More gain, less pain: How resistance training affects immune system functioning in multiple sclerosis patients: A review

Association between frailty and inflammatory cytokines in patients with multiple sclerosis: a case-control study

BACKGROUND

Frailty is a common symptom in Multiple Sclerosis (MS), yet its precise mechanism remains elusive, and the clinical implications of frailty in MS are uncertain. Moreover, inflammation is closely linked to frailty. This study aims to assess serum cytokine levels in individuals with MS and explore their correlation with frailty.

METHODS

A case-control study included 83 primary MS patients and 100 healthy individuals undergoing health check-ups. Serum cytokine levels were measured, and MS severity was determined using the Expanded Disability Status Scale (EDSS) score. Additionally, a comprehensive frailty index (FI) was calculated based on health deficits from various domains following standardized procedures.

RESULTS

Serum IL-6 and TNF-α levels were significantly higher in the frail group than in the non-frail group, with a statistically significant difference (P < 0.05). After adjusting for disease duration, sex, age, BMI, SBP, and DBP, serum IL-6 independently correlated with frailty in MS patients (OR = 1.46; 95 % CI = 1.02-1.93; P = 0.003). Moreover, increased serum IL-6 levels were associated positively with the frailty index (β = 0.123, P = 0.008).

CONCLUSION

Our initial findings suggest elevated levels of pro-inflammatory cytokines in MS patients with frailty, with IL-6 showing a positive correlation with frail indices. These results underscore the potential impact of inflammatory responses on frailty development in MS.

The Effect of Pain, Fatigue, and Sleep Quality on Activities of Daily Living in Patients with Multiple Sclerosis by Gender: A Descriptive Study from Turkey

BACKGROUND

Multiple sclerosis (MS) is a chronic neurological disease that progresses with crisis and remission and causes significant psychosocial problems. Fatigue and sleep disorders are reported to be the most frequent problems that could change by gender and potentially affect daily living activities.

AIM

This study aimed to examine the effects of pain, fatigue, and sleep quality on the activities of daily living in patients with multiple sclerosis by gender.

METHODS

This cross-sectional study involved 188 patients with MS. G*Power 3.4.9 was used in the study sample estimation, and it was found that at least 111 women and 45 men individuals should be reached with 0.5 (medium) effect size, 80% power, 5% type I error, and 2.5 allocation ratio. Considering 10% data loss, the study was completed with 188 multiple sclerosis patients, 134 women and 54 men.

RESULTS

PwMS's pain, fatigue, sleep, and daily living activities were compared according to gender; it was found that the difference in the mean scores of women's PSQI subdimension "habitual sleep efficiency" was statistically significantly higher than that of men's (P < 0.05). A negative correlation was found between FIS scores and NEADL total scores and subdimension scores in men and women with MS (P < 0.05). In women with MS, the degree of fatigue being "important" (9.184 units) and "very important" (7.893 units) reduces daily living activities. In men with MS, "poor sleep quality" reduces activities of daily living (11.559 units).

CONCLUSION

According to gender, women's DLA was negatively affected by fatigue, while men's DLA was negatively affected by poor sleep quality. Therefore, increased sleep disorders in men and fatigue in women may cause a decrease in daily life activities.

Pumping up the Fight against Multiple Sclerosis: The Effects of High-Intensity Resistance Training on Functional Capacity, Muscle Mass, and Axonal Damage

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.

Interventions to Improve Quality of Life in Multiple Sclerosis: New Opportunities and Key Talking Points

Background

Today, living well with multiple sclerosis (MS) is often measured by a person's overall quality of life rather than being limited to the more traditional metrics of reduced frequency of relapses or progression of disability. This change in focus, to a more holistic view of health, such as overall quality of life, has shifted the views of what both providers and people with multiple sclerosis view as essential for living well with MS.

Purpose

This narrative review aims to examine the relevant literature on existing and emerging non-pharmacological interventions shown to improve the quality of life for people with multiple sclerosis across all health domains.

Methods

A literature search was conducted on MEDLINE, CINAHL, and Scopus electronic databases using the following search terms: quality of life, health-related quality of life, life quality, life satisfaction, non-pharmacological intervention, non-drug, and intervention. After screening the abstracts, 24 were selected for this review.

Results

Common non-pharmacological interventions were used for fatigue and sleep, mental and emotional health, cognition, physical health, and chronic pain. Several non-pharmacological interventions included in this review positively improved the overall quality of life for people with multiple sclerosis. These interventions included exercise, cognitive behavior therapy, and cognitive rehabilitation.

Conclusion

Non-pharmacological interventions such as exercise and cognitive behavioral therapy improve the quality of life for people with MS. These interventions should be prescribed more during routine medical care. Translating this research into standard clinical practice should be one area of focus. In addition, higher quality studies, such as randomized control trials, need to be conducted on emerging nonpharmacological interventions to assess effectiveness.

Exploring the impact of exercise and essential amino acid plus cholecalciferol supplementation on physical fitness and body composition in multiple sclerosis: A case study

Key Clinical Message

In MS patients, especially those frail or malnourished, combining home-based exercise twice weekly with essential amino acids and vitamin D may improve body composition, strength, and physical performance, enabling long-term functional improvements.

Abstract

Multiple sclerosis (MS) is associated with reduced bone and muscle strength and function. We aimed to investigate the effectiveness of a 24-week intervention in a 57-year-old frail female with MS. The participant completed a 2×/week exercise intervention and ingested 2×/day a supplement containing 7.5 g essential amino acids and 500 IU cholecalciferol. Body composition, 6-m gait speed (GS), handgrip strength (HGS), 30-sec arm-curl test (30ACT), 6-min walking test (6MWT), 30-sec chair-stand test (30CST), and plasma concentrations of 25-hydroxyvitamin D3 [25(OH)D3], insulin-like growth factor 1 (IGF-1), and amino acids were assessed at baseline, and at Weeks 12 and 24. Plasma 25(OH)D3 increased from 23.2 to 41.3 ng/mL and IGF-1 from 131.6 to 140.7 ng/mL from baseline to post-intervention. BMI, total lean tissue mass (LTM), fat mass, bone mineral content, and the sum of 17 amino acids increased by 3.8, 1.0, 3.5, 0.2, and 19%, respectively, at Week 24. There were clinically significant increases in regional LTM (6.9% arms and 6.3% legs) and large increases in GS (67.3%), dominant HGS (31.5%), non-dominant HGS (11.8%), dominant 30ACT (100%), non-dominant 30ACT (116.7%), 6MWT (125.6%), and 30CST (44.4%). The current intervention was effective in improving components of physical fitness and body composition in a female with MS.