, P = 0.008). There was a tendency for symptomatic fatigue to be inversely associated with average fiber SDH activity (r = -0.57, P = 0.068). The results of this study suggest that the inherent characteristics of skeletal muscle fibers per se and of skeletal muscle as a whole are altered in the direction of disuse in MS. They also suggest that changes in skeletal muscle in MS may significantly affect function.
Article
Vesicourethral dysfunction is common in people with multiple sclerosis and results in significant impairment. We studied the clinical and urodynamic findings in such patients to define risk factors for incontinence and upper urinary tract infections. A cohort study of 149 patients with multiple sclerosis and urinary symptoms seen in our urodynamic laboratory. A complete urodynamic study of each patient with urethrocystometry and continuous recording of the urethral sphincter electromyography and assessment of postvoid residual. Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunctions. No significant relation between clinical features and urodynamic patterns was found. Women with low maximal urethral pressure were particularly prone to incontinence, which occurred in 69% of the patients. Pyelonephritis was associated with a postvoiding residual urine of > 30% of the functional detrusor capacity, and was found more often in the male population. Urodynamic assessment of bladder function is critical to direct therapy for urinary complaints in people with multiple sclerosis.