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Andreu-Caravaca L, Ramos-Campo DJ, Martos-Bonilla A, Rando-Martín A, Rubio-Arias JÁ. Sex differences in strength, functional capacity and mobility in patients with multiple sclerosis: An exploratory analysis. Mult Scler Relat Disord 2024; 87:105694. [PMID: 38796906 DOI: 10.1016/j.msard.2024.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Physical exercise programs are commonly designed without consideration for sex differences. Nevertheless, disease progression exhibits sex-specific patterns, resulting in different functionality and strength performances. OBJECTIVES To analyze sex differences in strength, functional capacity, and mobility, and to evaluate sex-dependent differences in leg strength in multiple sclerosis (MS) patients. METHODS A cross-sectional study was conducted with 35 participants (female: n = 19; Expanded Disability Status Scale (EDSS)= 3.0 ± 1.2, male: n = 16; EDSS= 3.3 ± 1.2). Body composition, maximal voluntary isometric contraction (MVIC), explosive strength (rate of force development, RFD), central activation ratio (CAR), functional capacity, and mobility were assessed. RESULTS Differences were observed between males and females (p = 0.001) in height, lean body mass and MVIC. No differences were observed in the other variables. Regarding the leg asymmetry, men showed higher values in the stronger leg for both MVIC (p < 0.001, d=large) and RFD, whereas women showed higher values only in RFD. Men with MS demonstrated a greater capacity to produce maximal strength than women with this disease. CONCLUSIONS The results found suggest that maximum strength differs between men and women in our sample of patients with multiple sclerosis. Furthermore, the weaker leg, regardless of sex, exhibits poorer results in explosive strength compared to the stronger leg. However, maximum strength only shows differences in men and not in women. Therefore, these findings should serve as a basis for rehabilitation professionals when planning training programs for this population.
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Affiliation(s)
- Luis Andreu-Caravaca
- Facultad de Deporte. UCAM, Universidad Católica de Murcia. Murcia. Spain; Sports Physiology Department, Faculty of Health Sciences. Universidad Católica de Murcia. Murcia. Spain
| | - Domingo J Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF. Madrid. Spain
| | - Ana Martos-Bonilla
- Health Research Centre, Department of Education, Faculty of Educational Sciences, HUM-628 Research Group, Universidad de Almería, Almería, Spain
| | - Alberto Rando-Martín
- Health Research Centre, Department of Education, Faculty of Educational Sciences, HUM-628 Research Group, Universidad de Almería, Almería, Spain
| | - Jacobo Á Rubio-Arias
- Health Research Centre, Department of Education, Faculty of Educational Sciences, HUM-628 Research Group, Universidad de Almería, Almería, Spain.
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2
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Luo B, Xiang D, Ji X, Chen X, Li R, Zhang S, Meng Y, Nieman DC, Chen P. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:353-367. [PMID: 38341137 PMCID: PMC11117003 DOI: 10.1016/j.jshs.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The anti-inflammatory effect of exercise may be an underlying factor in improving several autoimmune diseases. The aim of this systematic review was to examine the evidence on the role of exercise training in mitigating inflammation in adolescents and adults with autoimmune disease. METHODS PubMed, Web of Science, and Embase databases were systematically reviewed for related studies published between January 1, 2003, and August 31, 2023. All randomized and non-randomized controlled trials of exercise interventions with autoimmune disease study participants that evaluated inflammation-related biomarkers were included. The quality of evidence was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise scale and Cochrane bias risk tool. RESULTS A total of 14,565 records were identified. After screening the titles, abstracts, and full texts, 87 were eligible for the systematic review. These studies were conducted in 25 different countries and included a total of 2779 participants (patients with autoimmune disease, in exercise or control groups). Overall, the evidence suggests that inflammation-related markers such as C-reactive protein, interleukin 6, and tumor necrosis factor α were reduced by regular exercise interventions. Regular exercise interventions combined with multiple exercise modes were associated with greater benefits. CONCLUSION Regular exercise training by patients with autoimmune disease exerts an anti-inflammatory influence. This systematic review provides support for the promotion and development of clinical exercise intervention programs for patients with autoimmune disease. Most patients with autoimmune disease can safely adopt moderate exercise training protocols, but changes in inflammation biomarkers will be modest at best. Acute exercise interventions are ineffective or even modestly but transiently pro-inflammatory.
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Affiliation(s)
- Beibei Luo
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; Shanghai Key Laboratory of Human Performance, Shanghai University of Sport, Shanghai 200438, China
| | - Dao Xiang
- Department of Diving and Hyperbaric Medicine, Naval Medical Center, Shanghai 200433, China; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China
| | - Xiaorong Ji
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Xuan Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Rui Li
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Shuxin Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Yujun Meng
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - David C Nieman
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA.
| | - Peijie Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; Research Institute for Doping Control, Shanghai University of Sport, Shanghai 200438, China.
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3
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Maroto-Izquierdo S, Mulero P, Menéndez H, Pinto-Fraga J, Lista S, Santos-Lozano A, Téllez N. Pumping up the Fight against Multiple Sclerosis: The Effects of High-Intensity Resistance Training on Functional Capacity, Muscle Mass, and Axonal Damage. Healthcare (Basel) 2024; 12:837. [PMID: 38667599 PMCID: PMC11050496 DOI: 10.3390/healthcare12080837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Resistance training (RT) has been recognized as a beneficial non-pharmacological intervention for multiple sclerosis (MS) patients, but its impact on neurodegeneration is not fully understood. This study aimed to investigate the effects of high-intensity RT on muscle mass, strength, functional capacity, and axonal damage in MS patients. METHODS Eleven relapsing-remitting MS patients volunteered in this within-subject counterbalanced intervention study. Serum neurofilament light-chain (NfL) concentration, vastus lateralis thickness (VL), timed up-and-go test (TUG), sit-to-stand test (60STS), and maximal voluntary isometric contraction (MVIC) were measured before and after intervention. Participants performed 18 sessions of high-intensity RT (70-80% 1-RM) over 6 weeks. RESULTS Significant (p < 0.05) differences were observed post-intervention for VL (ES = 2.15), TUG (ES = 1.98), 60STS (ES = 1.70), MVIC (ES = 1.78), and NfL (ES = 1.43). Although moderate correlations between changes in VL (R = 0.434), TUG (R = -0.536), and MVIC (R = 0.477) and changes in NfL were observed, only the correlation between VL and MVIC changes was significant (R = 0.684, p = 0.029). CONCLUSIONS A 6-week RT program significantly increased muscle mass, functional capacity, and neuromuscular function while also decreasing serum NfL in MS patients. These results suggest the effectiveness of RT as a non-pharmacological approach to mitigate neurodegeneration while improving functional capacity in MS patients.
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Affiliation(s)
- Sergio Maroto-Izquierdo
- i+HeALTH, Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Patricia Mulero
- Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Héctor Menéndez
- i+HeALTH, Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - José Pinto-Fraga
- i+HeALTH, Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Simone Lista
- i+HeALTH, Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Nieves Téllez
- Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Nezhad NN, Parnow A, Khamoushian K, Eslami R, Baker JS. Resistance training modifies of serum levels of matrix metalloproteinase 2 and tissue inhibitor of matrix metalloproteinases in multiple sclerosis women - a randomized controlled trail. BMC Neurosci 2024; 25:13. [PMID: 38438999 PMCID: PMC10910672 DOI: 10.1186/s12868-024-00856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
The objectives of the present study was to investigate the effects of resistance training (RT) on serum levels of controlling blood-brain barrier (BBB) permeability indices and cognitive performance in MS women (MS-W). In this randomized control trail study (IRCT registration code: IRCT20120912010824N3, 07.09.2023), twenty-five MS-W were randomly divided into sedentary (MS) and resistance exercise (12 weeks/3 times per week/ 60-80% of 1RM) (MS + RT) groups. Fifteen healthy aged-matched women participated as a control group (HCON). The serum level of matrix metalloproteinase-2 (MMP-2), matrix metallopeptidase-9 (MMP-9), tissue metalloproteinase inhibitors-1 (TIMP-1), tissue metalloproteinase inhibitors-2 (TIMP-2), and S100 calcium-binding protein B (S100B) were assessed. In addition, cognitive performance was assessed pre- and post- intervention with the Brief International Cognitive Assessment for MS (BICAMS). A significant reduction in MMP-2, TIMP-2 serum levels, and MMP-2/TIMP-2 ratio were observed in post-test for MS + RT group (p < 0.01) in comparison to the HCON and MS groups; however, no changes were observed in MMP-9, TIMP-1, S100B and MMP-9/TIMP-1 ratio after RT (p > 0.05). The verbal learning was improved in post-test for MS + RT group (p < 0.01), although no change were observed for visuospatial memory and information processing speed (p > 0.05). These findings suggest that resistance training can modify some indices of BBB permeability and improve verbal learning in MS-W. The findings may also be beneficial as a non-pharmacological intervention to reduce inflammation.
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Affiliation(s)
- Nasrin Niazi Nezhad
- Sport Bio-Sciences Department, Physical Education and Sports Sciences Faculty, Razi University, University Street, Kermanshah, Iran
| | - Abdolhossein Parnow
- Sport Bio-Sciences Department, Physical Education and Sports Sciences Faculty, Razi University, University Street, Kermanshah, Iran.
| | - Kianoosh Khamoushian
- Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Eslami
- Exercise Physiology Department, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Julien S Baker
- Institute for Population Health and Medical Informatics, Hong Kong Baptist University, Kowloon, Hong Kong, China
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Lenne B, Donze C, Massot C, Degraeve B. Impact of physical activity, physical fitness and exercises on cognitive impairment in patients with multiple sclerosis: A review of evidence and underlying mechanisms. Rev Neurol (Paris) 2023:S0035-3787(23)01037-8. [PMID: 37798163 DOI: 10.1016/j.neurol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 10/07/2023]
Abstract
Cognitive impairment in persons with MS (pwMS) occurs commonly, early and independently of other clinical features of the disease. MS-related cognitive impairment is mainly characterized by weakening of information processing speed, working memory and episodic memory. Much evidence, based on both neuropsychological and neuroimaging outcomes, highlights successful cognitive rehabilitation interventions. In this context, promotion of physical activity and exercise training could be a dual, motor and cognitive, rehabilitation method. The aim of this article is, firstly, to review existing evidence regarding the effects of exercise on cognition among pwMS, and secondly, to explore the possible mechanisms of action of the cognitive-motor coupling.
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Affiliation(s)
- B Lenne
- Lille Catholic University, Lille, France; Groupement des hôpitaux de l'institut catholique de Lille (GHICL), Neurology Department, Lille, France.
| | - C Donze
- Lille Catholic University, Lille, France; Groupement des hôpitaux de l'institut catholique de Lille (GHICL), Neurology Department, Lille, France.
| | - C Massot
- Lille Catholic University, Lille, France; Groupement des hôpitaux de l'institut catholique de Lille (GHICL), Neurology Department, Lille, France; Université Polytechnique Hauts-de-France (UPHF), LAMIH, Valenciennes, France; CNRS, UMR 8201, Valenciennes, France.
| | - B Degraeve
- Lille Catholic University, Lille, France.
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6
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Bae M, Kasser SL. High intensity exercise training on functional outcomes in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 75:104748. [PMID: 37178578 DOI: 10.1016/j.msard.2023.104748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND There is growing interest and evidence for high intensity training (HIT) in clinical populations, including persons with multiple sclerosis (MS). While HIT has been shown to be a safe modality in this group, it is still unclear what collective knowledge exists for HIT on functional outcomes. This study examined HIT modalities (e.g., aerobic, resistance, functional training) on functional outcomes such as walking, balance, postural control, and mobility in persons with MS. METHODS High intensity training studies, including RCTs and non-RCTs, that targeted functional outcomes in persons with MS were included in the review. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2022. Other literature search methods were performed via website and citation searching. The methodological quality of included studies was assessed by TESTEX for RCTs and ROBINS-I for non-RCTs. This review synthesized the following data: study design and characteristics, participant characteristics, intervention characteristics, outcome measures, and effect sizes. RESULTS Thirteen studies (6 RCTs and 7 non-RCTs) were included in the systematic review. The included participants (N = 375) had varying functional levels (EDSS range: 0-6.5) and phenotypes (relapsing remitting, secondary progressive, primary progressive). HIT modalities involving high intensity aerobic training (n = 4), high intensity resistance training (n = 7), and high intensity functional training (n = 2), revealed a significant and consistent benefit on walking speed and walking endurance in response to HIT, while the evidence regarding balance and mobility improvement was less clear. CONCLUSION Persons with MS can successfully tolerate and adhere to HIT. While HIT appears to be an effective modality for improving some functional outcomes, the heterogeneous testing protocols, HIT modalities, and exercise doses among the studies preclude any conclusive evidence for its effectiveness thus necessitating future inquiry.
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Affiliation(s)
- Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA.
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Wallin A, Franzén E, Ekman U, Piehl F, Johansson S. A highly challenging balance training intervention for people with multiple sclerosis: a feasibility trial. Pilot Feasibility Stud 2023; 9:41. [PMID: 36922859 PMCID: PMC10015930 DOI: 10.1186/s40814-023-01265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/18/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Balance training interventions with a gradual progression of difficulty and highly challenging tasks designed specifically for people with multiple sclerosis (MS) are rare. The objective was to adapt a balance training intervention originally developed for Parkinson's disease through a co-design process and then conduct a pilot trial in MS to evaluate the feasibility of a large, full-scale study. METHODS Twelve people with MS with mild to moderate overall MS-disability were included in this single-group feasibility trial. Participants received one-hour training sessions twice or three times weekly for 10 weeks. The assessment included tests of physical and cognitive functioning and patient-reported quality of life-related outcomes. Data on feasibility aspects were collected at baseline and follow-up assessments and three times during the intervention period to inform the recruitment process, as well as to monitor retention and inclusion rates, study procedures, intervention delivery, and dynamic changes in the selected potential outcome measures. Progression criteria were used to determine whether to proceed to a full-scale trial. Descriptive statistics were used to present the data. RESULTS Out of six progression criteria, only retention and attendance at training sessions were not met. Reasons reported for not completing the intervention period mainly depended on external circumstances beyond the control of the study. In contrast, study procedures, intervention delivery, and intervention content (progression, adjustment, and control of challenge level of exercises) were considered feasible for a future, full-scale trial. The Mini-BESTest, which was used for the assessment of balance control, was considered suitable as the primary outcome in a full-scale trial with no ceiling or floor effects. Further, the Mini-BESTest showed a positive trend in outcome response with a median difference of 3.5 points between baseline and follow-up assessments. The power calculation performed suggests a feasible number of participants for recruitment. CONCLUSIONS Overall trial aspects and intervention delivery were deemed feasible for a full-scale trial, but adjustments are needed to increase retention and attendance.
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Affiliation(s)
- A Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. .,Rehab Station Stockholm, Research and Development Unit, Solna, Sweden.
| | - E Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholm Sjukhem Foundation, R&D Unit, Stockholm, Sweden
| | - U Ekman
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - F Piehl
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital and Neuroimmunology Unit, Stockholm, Sweden
| | - S Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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8
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Englund S, Piehl F, Kierkegaard M. High-intensity resistance training in people with multiple sclerosis experiencing fatigue: A randomised controlled trial. Mult Scler Relat Disord 2022; 68:104106. [PMID: 36037752 DOI: 10.1016/j.msard.2022.104106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Exercise studies including only fatigued persons with multiple sclerosis (PwMS) with fatigue as primary endpoint are lacking. OBJECTIVE To evaluate the effects of high-intensity resistance training (HIRT) on self-reported fatigue in fatigued PwMS in a single center randomised controlled trial. METHODS We recruited 71 PwMS scoring ≥ 53 on the Fatigue Scale for Motor and Cognitive Functions (FSMC), who were randomised 1:1 to either twice (group A) or once (group B) weekly supervised HIRT for twelve weeks. A non-randomised FSMC score-matched group (n=69) served as non-intervention control. RESULTS Between HIRT-group differences were non-significant for primary and most secondary endpoints. Mean difference in FSMC score (95% confidence intervals) was -10.9 (-14.8; -6.9) in group A and -9.8 (-13.2; -6.3) in group B. Corresponding values for combined HIRT groups vs non-intervention control were -10.3 (-12.9; -7.7) and 1.5 (-0.6;3.6), respectively, p<0.001. Secondary endpoints also improved in both HIRT groups, though only Hospital Anxiety and Depression Scale anxiety and MS Impact Scale-29 psychological subscales significantly favoured the twice a week HIRT (group A). As an exploratory endpoint, changes in plasma inflammatory protein markers were associated with reduced FSMC scores in the pooled material. CONCLUSION The finding that HIRT in fatigued PwMS leads to clinically relevant reductions in self-reported fatigue, associated with changes in plasma inflammatory protein levels, provide evidence for recommending HIRT for fatigued PwMS.
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Affiliation(s)
- S Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Specialist Center, Center of Neurology, Stockholm Health Services, SE-113 65 Stockholm, Sweden.
| | - F Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Specialist Center, Center of Neurology, Stockholm Health Services, SE-113 65 Stockholm, Sweden
| | - M Kierkegaard
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, SE-113 65 Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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9
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Shobeiri P, Seyedmirzaei H, Karimi N, Rashidi F, Teixeira AL, Brand S, Sadeghi-Bahmani D, Rezaei N. IL-6 and TNF-α responses to acute and regular exercise in adult individuals with multiple sclerosis (MS): a systematic review and meta-analysis. Eur J Med Res 2022; 27:185. [PMID: 36156182 PMCID: PMC9511785 DOI: 10.1186/s40001-022-00814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background In both the general population and people with multiple sclerosis (PwMS), physical exercise is associated with improved mental well-being. Moreover, there is evidence of the possible protection of physical activity against disease progression in multiple sclerosis (MS). However, the question arises if acute or regular exercise has any impact on the immune system in PwMS. To answer this question, we performed a systematic review and meta-analysis on both plasma and serum cytokine levels (IL-6 and TNF-α) before and after acute and regular exercise among PwMS and compared to healthy controls. Method We performed an online search via PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library till September 2021 to identify original studies on IL-6 and TNF-α changes after acute and regular exercise in PwMS and controls. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 11 original studies were included in the meta-analysis. Sensitivity analyses were used to identify the origins of heterogeneity. R 4.0.4 was used to perform the meta-analysis of IL-6 and TNF-α levels before and after acute and regular exercise in PwMS, compared to controls. This study does not qualify for a clinical trial number. Results IL-6 levels did neither increase nor decrease after acute and regular exercise in PwMS, and compared to controls (pre- vs. post-intervention: Standardized Mean Difference (SMD) -0.09, 95% CI [−0.29; 0.11], p-value = 0.37, PwMS vs. Control: SMD −0.08, 95% CI [−0.33; 0.16], p-value = 0.47). In PwMS, TNF-α levels decreased after regular exercise and when TNF-α levels of both acute and regular exercise were pooled (pre- vs. post-intervention: SMD −0.51, 95% CI [-0.91; 0.11], p-value = 0.01, PwMS vs. Control: SMD −0.23, 95% CI [−0.66; 0.18], p-value = 0.26). TNF-α levels did neither increase nor decrease after acute and regular exercise in PwMS, when compared to controls. Conclusion This systematic review and meta-analysis show that exercise does not lead to significant changes in peripheral levels of IL-6 in PwMS in contrast to the observed response in healthy subjects and other medical contexts. However, regular exercise had a specific anti-inflammatory effect on blood TNF-α levels in PwMS. It remains to be investigated why PwMS display this different exercise-induced pattern of cytokines. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00814-9.
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Affiliation(s)
- Parnian Shobeiri
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Seyedmirzaei
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Karimi
- School of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Fatemeh Rashidi
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran
| | - Antônio L Teixeira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Neuropsychiatry Program, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Serge Brand
- School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences (TUMS), Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi-Bahmani
- Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Department of Psychology, Stanford University, Stanford, CA, USA
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Cytokine Profile in Patients with Multiple Sclerosis Following Exercise: A Systematic Review of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138151. [PMID: 35805808 PMCID: PMC9266041 DOI: 10.3390/ijerph19138151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) is one of the most prevalent causes of nontraumatic neurological impairment in young adults. This review aims to determine the impact of exercise on cytokine and adipokine profile levels as inflammatory markers in MS patients across various exercise paradigms. We used specific keywords in PubMed, Web of Science, The Cochrane Library, and Scopus to find randomized clinical trials addressing the effects of physical activity and exercise training on inflammatory markers levels in MS patients. The majority of the research showed no considerable changes in IL-6 levels, while three studies reported declining levels after the intervention. Approximately half of the trials observed a change in TNF-α and IL-10 levels after exercise interventions, while the other half showed no meaningful changes. Other markers such as IL-17, IL-4, IL-12, adipokines, and BDNF showed fluctuations in levels. We found no universal agreement on the effects of different exercise training protocols on the serum level of inflammatory markers in patients with MS. More research is needed to fully identify the effects of exercise on cytokines in MS patients.
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Matysiak M, Siger M, Walczak A, Ciach A, Jonakowski M, Stasiołek M. The influence of COVID-19 pandemic lockdown on the physical activity of people with multiple sclerosis. The role of online training. Mult Scler Relat Disord 2022; 63:103843. [PMID: 35550480 PMCID: PMC9072836 DOI: 10.1016/j.msard.2022.103843] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND COVID-19 pandemic has affected people with multiple sclerosis (PwMS) on various levels. Pandemic lockdown influenced the access to typical measures of physical activity such as out-door training or gym exercises. METHODS We performed a survey assessing physical activity during pandemic lockdown among PwMS treated in our MS center. The questionnaire encompassed questions regarding physical activity before and during lockdown, including the employment of online technologies. RESULTS The survey was completed by 262 PwMS. Physical activity before lockdown was declared by 74.4% of PwMS, regular exercises were declared by 30.9% of participants. Among physically active PwMS 50.5% limited their physical activity during the COVID-19 lockdown. The decrease in physical activity was reported more frequently by PwMS with higher levels of disability, particularly declaring regular exercises before lockdown. In the opinion of 39,7% of PwMS online training could replace standard exercises, however only 19,9% of PwMS were actively looking for online training during the lockdown. The interest in online exercise was greatest in the group ≤30 years of age and EDSS ≤2. Synchronous exercises were the preferred online training, particularly among PwMS with EDSS≥4. CONCLUSION Our findings indicate a need for systematic educational and organizational measures, promoting physical activity among PwMS and acknowledging pandemic conditions.
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Martínez-Rodríguez A, Rubio-Arias JÁ. Effects and optimal dosage of resistance training on strength, functional capacity, balance, general health perception, and fatigue in people with multiple sclerosis: a systematic review and meta-analysis. Disabil Rehabil 2022; 45:1595-1607. [PMID: 35579532 DOI: 10.1080/09638288.2022.2069295] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze the effectiveness of resistance training programs (RTP) on strength, functional capacity, balance, general health perception, and fatigue for people with Multiple Sclerosis (MS) and to determine the most effective dose of RTP in this population. METHODS Studies examining the effect of RTP on strength, functional capacity, balance, general health perception, and fatigue in MS patients were included. 44 studies were included. The meta-analysis, subgroup analysis and meta-regression methods were used to calculate the mean difference and standardized mean difference. RESULTS Significant group differences were observed in knee extensor (p = 0.01) and flexor (p < 0.001), but not in 1-repetition maximum. Regarding functional capacity and balance, differences between groups, in favour of the RTP group, were found in the Timed Up and Go Test (p = 0.001), walking endurance, (p = 0.02) gait speed (p = 0.02) and balance (p = 0.02). No significant differences between groups were observed in fatigue or general health perception. The results regarding the optimal dose are inconsistent. CONCLUSIONS RTP improves strength, functional capacity, balance, and fatigue in people with MS. Registration: (PROSPERO): CRD42020182781Implications for rehabilitationResistance training is a valid strategy to improve isometric strength and functional capacity in MS patients.RTP using long durations (more than 6 weeks), high intensity (more than 80% 1-RM) and two-day weekly training frequency may be a correct stimulus to improve strength, functional capacity, balance, and fatigue in people with MS.Trainers and rehabilitators should consider these indicators in order to maximize muscular and functional adaptations in this population.
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Affiliation(s)
- Luis Andreu-Caravaca
- International Chair of Sports Medicine, Catholic University of Murcia, Murcia, Spain.,Faculty of Sport, Catholic University of Murcia, Murcia, Spain.,LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Madrid, Spain
| | - Domingo J Ramos-Campo
- Faculty of Sport, Catholic University of Murcia, Murcia, Spain.,LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Madrid, Spain
| | - Linda H Chung
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
| | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Sciences Faculty of Sciences, University of Alicante, Alicante, Spain
| | - Jacobo Á Rubio-Arias
- Health Research Centre, Department of Education, Faculty of Educational Sciences, University of Almería, Almería, Spain
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13
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Edwards T, Michelsen AS, Fakolade AO, Dalgas U, Pilutti LA. Exercise training improves participation in persons with multiple sclerosis: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:393-402. [PMID: 34325022 PMCID: PMC9189702 DOI: 10.1016/j.jshs.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although previous studies have examined the effects of exercise training on other International Classification of Functioning, Disability and Health (ICF) component levels in persons with multiple sclerosis (MS), the effects of exercise training on participation remain unclear. The objectives of this review were to: (1) characterize systematically the use of outcome measures that capture participation in exercise training studies; (2) quantify the effect of exercise training on participation in persons with MS. METHODS A search of 6 electronic databases (CINAHL, SPORTDiscuss, Embase, MEDLINE, Cochrane Central, and Scopus) was conducted to identify controlled and noncontrolled trials involving exercise training and participation in persons with MS. Search strings were built from Medical Subject Headings and CINAHL headings. ICF linking rules were used to identify participation chapters and categories captured. Meta-analysis was used to quantify the effect of exercise training on participation in randomized controlled trials comparing exercise effects to no intervention/usual care. RESULTS We included 49 articles involving controlled and noncontrolled exercise trials in the systematic review of outcome measures. We captured 16 different outcome measures that captured all 9 participation chapters and identified 89 unique participation categories. Across these 16 outcome measures, mobility was the most commonly represented participation chapter, with 108 items. A subsample of 23 randomized controlled trials was included in the meta-analysis. An overall effect of 0.60 (standard error = 0.12, 95% confidence interval: 0.36-0.84, z = 4.9, p < 0.001) was calculated, indicating a moderate, positive effect of exercise training on participation. CONCLUSION The current review provides information that can be used to guide the selection of outcome measures that capture participation in studies of exercise training in persons with MS. Exercise training has a positive effect on outcomes that capture participation, providing further evidence for the role of exercise training in promoting and maintaining engagement in everyday life.
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Affiliation(s)
- Thomas Edwards
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N6N5, Canada
| | - Anne Sophie Michelsen
- Department of Public Health-Exercise Biology, Aarhus University, Aarhus C 8000, Denmark
| | - Afolasade O Fakolade
- School of Rehabilitation Therapy, Queens University, Kingston, ON K7L3N6, Canada
| | - Ulrik Dalgas
- Department of Public Health-Exercise Biology, Aarhus University, Aarhus C 8000, Denmark
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1N6N5, Canada.
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Developing the Rationale for Including Virtual Reality in Cognitive Rehabilitation and Exercise Training Approaches for Managing Cognitive Dysfunction in MS. NEUROSCI 2022. [DOI: 10.3390/neurosci3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment is a common and detrimental consequence of multiple sclerosis (MS) and current rehabilitation methods are insufficient. Cognitive rehabilitation (CR) and exercise training (ET) are the most promising behavioral approaches to mitigate cognitive deficits, but effects are small and do not effectively translate to improvements in everyday function. This article presents a conceptual framework supporting the use of virtual reality (VR) as an ideal, common adjuvant traditional CR and ET in MS. VR could strengthen the effects of CR and ET by increasing sensory input and promoting multisensory integration and processing during rehabilitation. For ET specifically, VR can also help incorporate components of CR into exercise sessions. In addition, VR can enhance the transfer of cognitive improvements to everyday functioning by providing a more ecologically valid training environment. There is a clear interest in adding VR to traditional rehabilitation techniques for neurological populations, a stronger body of evidence of this unique approach is needed in MS. Finally, to better understand how to best utilize VR in rehabilitation for cognitive deficits in MS, more systematic research is needed to better understand the mechanism(s) of action of VR with CR and ET.
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Scorcine C, Veríssimo S, Couto A, Madureira F, Guedes D, Fragoso YD, Colantonio E. Effect of 12 weeks of aquatic strength training on individuals with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:505-509. [PMID: 35195224 DOI: 10.1590/0004-282x-anp-2020-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/09/2021] [Indexed: 11/21/2022]
Abstract
ANTECEDENTES Programas de exercícios físicos são recomendados para pacientes com esclerose múltipla. No entanto, são limitados os estudos que envolvem o treinamento aquático de força para a melhoria das capacidades funcionais. OBJETIVO Investigar o efeito de um programa de treinamento aquático de força nas capacidades funcionais e nos níveis de força e fadiga de pessoas diagnosticadas com esclerose múltipla. MÉTODOS Foram selecionados 29 voluntários com esclerose múltipla. Todos os participantes realizaram uma bateria de testes, incluindo os de capacidades funcionais, nível de força e níveis de fadiga em dois momentos distintos: pré-intervenção e pós-intervenção. O programa de treinamento de força foi realizado durante 12 semanas. Foram utilizados exercícios de força localizados, com controle específico de carga de trabalho, que variou entre 50 e 90% do máximo, de acordo com a semana de treinamento. Para a análise estatística, optou-se por utilizar o teste t de Student na comparação ente os momentos pré- e pós-intervenção. RESULTADOS Os resultados demonstraram melhora significativa em todas as variáveis investigadas: teste de 6 min de caminhada (p=0,00); força mão dominante (p=0,02); força mão não dominante (p=0,00); levantar (p=0,00); sentar e levantar-se (p=0,00); subir 15 degraus (p=0,00); descer 15 degraus (p=0,00); calçar meias (p=0,00); gravidade da fadiga (p=0,01); impacto da fadiga (p=0,01). CONCLUSÃO O treinamento aquático de força foi eficiente para melhorar as capacidades funcionais relacionadas à qualidade de vida de pacientes com esclerose múltipla.
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Affiliation(s)
- Claudio Scorcine
- Universidade Federal de São Paulo, Departamento de Educação Física, Santos SP, Brazil.,Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Stefanie Veríssimo
- Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Angela Couto
- Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Fabricio Madureira
- Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Dilmar Guedes
- Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Yara Dadalti Fragoso
- Universidae Metropolitana de Santos, Departamento de Educação Física e Neurociências, Santos SP, Brazil
| | - Emilson Colantonio
- Universidade Federal de São Paulo, Departamento de Educação Física, Santos SP, Brazil
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Manonelles P, Vilas Boas JP, Rubio-Arias JÁ. Fast-velocity resistance training improves force development and mobility in Multiple Sclerosis. Int J Sports Med 2021; 43:593-599. [PMID: 34847589 DOI: 10.1055/a-1710-1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to analyze the benefits of a lower-limb fast-velocity concentric resistance training on rate of force development, mobility, and quality of life in people with Multiple Sclerosis. A randomized controlled trial was conducted in 30 people with Multiple Sclerosis, who were randomly assigned to either an experimental (n=18) or a control (n=12) group. The experimental group carried out 10-weeks of fast-velocity concentric resistance training, while the control group did not perform any intervention. Early and late rate of force development during knee extension in both legs, sit-to-stand and Timed Up and Go tests and quality life questionnaire were evaluated before and after intervention. The training program evoked an increase in early rate of force development in experimental group (0-30; Rightleg: 63.9%, p<0.001;ES=-1.4; Leftleg: 52.7%, p<0.001;ES=-1.0) compared to control group (showed modest increases). Furthermore, experimental group improved mobility after training (Sit-to-stand: 22.2%, p<0.001;ES=1.0; Timed Up and Go Test: 10.1%, p<0.001;ES=1.1) and increased the perception of quality of life after training, while control showed no changes. The fast-velocity concentric resistance training has the potential to improve early rate of force development and mobility after 10-weeks of training. In addition, the increase in self-perceived quality of life following this training modality demonstrates promising results in the Multiple Sclerosis population.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sport, Universidad Católica San Antonio de Murcia, Murcia, Spain.,International Chair of Sports Medicine, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | | | - Linda H Chung
- UCAM Research Center for High Performance Sport, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Pedro Manonelles
- International Chair of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
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Tarakci E, Tarakci D, Hajebrahimi F, Budak M. Supervised exercises versus telerehabilitation. Benefits for persons with multiple sclerosis. Acta Neurol Scand 2021; 144:303-311. [PMID: 33961295 DOI: 10.1111/ane.13448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effectiveness of structured telerehabilitation on fatigue, health status, quality of life (QoL), and activities of daily living (ADL) and compare the possible effects with structured supervised exercise programs in patients with Multiple Sclerosis. MATERIALS AND METHODS This study was a randomized, single-blind trial. Thirty patients with relapsing-remitting Multiple Sclerosis were included in the study and randomly divided into two groups; structured supervised exercise group (Group 1) and telerehabilitation group (Group 2). Group 1 (n = 15) completed a 12 week structured supervised exercise program. Group 2 (n = 15) completed a 12 week structured home-based exercise program. Patients were evaluated with functional independence measure (FIM), first section of Nottingham Health Profile (NHP-I), fatigue severity scale (FSS), and quality of life scale (QoLS) before and after the intervention. RESULTS Significant differences were found in all parameters in both groups after the treatment (p < .05). No significant difference was found between groups regarding FIM-total, FIM-motor, FIM-cognitive, NHP sub-parameters, and QoLS (p > .05). Between-group differences revealed a significant difference in FSS and NHP total in favor of Group 1 (p < .05). CONCLUSION A structured home-based exercise program can be an alternative to supervised exercises with no side effects in patients with multiple sclerosis. Home-based rehabilitation exercises that are checked and controlled through telerehabilitation can help patients improve their health-related QoL and ADL. However, supervised exercises can be more beneficial regarding the fatigue and health profile compared to the home-based exercises.
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Affiliation(s)
- Ela Tarakci
- Department of Physiotherapy and Rehabilitation Faculty of Health Sciences Istanbul University Cerrahpaşa Istanbul Turkey
| | - Devrim Tarakci
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Farzin Hajebrahimi
- Department of Physical Therapy and Rehabilitation School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Miray Budak
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
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18
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Tadayon Zadeh F, Amini H, Habibi S, Shahedi V, Isanejad A, Akbarpour M. The Effects of 8-Week Combined Exercise Training on Inflammatory Markers in Women with Multiple Sclerosis. NEURODEGENER DIS 2021; 20:212-216. [PMID: 34348347 DOI: 10.1159/000518580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The present study was designed to investigate the effects of 8-week combined endurance, resistance, and balance exercise training on IL-6, CRP, and IL-10 concentrations in women with multiple sclerosis. METHODS Thirty participants with multiple sclerosis (Expanded Disability Status Scale ≤6) were randomized into either an exercise and control groups. The exercise group performed 8-weeks of endurance, resistance, and balance exercise training. Serum concentrations of IL-6, CRP, and IL-10 were measured before and after the 8-week intervention. Moreover, anthropometric measures were determined at the onset of and after the intervention. For within- and between groups comparisons of all variables, t test (independent and dependent) was used (p < 0.05). RESULTS The results revealed that IL-6 and CRP levels significantly decreased after exercise training (from 6.8 ± 1.52 to 3.2 ± 0.96, p < 0.001 and from 2.76 ± 0.98 to 1.55 ± 0.44, p = <0.001; respectively). Also, exercise training significantly increased IL-10 in the exercise group (from 16.4 ± 2.74 to 23.2 ± 2.11, p < 0.001). There was a significant difference between the 2 groups in all markers in the after 8-week exercise (p < 0.05). CONCLUSIONS One of the characteristics of MS disease is inflammation. Exercise training through physiological mechanisms and without aggravating the inflammatory pathology can be effective in functional and symptom reduction of patients with MS. In confirmation of this, the present study showed that 8 weeks of combined exercise training decreased pro-inflammatory markers (IL-6 and CRP) and increased anti-inflammatory cytokine (IL-10). Our findings suggested that an exercise training program can be an effective strategy for managing the immune system of women with MS at least by its significant effect on inflammatory markers.
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Affiliation(s)
- Fahime Tadayon Zadeh
- Department of Exercise Physiology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hamid Amini
- Department of Physical Education & Sport Sciences, Tolou-e-Mehr Non-profit Institute of Higher Education, Qom, Iran
| | - Saeed Habibi
- Physical Education Faculty, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
| | - Valiallah Shahedi
- Department of Physical Education and Sport Sciences, Parand Branch, Islamic Azad University, Parand, Iran
| | - Amin Isanejad
- Department of Physical Education & Sport Sciences, Faculty of Humanities, Shahed University, Tehran, Iran
| | - Mohsen Akbarpour
- Department of Physical Education, Faculty of Literature and Humanities, University of Qom, Qom, Iran
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Johansson S, Skjerbæk AG, Nørgaard M, Boesen F, Hvid LG, Dalgas U. Associations between fatigue impact and lifestyle factors in people with multiple sclerosis - The Danish MS hospitals rehabilitation study. Mult Scler Relat Disord 2021; 50:102799. [PMID: 33582566 DOI: 10.1016/j.msard.2021.102799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of medical treatment options to reduce fatigue in patients with multiple sclerosis (MS) emphasize the importance of identifying potential non-pharmacological modifiable factors, as this may help advance current treatment strategies. The aim of this study was to identify potential modifiable lifestyle factors as well as patient- and disease-related characteristics, that are associated with fatigue in a large sample of clinically well-characterized patients with MS. METHODS This study was a secondary analysis of a pragmatic randomized controlled trial of inpatient multidisciplinary rehabilitation in Denmark. MS patients aged 18 to 65 years and with a disease severity score ≤ 7.5 according to the Expanded Disability Status Scale participated. Data on patient- and disease-related characteristics, fatigue impact (Modified Fatigue Impact Scale (MFIS)), and on lifestyle factors (tobacco smoking, alcohol intake, and physical activity), were collected at baseline. A linear mixed model was used to compare MFIS total, physical, cognitive, and psychosocial scores across subgroups of selected characteristics. Regression analyses were used to examine associations between lifestyle factors and MFIS total, physical, cognitive, and psychosocial scores. RESULTS In the sample of 417 MS patients, median age was 51 years, 69% were female, median time since diagnosis was 8 years, with 41% having relapsing remitting MS. Higher MFIS total scores were observed in MS patients with shorter time since diagnosis, being a tobacco smoker, and not undertaking regular physical activity. Somewhat similar findings were observed for MFIS subscores (physical, cognitive, psychosocial), especially MFIS physical scores. In the multivariate analyses, physical activity was significantly associated with fatigue impact on total, physical and psychosocial functioning. Tobacco smoking was significantly associated with fatigue impact on psychosocial functioning. Alcohol intake was not associated with fatigue impact. None of the lifestyle factors were associated with fatigue impact on cognitive functioning. In the adjusted models time since diagnosis was significantly associated with fatigue impact on total, physical and cognitive functioning, as was disease severity with fatigue impact on physical and cognitive functioning. CONCLUSION Physical activity showed the most pronounced associations with fatigue impact on physical and psychosocial functioning, while the impact on cognitive functioning showed a trend. Tobacco smoking contributed significantly to impact on psychosocial functioning, while alcohol intake did not contribute to fatigue impact. Introducing or supporting maintenance of physical activity/exercise and cessation of tobacco smoking seems to be a useful approach for rehabilitation services to help patients with MS manage fatigue.
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Affiliation(s)
- Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals Function, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | - Finn Boesen
- MS Hospitals in Denmark, Ry and Haslev, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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20
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Effects of Maximal Strength Training on Perceived-Fatigue and Functional Mobility in Persons with Relapsing-Remitting Multiple Sclerosis. ACTA ACUST UNITED AC 2020; 56:medicina56120718. [PMID: 33419374 PMCID: PMC7765935 DOI: 10.3390/medicina56120718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Background and objectives: Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods: 26 participants with MS were balanced according to their pre-intervention fatigue scores and distributed into an MST group (n = 13) and a control group (CG; n = 13). The MST group completed eight weeks using high loads, evaluating detraining after ten weeks. Quadriceps and hamstring isokinetic (QPTIK; HPTIK) and isometric (QPTIM; HPTIM) peak torques were assessed using an isokinetic dynamometer. Effect size differences were estimated with the Hedges' g index (dg
). Fatigue was evaluated through the Fatigue Severity Scale (FSS), while functional mobility was assessed via the Timed Up and Go Test (TUG). Results: The MST significantly improved all the strength measurements after the intervention (Δ6.43-29.55%; p < 0.05) compared to the control group. FSS showed a significant reduction (59.97%, dg
= 5.41, large). The MST group also reduced the TUG time (19.69%; dg
= 0.93, large) compared to the control group. Improvements caused by the intervention did not remain after a 10-week follow-up, with decreases in strength performance from 4.40% to 13.86% (dg
= 0.24-0.56, small to moderate), 112.08% in the FSS (dg
= -3.88, large), and 16.93% in TUG (dg
= -1.07, large). Conclusions: MST (up to 90% 1RM) seems to be a feasible and useful way to obtain clinically relevant improvements in the perceived-fatigue symptoms and functional mobility. Still, symptom improvements decrease after a 10-week detraining period.
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21
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Langeskov-Christensen M, Hvid LG, Jensen HB, Nielsen HH, Petersen T, Stenager E, Hämäläinen P, Dalgas U. Efficacy of high-intensity aerobic exercise on cognitive performance in people with multiple sclerosis: A randomized controlled trial. Mult Scler 2020; 27:1585-1596. [PMID: 33232191 DOI: 10.1177/1352458520973619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment is highly prevalent in multiple sclerosis (MS). Progressive aerobic exercise (PAE) represents a promising approach toward preservation or even improvement of cognitive performance in people with MS (pwMS). OBJECTIVE To investigate the effects of PAE on the cognitive domains of information processing, learning and memory, and verbal fluency in pwMS. METHODS This randomized controlled trial included an exercise (n = 43, 24 weeks of supervised PAE, followed by self-guided physical activity) and a waitlist group (n = 43, 24 weeks of habitual lifestyle, followed by supervised PAE). Assessments included the Brief Repeatable Battery of Neuropsychological tests (BRB-N), self-reported mood, and cardiorespiratory fitness. Published reference data were used to compute Z-scores for BRB-N scores. Cognitive impairment was defined as one or more Z-scores ⩽ -1.5SD. RESULTS No between-group changes in the total group were observed in BRB-N scores following PAE. In the cognitively impaired subgroup (43% of the total group) the between-group point estimate suggested a potential clinical relevant improvement in the Symbol Digit Modalities Test (95% CI overlapping zero). Cardiorespiratory fitness increased in the total group and the cognitively impaired subgroup. CONCLUSION In the present representative MS group, 24 weeks of supervised PAE had no effect on any cognitive domain in the total group but potentially improved processing speed in the cognitively impaired subgroup.
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Affiliation(s)
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Henrik Boye Jensen
- Brain and Nerve Diseases, Lillebaelt Hospital, Kolding, Denmark/Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark/Department of Neurology, Odense University Hospital, Odense, Denmark/Brain Research - Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thor Petersen
- The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus C, Denmark
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22
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New Strategies for Rehabilitation and Pharmacological Treatment of Fatigue Syndrome in Multiple Sclerosis. J Clin Med 2020; 9:jcm9113592. [PMID: 33171768 PMCID: PMC7695014 DOI: 10.3390/jcm9113592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system (CNS), with an inflammatory demyelinating basis and a progressive course. The course of the disease is very diverse and unpredictable. Patients face many problems on a daily basis, such as problems with vision; sensory, balance, and gait disturbances; pain; muscle weakness; spasticity; tremor; urinary and fecal disorders; depression; and rapidly growing fatigue, which significantly influences quality of life among MS patients. Excessive fatigue occurs in most MS patients in all stages of this disease and is named MS-related fatigue. The crucial issue is the lack of effective treatment; therefore, this review focuses not only on the most common treatment methods, but also on additional novel therapies such as whole-body cryotherapy (WBC), functional electrical stimulation (FES), and non-invasive brain stimulation (NIBS). We also highlight the advantages and disadvantages of the most popular clinical scales used to measure fatigue. The entire understanding of the origins of MS-related fatigue may lead to the development of more effective strategies that can improve quality of life among MS patients. A literature search was performed using MEDLINE, EMBASE, and PEDro databases.
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23
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Ozkul C, Guclu-Gunduz A, Eldemir K, Apaydin Y, Yazici G, Irkec C. Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial. Mult Scler Relat Disord 2020; 45:102419. [PMID: 32736216 DOI: 10.1016/j.msard.2020.102419] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis (MS). The effects of different exercise trainings on cognitive functions in patients with MS are promising. However, the effects are not yet clear in MS patients with cognitive impairment. This study aimed to investigate the effect of combined exercise training on different cognitive functions in MS patients with cognitive impairment. METHODS Relapsing-remitting and mild disabled MS patients with cognitive impairment were randomly assigned to two groups: Exercise Group (EG, n:17) and the Control Group (CG, n:17). The EG received a combined exercise training consisting of aerobic and Pilates training in three sessions per week for 8 weeks while the CG performed the relaxation exercises at home. Cognitive functions, walking capacity, fatigue, mood, and quality of life were assessed at baseline and after eight weeks using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Six-Minute Walk Test (6-MWT), Fatigue Impact Scale (FIS), Beck's Depression Inventory (BDI) and MS Quality of Life-54 (MSQoL-54), respectively. RESULTS This study showed significant group-by-time interactions on long-term verbal memory, walking capacity, cognitive fatigue, and physical quality of life in favor of the EG (p<0.003). Moreover, verbal memory, visuospatial memory, verbal fluency, information processing speed, walking capacity, fatigue, and quality of life improved in the EG (p<0.05) while only verbal memory increased in the CG (p<0.05). Furthermore, the change in visuospatial memory was associated with the change in mental quality of life (r:0.352, p: 0.041) while the change in verbal fluency (r: -0.362, p:0.035) and processing speed (r: -0.356, p:0.039) were associated with the change in mood. CONCLUSION Combined exercise training has beneficial effects on different cognitive functions in mild disabled RRMS patients with cognitive impairment. In addition, there is a mutual relationship in improvements in cognitive functions, mood, and quality of life after exercise.
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Affiliation(s)
- Cagla Ozkul
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Arzu Guclu-Gunduz
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Kader Eldemir
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Yasemin Apaydin
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Gokhan Yazici
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Ceyla Irkec
- Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
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24
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Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti N, Dalgas U, DeLuca J, Feys P, Filippi M, Freeman J, Meza C, Inglese M, Motl RW, Rocca MA, Sandroff BM, Salter A, Cutter G. Study protocol: improving cognition in people with progressive multiple sclerosis: a multi-arm, randomized, blinded, sham-controlled trial of cognitive rehabilitation and aerobic exercise (COGEx). BMC Neurol 2020; 20:204. [PMID: 32443981 PMCID: PMC7245035 DOI: 10.1186/s12883-020-01772-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cognitive dysfunction affects up to 70% of people with progressive MS (PMS). It can exert a deleterious effect on activities of daily living, employment and relationships. Preliminary evidence suggests that performance can improve with cognitive rehabilitation (CR) and aerobic exercise (EX), but existing data are predominantly from people with relapsing-remitting MS without cognitive impairment. There is therefore a need to investigate whether this is also the case in people with progressive forms of the disease who have objectively identified cognitive impairment. It is hypothesized that CR and EX are effective treatments for people with PMS who have cognitive impairment, in particular processing speed (PS) deficits, and that a combination of these two treatments is more effective than each individual treatment given alone. We further hypothesize that improvements in PS will be associated with modifications of functional and/or structural plasticity within specific brain networks/regions involved in PS measured with advanced MRI techniques. METHODS This study is a multisite, randomized, double-blinded, sham controlled clinical trial of CR and aerobic exercise. Three hundred and sixty subjects from 11 sites will be randomly assigned into one of four groups: CR plus aerobic exercise; CR plus sham exercise; CR sham plus aerobic exercise and CR sham plus sham exercise. Subjects will participate in the assigned treatments for 12 weeks, twice a week. All subjects will have a cognitive and physical assessment at baseline, 12 weeks and 24 weeks. In an embedded sub-study, approximately 30% of subjects will undergo structural and functional MRI to investigate the neural mechanisms underlying the behavioral response. The primary outcome is the Symbol Digit Modalities Test (SDMT) measuring PS. Secondary outcome measures include: indices of verbal and non-verbal memory, depression, walking speed and a dual cognitive-motor task and MRI. DISCUSSION The study is being undertaken in 6 countries (11 centres) in multiple languages (English, Italian, Danish, Dutch); with testing material validated and standardized in these languages. The rationale for this approach is to obtain a robustly powered sample size and to demonstrate that these two interventions can be given effectively in multiple countries and in different languages. TRIAL REGISTRATION The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - Jeremy Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, DK-8000, Aarhus, Denmark.
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter Feys
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Devon, UK
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
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25
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Gharakhanlou R, Wesselmann L, Rademacher A, Lampit A, Negaresh R, Kaviani M, Oberste M, Motl RW, Sandroff BM, Bansi J, Baker JS, Heesen C, Zimmer P, Javelle F. Exercise training and cognitive performance in persons with multiple sclerosis: A systematic review and multilevel meta-analysis of clinical trials. Mult Scler 2020; 27:1977-1993. [PMID: 32390502 DOI: 10.1177/1352458520917935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive impairment is common, debilitating, and poorly managed in persons with multiple sclerosis (pwMS). Exercise training might have positive effects on cognitive performance in pwMS, yet the overall magnitude, heterogeneity, and potential moderators remain unclear. OBJECTIVE This three-level meta-analysis aims to identify the effects of exercise training and those of exercise modalities on global and domain-specific cognitive performance in pwMS. METHODS MEDLINE, PsycInfo, SportDiscus, CENTRAL, and EMBASE were screened for randomized and non-randomized clinical trials from inception to 27 January 2020, yielding 3091 articles. Based on titles and abstracts, 75 articles remained in the selection process. After full-text evaluation, 13 studies were finally selected (PROSPERO pre-registered). RESULTS The pooled effect of exercise training on the global cognitive performance was null (g = 0.04, 95% confidence interval (CI): -0.11 to 0.18) and no significant differences were displayed among domains. Heterogeneity within studies was null (I(2)2= 0.0%) and between studies was low (I(3)2= 25.1%). None of the moderators (exercise modalities, age, Expanded Disability Status Scale (EDSS), supervision, cognitive domains) reached significance. However, the exercise volume explained most of the overall heterogeneity (slope = 4.651 × 10-5, R(2)2 = 100%, R(3)2 = 52.34%). CONCLUSION These results do not support the efficacy of exercise training on global or domain-specific cognitive performance in pwMS. Future studies are needed to determine whether higher training dose are beneficial.
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Affiliation(s)
- Reza Gharakhanlou
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Leonie Wesselmann
- Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Annette Rademacher
- Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Amit Lampit
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Raoof Negaresh
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Mojtaba Kaviani
- School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada
| | - Max Oberste
- Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M Sandroff
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jens Bansi
- Department of Neurology, Kliniken-Valens, Rehabilitationsklinik-Valens, Valens, Switzerland
| | - Julien S Baker
- Institute for Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, UK
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Zimmer
- Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany/Department for Performance and Health (Sports Medicine), Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Florian Javelle
- Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
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26
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Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nat Rev Neurol 2020; 16:319-332. [PMID: 32372033 DOI: 10.1038/s41582-020-0355-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade.
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27
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Rooney S, Albalawi H, Paul L. Exercise in the management of multiple sclerosis relapses: current evidence and future perspectives. Neurodegener Dis Manag 2020; 10:103-115. [PMID: 32352357 DOI: 10.2217/nmt-2019-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Relapses are a common feature of multiple sclerosis; however, recovery from relapses is often incomplete, with up to half of people experiencing residual disabilities postrelapse. Therefore, treatments are required to promote recovery of function and reduce the extent of residual disabilities postrelapse. Accordingly, this Perspective article explores the role of exercise in relapse management. Current evidence from two studies suggests that exercise in combination with steroid therapy improves disability and quality of life postrelapse, and may be more beneficial in promoting relapse recovery than steroid therapy alone. However, given the small number of studies and methodological limitations, further studies are required to understand the effects of exercise in relapse management and the mechanism through which exercise influences relapse recovery.
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Affiliation(s)
- Scott Rooney
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom, G4 0BA
| | - Hani Albalawi
- College of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia, 47713
| | - Lorna Paul
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom, G4 0BA
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28
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Smith M, Williams G, Barker R. Finding the right balance with participation in exercise and sport for individuals with multiple sclerosis: protocol for a pre and post intervention feasibility study. BMJ Open 2020; 10:e035378. [PMID: 32193273 PMCID: PMC7150603 DOI: 10.1136/bmjopen-2019-035378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Individuals with minimal disability from multiple sclerosis (MS) requested advice on finding the right balance, between too much and too little exercise, when participating in their choice of sport or exercise. To optimise exercise participation during the early stages of the disease, a flexible exercise participation programme (FEPP) has been developed. The FEPP is novel because it provides guidance and support for individuals with MS to participate and progress in their preferred sport or exercise. The primary objective was to assess the feasibility of the FEPP. The secondary objective was to assess the feasibility of a larger trial to demonstrate the efficacy of the FEPP. METHODS AND ANALYSIS A stage I feasibility study of the FEPP, using a single group preintervention/post-intervention design, will be conducted with 16 participants with minimal disability from MS (Expanded Disability Status Scale level of 0-3.5). The 12-week FEPP will guide participants to independently participate in their preferred sport or exercise at a location of their choice. Exercise progression will be guided by individual energy levels and a weekly telephone coaching session with a physiotherapist. Participation in exercise or sport will be recorded in parallel with assessment of disease biomarkers (plasma cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor (TNF)), subjective vitality and high-level mobility. Acceptability of the FEPP will be assessed using a sequential explanatory mixed methods design where the findings of a participant survey will inform the interview guide for a series of focus groups.Feasibility of a larger trial will be assessed via process, resources, management and scientific metrics. Progression to a larger trial will depend on the achievement of specified minimum success criteria. ETHICS AND DISSEMINATION Ethical approval has been obtained for this study from the James Cook University Human Research Ethics Committee (H7956). Dissemination of findings is planned via peer-reviewed journals, conference presentations and media releases. The protocol date was 21 December 2019, V.1. TRIAL REGISTRATION NUMBER The trial is registered with Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000076976.
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gavin Williams
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
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29
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Kullberg S, Rivera NV, Eriksson MJ, Grunewald J, Eklund A. High-intensity resistance training in newly diagnosed sarcoidosis- an exploratory study of effects on lung function, muscle strength, fatigue, dyspnea, health-related quality of life and lung immune cells. Eur Clin Respir J 2020; 7:1730137. [PMID: 32158524 PMCID: PMC7048202 DOI: 10.1080/20018525.2020.1730137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023] Open
Abstract
Background: High-intensity resistance training is unexplored in untreated patients with newly diagnosed sarcoidosis. Objectives: To evaluate the effects of high-intensity resistance training on lung function, muscle strength, fatigue, dyspnea, health-related impairments, and lung immune cells. Methods: Eleven untreated patients with newly diagnosed sarcoidosis performed high-intensity resistance training at an intensity of 80% of 1 Repetition Maximum (RM) twice a week and daily inspiratory muscle training at regular intensity for 12 weeks. Assessment with spirometry, chest X-ray, questionnaires, and BAL (bronchoalveolar lavage) cells was performed before and in close adjacent to completed training. A final third assessment except bronchoscopy was performed at an average 5 months after the training period. Results: The training was well tolerated and muscular strength increased significantly while fatigue, dyspnea, and health-related impairments decreased, though not significantly in all measures. Mean percentage of lung lymphocytes decreased (p = 0.006). Conclusions: High-intensity resistance training and inspiratory muscle training at regular intensity in patients with newly diagnosed sarcoidosis led to improvements in muscular strength without adverse events and seems to be a non-invasive attractive way to improve fatigue, dyspnea, and quality of life. Analysis of lung immune cells possibly indicated a decreased inflammatory activity. These results provide a basis for larger randomized trials.
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Affiliation(s)
- Susanna Kullberg
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalia V Rivera
- Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria J Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Respiratory Medicine Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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30
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Grongstad A, Vøllestad NK, Oldervoll LM, Spruit MA, Edvardsen A. The acute impact of resistance training on fatigue in patients with pulmonary sarcoidosis. Chron Respir Dis 2020; 17:1479973120967024. [PMID: 33820449 PMCID: PMC7716061 DOI: 10.1177/1479973120967024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fatigue is the most prevalent symptom among patients with sarcoidosis, and skeletal muscle dysfunction is a common clinical feature, making resistance training (RT) a recommended treatment strategy. Despite lacking knowledge regarding whether high-intensity RT will aggravate fatigue, low to moderate-intensity is routinely used even if the evidence for this protocol to improve muscle strength is inconclusive. This study aimed to investigate whether one single session of high-intensity RT induces a higher increase in fatigue than one single session of moderate-intensity RT. In this randomized crossover study, 41 patients with pulmonary sarcoidosis (age: 53 ± 11 yr) were recruited. They randomly performed one single session of high-intensity RT, 4 sets × 5 repetitions maximum (5RM), and one single session of moderate-intensity RT, 2 sets × 25 RM. Fatigue was assessed with the Visual Analogue Scale (0–100 mm) immediately before (T0), immediately after (T1) and 24 hours after (T2) each exercise session. Fatigue development from T0 to T1 was significantly lower after 5RM (−3 ± 18 mm) than after 25RM (5 ± 15 mm), p = 0.004. No difference was seen from T0 to T2 between 5RM (0 ± 17 mm) and 25RM (6 ± 18 mm), p = 0.147. The high-intensity 5RM session did not induce a larger increase in fatigue than the moderate-intensity 25RM session. RT appears feasible and safe in patients with pulmonary sarcoidosis irrespective of the intensity. Thus, the long-term effects of high-intensity RT on fatigue should be explored in a RT programme of longer duration.
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Affiliation(s)
- Anita Grongstad
- LHL Hospital Gardermoen, Jessheim, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Line Merethe Oldervoll
- LHL Clinics, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Martijn Arthur Spruit
- Department of Research & Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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31
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Ramari C, Hvid LG, David ACD, Dalgas U. The importance of lower-extremity muscle strength for lower-limb functional capacity in multiple sclerosis: Systematic review. Ann Phys Rehabil Med 2019; 63:123-137. [PMID: 31816449 DOI: 10.1016/j.rehab.2019.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle strength) appear to have critical implications for lower-limb functional capacity. However, no review has summarized the current knowledge about the importance of muscle strength for functional tasks in PwMS. Expanding the current knowledge would advance the design of both clinical and research interventions aiming to improve functional capacity in PwMS. OBJECTIVES (1) To identify studies that measured lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS, and (2) to map associations between muscle strength and functional capacity. METHODS This review was based on a literature search (databases: PubMed, Embase). Included studies had to report data on lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS. The associations between muscle strength and functional capacity were analyzed by using the reported correlation coefficients (R) recalculated to the determination coefficient R2. Randomized trials and observational studies were included. RESULTS A total of 59 articles were reviewed; 17 (773 participants) reported associations between muscle strength and functional capacity. Lower-extremity muscle mechanical function explained a significant part of the variance in most lower-limb functional capacity tests (approximately 20-30%). This was particularly evident in muscle strength from the weakest leg. Muscle strength was predominantly tested on knee extensors and knee flexors by using isokinetic dynamometry during maximal isometric (0°/s) and dynamic (30-60°/s) contractions. Walking tests such as the timed 25-Foot Walk Test and 10-Min, 2-Min and 6-Min Walk Test were the most frequently performed functional capacity tests. CONCLUSIONS In PwMS, muscle strength of particularly the weakest limb explains 20% to 30% of the variance across a number of lower-limb functional capacity tests. Thus, exercise programs should focus on increasing lower-extremity muscle mechanical function in PwMS and minimizing strength asymmetry between limbs.
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Affiliation(s)
- Cintia Ramari
- Faculty of Physical Education, University of Brasilia, Brasília, Brazil.
| | - Lars G Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
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32
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Exercise and Neuroinflammation in Health and Disease. Int Neurourol J 2019; 23:S82-92. [PMID: 31795607 PMCID: PMC6905205 DOI: 10.5213/inj.1938214.107] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Neuroinflammation is a central pathological feature of several acute and chronic brain diseases, including Alzheimer disease (AD), Parkinson disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS). It induces microglia activation, mitochondrial dysfunction, the production of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), pro-inflammatory cytokines, and reactive oxygen species. Exercise, which plays an important role in maintaining and improving brain health, might be a highly effective intervention for preventing neuroinflammation-related diseases. Thus, since exercise can improve the neuroimmune response, we hypothesized that exercise would attenuate neuroinflammation-related diseases. In this review, we will highlight (1) the biological mechanisms that underlie AD, PD, ALS, and MS, including the neuroinflammation pathways associated with microglia activation, NF-κB, pro-inflammatory cytokines, mitochondrial dysfunction, and reactive oxygen species, and (2) the role of exercise in neuroinflammation-related neurodegenerative diseases.
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Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: A systematic review. Mult Scler Relat Disord 2019; 37:101485. [PMID: 31706166 DOI: 10.1016/j.msard.2019.101485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/03/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date. OBJECTIVE The objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention. METHODS A systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was (1) include human participants with definite diagnosis of MS (2) participants had to be aged 18 years or older (3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) (4) evaluate FES cycling as an intervention study. RESULTS Initial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n = =76 unique participants, with n = =82 completing a FES cycling intervention. Of the n = =4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n = =10 adverse events across 36 participants. CONCLUSION Findings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.
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Guo LY, Lozinski B, Yong VW. Exercise in multiple sclerosis and its models: Focus on the central nervous system outcomes. J Neurosci Res 2019; 98:509-523. [DOI: 10.1002/jnr.24524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Ling Yi Guo
- Department of Physiology and Pharmacology Western University London Ontario Canada
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
| | - Brian Lozinski
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
| | - Voon Wee Yong
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
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Herold F, Törpel A, Schega L, Müller NG. Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements - a systematic review. Eur Rev Aging Phys Act 2019; 16:10. [PMID: 31333805 PMCID: PMC6617693 DOI: 10.1186/s11556-019-0217-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND During the aging process, physical capabilities (e.g., muscular strength) and cognitive functions (e.g., memory) gradually decrease. Regarding cognitive functions, substantial functional (e.g., compensatory brain activity) and structural changes (e.g., shrinking of the hippocampus) in the brain cause this decline. Notably, growing evidence points towards a relationship between cognition and measures of muscular strength and muscle mass. Based on this emerging evidence, resistance exercises and/or resistance training, which contributes to the preservation and augmentation of muscular strength and muscle mass, may trigger beneficial neurobiological processes and could be crucial for healthy aging that includes preservation of the brain and cognition. Compared with the multitude of studies that have investigated the influence of endurance exercises and/or endurance training on cognitive performance and brain structure, considerably less work has focused on the effects of resistance exercises and/or resistance training. While the available evidence regarding resistance exercise-induced changes in cognitive functions is pooled, the underlying neurobiological processes, such as functional and structural brain changes, have yet to be summarized. Hence, the purpose of this systematic review is to provide an overview of resistance exercise-induced functional and/or structural brain changes that are related to cognitive functions. METHODS AND RESULTS A systematic literature search was conducted by two independent researchers across six electronic databases; 5957 records were returned, of which 18 were considered relevant and were analyzed. SHORT CONCLUSION Based on our analyses, resistance exercises and resistance training evoked substantial functional brain changes, especially in the frontal lobe, which were accompanied by improvements in executive functions. Furthermore, resistance training led to lower white matter atrophy and smaller white matter lesion volumes. However, based on the relatively small number of studies available, the findings should be interpreted cautiously. Hence, future studies are required to investigate the underlying neurobiological mechanisms and to verify whether the positive findings can be confirmed and transferred to other needy cohorts, such as older adults with dementia, sarcopenia and/or dynapenia.
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Affiliation(s)
- Fabian Herold
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Alexander Törpel
- Institute III, Department of Sport Science, Otto von Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany
| | - Lutz Schega
- Institute III, Department of Sport Science, Otto von Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany
| | - Notger G. Müller
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Brenneckestraße 6, 39118 Magdeburg, Germany
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
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Mezini S, Soundy A. A Thematic Synthesis Considering the Factors which Influence Multiple Sclerosis Related Fatigue during Physical Activity. Behav Sci (Basel) 2019; 9:E70. [PMID: 31266231 PMCID: PMC6680722 DOI: 10.3390/bs9070070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/04/2019] [Accepted: 06/21/2019] [Indexed: 01/18/2023] Open
Abstract
The purpose of this study is to consider the factors that influence fatigue related to physical activity in patients with multiple sclerosis (PwMS) and to identify the necessary adaptations undertaken by patients to remain active. A review using a thematic synthesis methodology situated within a subtle realist paradigm was undertaken. The review was completed in three stages: 1) search of relevant studies; 2) critical appraisal of literature; and 3) thematic synthesis. Nineteen studies met the inclusion criteria. This included a total of 263 participants of whom 243 were PwMS (159 females, 70 males and 14 unknown). The aggregated mean age was 53.3 years and aggregated mean time living with MS post diagnosis 11.3 years. Following critical appraisal, no articles were excluded. Three major themes were identified: (1) fatigue-related consequences, (2) exercise related barriers affecting fatigue, and (3) factors that make fatigue bearable for MS individuals. The thematic synthesis identified the cycle of activity and inactivity as a result of fatigue perception. Exercise experience, professional and social support, as well as the necessary adaptation of a training programme empower PwMS to adopt a more active coping strategy and enjoy the benefits of exercise. Clinicians could consider the implementation of a suitable, individualised exercise programme to reduce PwMS's stress during physical activities.
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Affiliation(s)
- Sofia Mezini
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
- Stratford Hospital, Arden Street, Stratford, Warwickshire CV37 6NX, UK.
| | - Andrew Soundy
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Mokhtarzade M, Agha-Alinejad H, Motl RW, Negaresh R, Baker JS, Zimmer P. Weight control and physical exercise in people with multiple sclerosis: Current knowledge and future perspectives. Complement Ther Med 2019; 43:240-246. [DOI: 10.1016/j.ctim.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/07/2019] [Indexed: 01/24/2023] Open
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Mañago MM, Glick S, Hebert JR, Coote S, Schenkman M. Strength Training to Improve Gait in People with Multiple Sclerosis: A Critical Review of Exercise Parameters and Intervention Approaches. Int J MS Care 2019; 21:47-56. [PMID: 31049034 DOI: 10.7224/1537-2073.2017-079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background There are mixed reports on the effectiveness of strength training to improve gait performance in people with multiple sclerosis (MS), yet the reasons for these inconsistent results are not clear. Therefore, a critical review was conducted to explore dosage, frequency, mode, position, and muscle targets of studies that have included strength training in people with MS. Methods An electronic search was conducted through July 2017. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets. Results Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, and four reported within-group changes. Four studies reported significant between-group gait improvements for gait speed and/or endurance, and two reported within-group changes. Most exercises were performed on exercise machines while sitting, supine, or prone. The most common intervention target was knee extension. Conclusions Studies generally improved strength, yet only two studies reported potentially meaningful between-group changes in gait. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength and explore muscles targets, positions, and modes that are task-specific to walking.
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Sandroff BM, DeLuca J. Will behavioral treatments for cognitive impairment in multiple sclerosis become standards-of-care? Int J Psychophysiol 2019; 154:67-79. [PMID: 30825477 DOI: 10.1016/j.ijpsycho.2019.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 02/08/2023]
Abstract
Cognitive impairment is common and debilitating in persons with multiple sclerosis (MS), and further is poorly-managed by pharmacotherapy. Cognitive rehabilitation and exercise training have been identified as promising behavioral approaches for managing MS-related cognitive impairment based on systematic reviews and meta-analyses. However, each body of literature is associated with similar sets of methodological shortcomings, as has been identified by periodic systematic reviews and meta-analyses. Thus, there is little generalizability or transportability research supporting either behavioral approach for managing cognitive dysfunction in this population under real-world conditions (i.e., as a standard-of-care). To that end, this paper aims to catalyze the advancement of cognitive rehabilitation and exercise training research in MS, respectively, towards the successful implementation of generalizability/transportability trials. This first involves critical examinations of the respective cognitive rehabilitation and exercise training literatures in MS from a chronological perspective, with particular emphasis on how the fields have each evolved in response to systematic reviews and meta-analyses. Accordingly, the current paper then provides a roadmap for harmonizing research in those areas to systematically and efficiently inform the development of generalizability/transportability trials for behavioral approaches to manage MS-related cognitive dysfunction. This involves the recognition of overlapping facilitators and impediments for progress in each field, including considerations for the implementation of neuroimaging. Ultimately, the provision of such a framework aims to shorten the timeline for research to influence clinical practice and improve the lives of cognitively-impaired persons with MS.
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Affiliation(s)
- Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, NJ, USA
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Effects of running on adiponectin, insulin and cytokines in cerebrospinal fluid in healthy young individuals. Sci Rep 2019; 9:1959. [PMID: 30760755 PMCID: PMC6374465 DOI: 10.1038/s41598-018-38201-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/19/2018] [Indexed: 12/17/2022] Open
Abstract
Exercise can prevent the sedentary lifestyle-related risk of metabolic and cognitive decline, but mechanisms and mediators of exercise effects on human brain are relatively unexplored. We measured acute exercise-induced changes in adiponectin, insulin and other bioactive molecules in cerebrospinal fluid (CSF) and serum from young lean individuals. Samples of serum and CSF were obtained before and 1-h after the 90-min run (75–80% HRmax; maximal heart rate), additional serum was taken at finish-line. Body composition, physical fitness, metabolic rate, cognitive functions, food preference, glucose, insulin and albumin were measured. The spectrum of 174 cytokines was assessed by protein arrays, adiponectin was also determined by ELISA and immunoblotting. CSF adiponectin decreased post-exercise by 21.3% (arrays) and 25.8% (ELISA) (p < 0.009). Immunoblotting revealed reduction in a low-molecular-weight-adiponectin (p < 0.005). CSF adiponectin positively correlated with CSF/serum albumin ratio (p < 0.022), an indicator of blood-brain-barrier permeability. CSF and serum adiponectin were positively associated with memory and running-induced changes in insulinemia and CSF insulin. Additionally, running modulated CSF levels of 16 other cytokines. Acute running reduced CSF adiponectin and modulated insulin and albumin in CSF and serum. Associations of adiponectin with memory and metabolism indicate the potential role of this bioactive molecule in mediating exercise-induced adaptive response in human brain.
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Langeskov-Christensen M, Eskildsen S, Stenager E, Boye Jensen H, Hvilsted Nielsen H, Petersen T, Grøndahl Hvid L, Hämäläinen P, Marstrand L, Dalgas U. Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis-A Cross-Sectional Investigation. J Clin Med 2018; 7:jcm7090272. [PMID: 30208632 PMCID: PMC6162835 DOI: 10.3390/jcm7090272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022] Open
Abstract
(1) Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Staying physically fit may be associated with preservation of cognitive performance in persons with MS (pwMS); (2) Objective: To investigate the association between aerobic capacity and the cognitive domains of information processing, learning and memory, and verbal fluency as well as single and composite z-scores of the Brief Repeatable Battery of Neuropsychological tests (BRBNT) in pwMS; (3) Methods: All subjects first performed the BRBNT and then a maximal oxygen consumption (VO2-max) test on a bicycle ergometer as a measure of aerobic capacity. Simple and multiple (adjusting for age, sex, and education level) regression analyses were performed to evaluate the relationship between aerobic capacity and cognitive performance in different domains. Published international norms were used to compute z-scores for each individual and composite BRBNT score. Furthermore, cognitive impairment was defined as one or more z-scores ≤−1.5 standard deviation (SD) of healthy controls; (4) Results: Eighty-four subjects were included (44.9 ± 9 years, 16.3 ± 2 education years, Expanded Disability Status Scale (EDSS): 2.6 ± 1.4, MS-type (relapsing-remitting, primary progressive, or secondary progressive): 73/6/5, disease duration: 9.9 ± 7 years, VO2-max: 28.4 ± 7.0 mL O2/min/kg). No significant associations between aerobic capacity and cognitive performance in the individual BRBNT tests were found, except that a weak relationship was found between aerobic capacity and the composite processing speed z-score (R2 = 0.06, p = 0.02). The average global BRBNT z-score (−0.2 ± 0.66) was not associated with aerobic capacity. Comparison of the cognitively impaired group (34.5%) with the nonimpaired group (65.5%) showed lower aerobic capacity in the impaired group (25.9 ± 1 vs. 29.7 ± 1 mLO2/min/kg, p = 0.02); (5) Conclusions: Limited support was found for an association between performance in most cognitive domains and aerobic capacity in the present MS group with a third of patients showing signs of cognitive impairments.
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Affiliation(s)
| | - Søren Eskildsen
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
| | - Henrik Boye Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
- Brain and Nerve Diseases, Department of Neurology, Hospital Lillebaelt, 6000 Kolding, Denmark.
| | - Helle Hvilsted Nielsen
- The Multiple Sclerosis Clinic, Department of Neurology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Thor Petersen
- The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - Lars Grøndahl Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Lisbet Marstrand
- The Danish Multiple Sclerosis Centre, Department of Neurology, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
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Hanken K, Sander C, Qaiser L, Schlake HP, Kastrup A, Haupts M, Eling P, Hildebrandt H. Salivary IL-1ß as an Objective Measure for Fatigue in Multiple Sclerosis? Front Neurol 2018; 9:574. [PMID: 30061859 PMCID: PMC6055002 DOI: 10.3389/fneur.2018.00574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022] Open
Abstract
Background: The causes of fatigue in multiple sclerosis (MS) and other inflammatory disorders are not well understood. One possible cause that might explain fatigue in inflammatory disorders appears to be the immunological process itself, triggering neural activity that is experienced as fatigue. Objectives: To investigate whether salivary IL-1ß concentration, associated with systemic inflammation, is related to subjective fatigue in MS. Methods: 116 MS patients (62 relapsing remitting MS, 54 secondary progressive MS) and 51 healthy controls participated in this study. Salivary concentration of IL-1ß was determined using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Fatigue was assessed using various fatigue scales. We compared IL-1ß concentration between groups and performed regression analyses to investigate which variables best predict fatigue scores. Results: We found that the IL-1ß concentration best predicts fatigue scores in relapsing remitting MS patients, even though the IL-1ß concentration did not differ significantly between relapsing remitting MS patients and healthy controls. Secondary progressive MS patients showed a somewhat elevated IL-1ß concentration compared to relapsing remitting MS patients and healthy controls. Furthermore, disease modifying treatment had a significant effect on the IL-1ß concentration, with treated patients showing a lower IL-1ß concentration than non-treated patients. Conclusions: The present study points to a significant relation between the proinflammatory cytokine IL-1ß and fatigue in relapsing remitting MS patients. It also suggests a potential effect of disease modifying treatment on the peripheral IL-1ß concentration.
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Affiliation(s)
- Katrin Hanken
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
| | - Carina Sander
- Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Rehabilitationszentrum Oldenburg GmbH, Oldenburg, Germany
| | - Lara Qaiser
- Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | - Andreas Kastrup
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
| | - Michael Haupts
- Augustahospital Anholt, Clinic for Neurology, Anholt, Germany.,Department of Neurology, Heinrich-Heine-Uni, Dusseldorf, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany.,Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Effects of exercise training on cytokines and adipokines in multiple Sclerosis: A systematic review. Mult Scler Relat Disord 2018; 24:91-100. [PMID: 29982111 DOI: 10.1016/j.msard.2018.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/12/2018] [Accepted: 06/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Physical activity, particularly exercise training, is an evidence-based approach for managing symptoms, restoring function and improving overall wellness in people with multiple sclerosis (MS). Several recent studies have argued for a potential disease modifying effect of exercise in people with MS, and among the potential mediating mechanisms are exercise training effects on both cytokines and adipokines. The objectives of this study were to perform a systematic review of exercise training effects on cytokine and adipokine profiles in persons with MS. METHODS We conducted open-dated searches of PubMed, Cochrane Library, EMBASE and PEDro using the terms 'Multiple sclerosis' or 'MS' AND 'exercise' OR 'training' OR 'physical activity' AND 'cytokine' OR 'inflammatory' OR 'immune' OR 'adipokine'. Included studies were written in English; comprised of humans with MS, and evaluated the effects of regular physical activity or exercise on pro-inflammatory, anti-inflammatory cytokines or adipokines. Two authors independently scanned titles and abstracts, and read the studies included. All studies were rated on the PEDro scale and further classified based on American Academy of Neurology criteria. RESULTS Twelve studies were included of which 10 studies focused on cytokines, 1 study focused on adipokines, and 1 study included both cytokines and adipokines. The selected studies included 3 Class I studies, 7 Class II studies, and 2 Class IV studies and had average PEDro scores of 6.9 ± 1.6. Studies included endurance (n = 5), resistance (n = 3), combined (n = 3), and vibration (n = 1) training. Overall, there is a general lack of standardization of procedures across studies and inconsistent evidence for the effects of physical activity and exercise on cytokine and adipokine profiles in MS, with a general pattern indicating a lack of effect. CONCLUSION Research regarding the effects of exercise training on cytokines and adipokines in MS is in its infancy, but exercise represents an adjuvant therapy in MS, and future studies are essential for clarifying the role of exercise on cytokines and adipokines in MS.
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Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation. Mult Scler 2018; 24:886-894. [DOI: 10.1177/1352458518777377] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While early medical treatment has proven effective in MS, early-phase MS rehabilitation has not gained much attention in MS research and clinical practice. Exercise therapy is one of the most promising treatment strategies in MS rehabilitation. Here, we provide a topical review investigating when exercise therapy is initiated in existing MS studies, showing that exercise is initiated at a rather late disease stage, where it predominantly serves as a symptomatic treatment. Recent findings in MS suggest that exercise may have neuroprotective and disease-modifying effects. Such findings along with the findings from medical trials that an early-stage “window of opportunity” exists leads to the proposal that early exercise therapy should be an increased focus in research and clinical practice for persons with MS. A further perspective relates to other rehabilitation interventions that are also initiated at a later disease stage, as these may also take advantage of an early-phase approach.
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Affiliation(s)
- Morten Riemenschneider
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Lars G Hvid
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
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Chalah MA, Ayache SS. Is there a link between inflammation and fatigue in multiple sclerosis? J Inflamm Res 2018; 11:253-264. [PMID: 29922081 PMCID: PMC5995280 DOI: 10.2147/jir.s167199] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Among autoimmune diseases of the central nervous system stands multiple sclerosis (MS), which is characterized by demyelination, synaptopathy, and neurodegeneration. MS fatigue can affect up to 90% of patients and be very disabling, with a drastic impact on their quality of life. To date, the evaluation of MS fatigue has relied mainly on subjective scales, and actual therapeutic interventions are challenged by modest efficacy and numerous undesirable effects. Therefore, finding biomarkers of MS fatigue might help in optimizing evaluation and treatment strategies. The main objective here was to assess the relationship between MS fatigue and inflammatory or other immunomediated markers. Methods Research was conducted according to PRISMA guidelines. Computerized databases (ie, PubMed/Medline and Scopus) were consulted till February 2018 aiming to identify articles that addressed inflammation and MS fatigue. Studies in English and French published at any time were considered. Results A total of 27 studies matched the research criteria. Inconsistency existed regarding the relationship between fatigue and the orexin A system, hypothalamus–pituitary–adrenal axis, and cerebrospinal fluid inflammatory markers. As for peripheral markers, although there was scarcity in the available data, serum proinflammatory cytokines (ie, IL6, TNFα, and IFNγ) seem to be associated with MS fatigue. Finally, no link was found between MS fatigue and T-cell populations (ie, CD3+CD4+ T lymphocytes, regulatory T cells) or other peripheral markers of inflammation (ie, CRP, erythrocyte-sedimentation rate, soluble ICAM1). Conclusion Future large-scale studies would benefit from comparing the relationship between fatigue and immune measures in patients with different disease phenotypes with and without disease-modifying drugs. With the subjective nature of fatigue scales, finding objective biomarkers for fatigue would be of great help.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Neurology Division, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
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Willekens B, Perrotta G, Cras P, Cools N. Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis? Front Behav Neurosci 2018; 12:103. [PMID: 29872382 PMCID: PMC5972188 DOI: 10.3389/fnbeh.2018.00103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/30/2018] [Indexed: 01/01/2023] Open
Abstract
Mindfulness was introduced in the Western world by Jon Kabat-Zinn in 1979. He defined it as "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally." Since then, research on mindfulness-based interventions (MBIs) has increased exponentially both in health and disease, including in patients with neurodegenerative diseases such as dementia and Parkinson's disease. Research on the effect of mindfulness and multiple sclerosis (MS) only recently gained interest. Several studies completed since 2010 provided evidence that mindfulness improves quality of life (QoL), depression and fatigue in MS patients. In addition to patient-reported outcome measures, potential effects on cognitive function have been investigated only to a very limited extent. However, research on laboratory biomarkers and neuroimaging, capable to deliver proof-of-concept of this behavioral treatment in MS, is mainly lacking. In this perspective, we illustrate possible neurobiological mechanisms, including the tripartite interaction between the brain, the immune system and neuroendocrine regulation, through which this treatment might affect multiple sclerosis symptoms. We propose to (1) include immunological and/or neuroimaging biomarkers as standard outcome measures in future research dedicated to mindfulness and MS to help explain the clinical improvements seen in fatigue and depression; (2) to investigate effects on enhancing cognitive reserve and cognitive function; and (3) to investigate the effects of mindfulness on the disease course in MS.
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Affiliation(s)
- Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | | | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Department of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Neurology, Laboratory for Neurobiology, Born-Bunge Institute, University of Antwerp, Antwerp, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Ozkul C, Guclu-Gunduz A, Irkec C, Fidan I, Aydin Y, Ozkan T, Yazici G. Effect of combined exercise training on serum brain-derived neurotrophic factor, suppressors of cytokine signaling 1 and 3 in patients with multiple sclerosis. J Neuroimmunol 2018; 316:121-129. [DOI: 10.1016/j.jneuroim.2018.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
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Zimmer P, Bloch W, Schenk A, Oberste M, Riedel S, Kool J, Langdon D, Dalgas U, Kesselring J, Bansi J. High-intensity interval exercise improves cognitive performance and reduces matrix metalloproteinases-2 serum levels in persons with multiple sclerosis: A randomized controlled trial. Mult Scler 2017; 24:1635-1644. [PMID: 28825348 DOI: 10.1177/1352458517728342] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aerobic exercise can improve cognitive performance in healthy elderly people. OBJECTIVE The aim of this study was to investigate the influence of a 3-week high-intensity aerobic exercise programme (high-intensity training group (HIT)) on cognitive performance in persons with multiple sclerosis (MS) compared with a standard exercise programme (control training (CT)). METHODS A total of 60 persons with MS (Expanded Disability Status Scale (EDSS): 1.0-6.5) were randomized to a HIT group (3×/week for 20 minutes, including five 3-minute exercise intervals at 80% of peak oxygen uptake (VO2-peak)) or a CT group (continuously 5×/week for 30 minutes/session at 65% of VO2-peak). Cognitive performance was assessed using the Brief International Cognitive Assessment for MS at entry ( t0) and discharge ( t1). Furthermore, VO2-peak, brain-derived neurotrophic factor, serotonin and matrix metalloproteinases (MMP)-2 and -9 were measured. RESULTS Compared to CT, HIT significantly improved verbal memory. Significant improvements over time in executive functions were found in both groups. Secondary outcomes indicated significant improvements in VO2-peak and a significant reduction in MMP-2 in the HIT group only. CONCLUSION HIT represents a promising strategy to improve verbal memory and physical fitness in persons with MS. Further research is needed to determine the impact of exercise on biomarkers in MS.
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Affiliation(s)
- Philipp Zimmer
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany/National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alexander Schenk
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Max Oberste
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | | | - Jan Kool
- Department of Neurology, Kliniken Valens, Valens, Switzerland
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jürg Kesselring
- Department of Neurology, Kliniken Valens, Valens, Switzerland
| | - Jens Bansi
- Department of Neurology, Kliniken Valens, Valens, Switzerland
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Mokhtarzade M, Ranjbar R, Majdinasab N, Patel D, Molanouri Shamsi M. Effect of aerobic interval training on serum IL-10, TNFα, and adipokines levels in women with multiple sclerosis: possible relations with fatigue and quality of life. Endocrine 2017; 57:262-271. [PMID: 28616851 DOI: 10.1007/s12020-017-1337-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/29/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE Multiple sclerosis is associated with immune system dysfunction and chronic inflammation; however, possible relations between immunologic and metabolic factors and some psychological indexes such as fatigue and quality of life, especially in relation to exercise training, have not yet been investigated. The present study was designed to investigate the effect of aerobic interval training on interleukin-10/tumor necrosis factor ratio and adipokine (leptin and adiponectin) concentrations in women with multiple sclerosis. Furthermore, the relationship between these factors with fatigue and quality of life were assessed. METHODS Forty women with multiple sclerosis (Expanded Disability Status Scale ≤3) were randomized into either a non-exercising control or training group. The training group performed 8-weeks of upper and lower limb aerobic interval training. Serum concentrations of tumor necrosis factorα, interleukin-10, leptin, and adiponectin were measured before and after the 8-week intervention. Moreover, antropometric measures and measures for fatigue and quality of life were determined at the onset of and after exercise training. RESULTS The results revealed that leptin and tumor necrosis factorα levels significantly decreased subsequent to the aerobic interval training. Although blood adiponectin levels considerably increased in the training group, interleukin-10 and interleukin-10/tumor necrosis factorα ratio underwent no substantial change after the exercise training. In addition, the aerobic interval training was associated with improvement in fatigue, quality of life, and maximal oxygen consumption. CONCLUSIONS Our findings suggested that aerobic interval training can be an effective strategy for managing the immune system at least by its significant impact on inflammatory cytokines and adipokines levels in women with multiple sclerosis. Additionally, this positive impact improved fatigue and adipose tissue indicators.
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Affiliation(s)
| | - Rouholah Ranjbar
- Department of Sport Physiology, Shahid Chamran University, Ahvaz, Iran
| | - Nastaran Majdinasab
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Darpan Patel
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mehdieh Molanouri Shamsi
- Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
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Lee JE, Bisht B, Hall MJ, Rubenstein LM, Louison R, Klein DT, Wahls TL. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr 2017; 36:150-168. [PMID: 28394724 DOI: 10.1080/07315724.2016.1255160] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether participation in a 12-month multimodal intervention would improve mood and cognitive function in adults with progressive multiple sclerosis (MS). METHODS In this one-arm, open-label feasibility trial, participants were prescribed a home-based multimodal intervention, including (1) a modified Paleolithic diet; (2) an exercise program (stretching and strengthening of the trunk and lower limb muscles); (3) neuromuscular electrical stimulation (EStim) of trunk and lower limb muscles; and (4) stress management (meditation and self-massage). Individuals completed measures of mood (Beck Anxiety and Depression Inventories) and cognitive (Cognitive Stability Index, Cognitive Screening Test, Delis-Kaplan Executive Function System) and executive function (Wechsler Adult Intelligence Scale) at baseline and 3, 6, 9, and 12 months after the start of the intervention. Dosage of the multimodal intervention was assessed at 3, 6, 9, and 12 months. RESULTS The more individuals participated in the intervention activities, the greater improvements they had from baseline to 12 months on self-report measures of anxiety (Beck Anxiety Inventory [BAI]; ps = 0.001 to 0.02), depression (Beck Depression Inventory [BDI]; ps = <0.0001 to 0.09), cognitive function (Cognitive Stability Index [CSI/T], Delis-Kaplan Executive Function System [DKEFS]; ps = 0.001 to 0.06), and executive function (Wechsler Adult Intelligence Scale [WAIS]; ps = <0.0001 to 0.09). Mood and cognitive improvements were more closely related to a higher intake of the modified Paleolithic diet than to exercise and stress management dosage. Anxiety and depression changes were evident after just a few months, whereas changes in cognitive function were generally not observed until later in the intervention period. Mood and cognitive function changes from baseline to 12 months were significantly associated with fatigue improvements (ps = <0.0001 to 0.03). CONCLUSIONS A modified Paleolithic diet, exercise, EStim, and stress management intervention like this one has the potential to improve the mood and cognitive symptoms that can lead to considerable suffering in people with MS, potentially improving quality of life and function for people with progressive MS.
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Affiliation(s)
- Jennifer E Lee
- a Department of Psychology , Mount Mercy University , Cedar Rapids , Iowa.,b College of Nursing, The University of Iowa , Iowa City , Iowa
| | - Babita Bisht
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa
| | - Michael J Hall
- d Department of Psychiatry , Iowa City VA Health Care System , Iowa City , Iowa.,e Department of Psychiatry , Carver College of Medicine, University of Iowa , Iowa City , Iowa
| | | | - Rebecca Louison
- a Department of Psychology , Mount Mercy University , Cedar Rapids , Iowa
| | - Danielle T Klein
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa
| | - Terry L Wahls
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa.,g Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System , Iowa City , Iowa
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