Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis

Scoping review of the music-based movement therapy Ronnie Gardiner Method

PURPOSE

Ronnie Gardiner Method (RGM) is a music-based movement therapy that has long been used within rehabilitation. There is a need to (1) identify the scope of the use of RGM, (2) explore potential benefits, (3) examine qualitative studies to capture perspectives from participants and practitioners, and (4) identify knowledge gaps to be addressed in future research.

MATERIALS AND METHODS

A scoping review methodology was conducted. PubMed, CINAHL, Scopus, as well as the search engines DIVA portal, Libris.se, Google Scholar, and uppsatser.se were searched. Quantitative studies were summarised using diagnosis as a differentiating criterion, and qualitative studies were summarised in a narrative synthesis.

RESULTS

Twenty-three studies were included, the vast majority of which consisted of non-peer-reviewed publications/grey literature. There is initial research evidence on potential benefits for stroke rehabilitation, with inconclusive results in other populations. Qualitative data indicate that RGM is adequately challenging and motivating for participants, with positive perceptions of recovery and quality of life.

CONCLUSIONS

Findings indicate that RGM could serve as a valuable addition to neurological rehabilitation. Potential benefits were identified, and qualitative data indicate that RGM is perceived as motivating and enjoyable. Future research should employ robust study designs, including controlled trials, to further validate RGM.

Dry needling in multiple sclerosis: a scoping review

OBJECTIVE

Dry needling (DN) has recently been investigated as an alternative strategy to reduce muscle spasticity and improve mobility in people with multiple sclerosis (pwMS). The aim of the present review was to identify any available literature on the potential benefits of DN in pwMS.

METHODS

A systematic literature search was conducted in the PubMed, Scopus, ScienceDirect, Embase/Ovid, CINAHL, CENTRAL, Web of Science and PEDro databases and at ClinicalTrials.gov. The search results were limited to studies published between 2000 and 2023 without language restrictions. All articles reporting on the application of DN (defined as the use of a needle to target myofascial trigger point(s) without injection) in pwMS were included. Studies related to traditional medicine were excluded. Two reviewers independently investigated the quality of reporting based on Joanna Briggs Institute critical appraisal tools. Data on the effects of DN on muscle spasticity, pain intensity, mobility and other reported outcomes in pwMS were extracted and analyzed.

RESULTS

Four original articles (two case reports and two case series) and one conference paper reporting the findings of a randomized controlled trial randomized controlled trial (RCT) were included. The RCT was small (n = 16 participants) and sham-controlled with no significant differences between groups. In all four case reports/series, reduced spasticity was observed following DN treatment in pwMS. Findings with respect to other outcomes (including pain intensity, mobility, quality of life, manual dexterity and disability reduction) were mixed.

CONCLUSION

Although no firm conclusions can be drawn from these uncontrolled case reports/series, DN for pwMS appears feasible and (based on limited clinical observation) may have potential as an adjunct therapeutic method to address spasticity in pwMS. However, the quantity and quality of available data are extremely limited. There is a need for high-quality studies of DN (ideally adequately sized RCTs with a low risk of bias) to further explore its effectiveness in the MS population.

Comparative Effectiveness of Exercise on Cardiorespiratory Function or Exercise Efficiency After Stroke: A Network Meta-analysis of Randomized Control Trials

OBJECTIVE

The network meta-analysis was to compare and rank the effectiveness of different exercises on cardiorespiratory function or exercise efficiency in poststroke patients.

DESIGN

A network meta-analysis of randomized controlled trials was conducted. PubMed, Embase, Cochrane Library, and Web of Science were searched. The impact of exercises including individual and combination of aerobic exercise, resistance exercise, task-oriented training, gait training, breathing exercise, and regular rehabilitation training on 6-min walk test, peak oxygen consumption, maximum oxygen consumption, resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure were assessed.

RESULTS

In total, 36 studies were included in the meta-analysis. Aerobic exercise + GT (63.06%) had the highest likelihood of improving 6-min walk test performance in poststroke patients. Regular rehabilitation training + resistance exercise was the most favorable exercise in terms of 6-min walk test performance assessing by minimum clinically significant difference. Aerobic exercise + resistance exercise had the highest likelihood of improving peak oxygen consumption and reducing resting heart rate in poststroke patients.

CONCLUSION

Different types of exercise demonstrated the benefits of improving cardiorespiratory function in stroke patients. Further research is needed to determine the best exercise regimen to maximize the benefits of rehabilitation interventions for poststroke patients.

Comparison of Five Rehabilitation Interventions for Acute Ischemic Stroke: A Randomized Trial

Background: Comparative efficacy of rehabilitation interventions in persons with acute ischemic stroke (PwS) is limited. This randomized trial assessed the immediate and lasting effects of five interventions on clinical and mobility outcomes in 75 PwS. Methods: Five days after stroke, 75 PwS were randomized into five groups: physical therapy (CON, standard care, once daily); walking with a soft robotic exoskeleton (ROB, once daily); agility exergaming once (EXE1, once daily) or twice daily (EXE2, twice daily); and combined EXE1+ROB in two daily sessions. Interventions were performed 5 days per week for 3 weeks. Outcomes were assessed at baseline, post-intervention, and after 5 weeks of detraining. Results: Modified Rankin Scale (primary outcome) and Barthel Index showed no changes. EXE1, EXE2, ROB, and EXE1+ROB outperformed standard care (CON) in five secondary outcomes (Berg balance scale, 10m walking speed, 6-min walk test with/without robot, standing balance), with effects sustained after 5 weeks. Dose effects (EXE1 vs. EXE2) were minimal, while EXE1+ROB showed additive effects in 6-min walk tests. Conclusions: These novel comparative data expand evidence-based options for therapists to design individualized rehabilitation plans for PwS. Further confirmation is needed.

The Role of Virtual Reality on Parkinson's Disease Management: A Bibliometric and Content Analysis

The management of Parkinson's disease (PD) has increasingly focused on innovative technologies, particularly virtual reality (VR), which has emerged as a significant tool for addressing neurological disorders. This bibliometric analysis summarizes current research trends and hotspots regarding VR applications in PD management. A comprehensive search of the Science Citation Index Expanded (SCIE) within the Web of Science Core Collection (WoSCC) identified 475 publications from 2000 to 2024. Key findings indicate a substantial increase in publication output, especially after 2013, driven by technological advancements and investments from major IT companies. Prominent research institutions and scholars from Australia, Israel, Italy, and Spain have led this field, exploring various VR applications for PD patients. The focus of VR therapy research has evolved from primarily addressing freezing of gait (FOG) to a broader range of functional impairments, including balance, postural control, upper limb motor, and cognitive function. This study provides valuable insights into the evolving landscape of clinical research on VR in PD management, highlighting global trends and potential areas for future investigation and application of VR therapies.

Effects of Exercise on Post-Stroke Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Numerous studies have investigated the effects of exercise on post-stroke depression (PSD), yet the findings remain inconclusive. This study aims to evaluate the impact of exercise on depressive symptoms in stroke patients and to identify the most effective exercise protocols for this population. A systematic review of the Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases was conducted, with a search cutoff date of 13 September 2024. Quantitative synthesis was employed to assess the intervention effects, with effect sizes expressed as standardized mean differences (SMDs) and 95% confidence intervals to evaluate the efficacy of exercise in alleviating PSD. A total of 24 studies met the inclusion criteria. The results indicated that exercise significantly alleviated depressive symptoms in stroke patients (SMD = -0.18; p = 0.007). Specifically, multicomponent training emerged as the most effective intervention for reducing depression (SMD = -0.24; p = 0.008). Additionally, exercise programs with a duration of ≥12 weeks (SMD, -0.17; p = 0.04), ≥3 sessions per week (SMD, -0.20; p = 0.02), <60 min per session (SMD, -0.19; p = 0.05), and <180 min per week (SMD, -0.27; p = 0.02) were found to be the most effective in alleviating PSD. Exercise represents an effective strategy for managing PSD, with multicomponent training potentially serving as the optimal intervention. These findings provide evidence for clinicians, recommending that stroke patients engage in exercise at least three times weekly, with individual sessions not exceeding 60 min. By increasing the frequency of exercise, the cumulative weekly time should ideally remain below 180 min for optimal outcomes.

Comparative effects of dual-task training versus combined exercise training in water and on land on patients with multiple sclerosis: a study protocol of a randomised factorial trial

INTRODUCTION

People with multiple sclerosis (PwMS) experience cognitive and motor impairments, including cognitive training and exercise training. This study compares dual task and combined exercise training in water and on land. Water-based training may enhance cognitive and motor function more effectively than land-based training, presenting a promising intervention for PwMS. We explore dual-task training (DTT), including cognitive and motor exercise, with combined exercise in water and on land on the cognition, balance and gait PwMS.

METHODS AND ANALYSIS

This is a double-blind 3*2*2 factorial randomised trial. Participants will be randomly allocated to one of six groups: four intervention groups and two control groups. All patients will receive supervised 12-week training sessions, two times per week, and will be assessed by a blinded outcome assessor before and at the end of the 12-week programme. The primary outcome includes the Symbol Digit Modalities Test. The secondary outcomes involve the California Verbal Learning Test-II, the Brief Visuospatial Memory Test-Revised, kinetics and kinematics throughout the balance and gait cycle. All the data will be analysed by a blinded data analyst.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Sports Science Research Institute (No. IR.SSRC.REC.1401.082). The results of the trial will be submitted for publication in journals and distributed to PwMS and physiotherapists.

TRIAL REGISTRATION NUMBER

The trial is prospectively registered on 22 March 2024, at https://www.umin.ac.jp/ with an identification number (UMIN000053947).

Self-reported physical activity more than 1 year after stroke and its determinants in relation to the WHO recommendations

BACKGROUND

Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.

OBJECTIVE

To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.

DESIGN

Cross-sectional descriptive survey.

SETTING

Community settings.

PARTICIPANTS

Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.

RESULTS

Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.

CONCLUSIONS

A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

The impact of combined aerobic and resistance exercise on the prognosis of early Parkinson's disease patients

BACKGROUND

Although literature suggests that exercise can improve symptoms in Parkinson's Disease (PD) patients, research on the effects of aerobic exercise and resistance training (AE&RT) in early-stage PD remains limited. Understanding the synergistic effects of these exercise modalities can provide valuable insights for optimizing exercise interventions for PD patients, particularly in the early stages of the disease, where interventions may have the greatest impact on long-term functional outcomes.

OBJECTIVE

This study aimed to investigate the effects of a combined AE&RT program on motor function, postural stability, and cognitive processing speed in early stage PD patients.

METHODS

A total of 236 participants with early-stage PD were assigned to either the Aerobic Exercise Group (AE group) (n= 112) or the AE&RT Group (n= 124) inthis controlled randomized trial. The study employed a one-year supervised exercise program, with the AE Group participating in aerobic activities and the AE&RT Group engaging in combined AE&RT. Outcome measures included symptom improvement, motor function, postural stability, cognitive processing speed, peak oxygen consumption, quality of life evaluation, and the incidence of adverse events.

RESULTS

The AE&RT Group demonstrated greater improvements in tremor, muscle rigidity, gait instability, sleep problems, and hyposmia compared to the AE Group. Additionally, the combined exercise group exhibited better cognitive processing speed, as well as enhanced motor function and postural stability. Peak oxygen consumption was significantly higher in the AE&RT Group. However, the quality of life evaluation indicated a statistically higher quality of life in the AE Group. There was no significant difference in the incidence of adverse events between the two groups.

CONCLUSION

The findings suggest that the integration of AE&RT in early-stage PD patients leads to more comprehensive improvements in motor symptoms, cognitive function, postural stability, and cardiovascular fitness compared to aerobic exercise alone. These results have important implications for developing tailored exercise interventions to enhance the physical and cognitive well-being of individuals with early-stage PD.

Advancements and Challenges in Exercise Training for Multiple Sclerosis: Comprehensive Review and Future Directions for Randomized Controlled Trials

Exercise training represents a health behavior for the treatment and management of the multi-faceted manifestations of multiple sclerosis (MS). This paper provides a comprehensive overview of evidence from randomized controlled trials (RCTs) regarding benefits, safety, participation, and guidelines for exercise training in MS, based on systematic reviews and meta-analyses. The paper then provides our opinions based on extensive experience regarding challenges for improving and expanding future RCTs that will advance our understanding of exercise training in MS. The comprehensive review of evidence from RCTs indicates that exercise training yields substantial improvements in aerobic and muscle fitness, mobility, fatigue and depression, quality of life, and participation outcomes. There is a non-significant increase in the risk of adverse events or serious adverse events with exercise training compared with control conditions or healthy populations. Rates of adherence and compliance with exercise training (i.e., participation) approximate 80% and 70%, respectively. The current prescriptive guidelines suggest 2-3 days per week of aerobic and resistance exercise training as the minimal dose for safely benefiting from exercise training in MS. We propose 10 important topics as avenues for expanding the body of research and improving its scope for evidence-based practice in MS. Overall, the research on exercise training in MS is strong, but it can get stronger. The expansion and advancement of evidence are critical for moving exercise training into the clinical armamentarium of MS disease treatment and management.

Identifying Preferences for Exercise and Sport in Australians With Mild Multiple Sclerosis: Looking Beyond Clinical Characteristics when Implementing Exercise Interventions

OBJECTIVE

Exercise is a salient component in delaying disability progression in multiple sclerosis (MS). This study considers personal preferences regarding exercise program prescription and the resources needed to facilitate exercise.

DESIGN

Cross-sectional study.

SETTING

Community online, Australia.

PARTICIPANTS

Adults with MS.

INDEPENDENT VARIABLES

Participants completed online questionnaires on current exercise and sport, and preferences toward exercise prescription variables, facilitative resource needs, and delivery method.

MAIN OUTCOMES

We established preference responses for the entire sample, and separately, we used logistic regression and analysis of variance to compare preferences between participants stratified according to (1) geographical rurality (ie, metro vs rural and remote) and (2) current exercise engagement (ie, active, moderately active, and insufficiently active).

RESULTS

Fifty people with a diagnosis of MS completed the survey. Participants had mild disability; most were metro-dwelling (74%) and physically active (58%). Preferences included a program of at least 6 months (70%), where exercise sessions are performed 5 d/wk (38%) at a moderate intensity (50%). Half (50%) of responders wanted to participate in sports for exercise. There was a significant difference in the preference toward higher-intensity exercise in active persons compared with inactive persons. Facilitative resources selected included a behavioral exercise coach (80%) who provides MS-specific information (46%) and behavioral change strategies (41%).

CONCLUSIONS

Persons with mild MS are interested in participating in various exercises and sports. Encouraging participation will have long-term benefits. We recommend that HCPs and researchers consider individual social factors, in addition to patient symptoms and disability, when designing exercise programs for an Australian MS population.

Exercise-based telerehabilitation for patients with multiple sclerosis using physical activity: a systematic review

BACKGROUND

Telerehabilitation is a practical option for individuals with multiple sclerosis (MS) to engage in sustained physical activity without -visiting a rehabilitation facility. The aim of this systematic review was to evaluate the feasibility, effectiveness, safety, and adherence of exercise-based telerehabilitation as compared with usual care for MS patients.

METHODS

A comprehensive literature search adhering to PRISMA guidelines was conducted, focusing on studies published in English since 2000. The systematic review protocol was registered in PROSPERO. The selection process involved strict criteria, including studies focusing on people with MS, telerehabilitation centred on regular exercise, a control group receiving usual care, valid exercise testing, and adherence to randomized controlled trial principles. Methodological quality was assessed using the TESTEX tool, ensuring rigour in study design and reporting.

RESULTS

Among the 281 records screened, 10 studies met the criteria. Telerehabilitation interventions varied in format and outcomes were assessed using diverse exercise tests and questionnaires. Despite variations, the studies collectively demonstrated promising feasibility and safety, with minimal withdrawals and minor adverse events. Effectiveness varied, with 5 out of 10 studies showing significant improvements in the intervention group. Adherence rates ranged from 38% to 100%.

CONCLUSION

In most of the assessed aspects, telerehabilitation is comparable to regular centre-based rehabilitation.

Effectiveness and Feasibility of Blood Flow Restriction Training for People with Multiple Sclerosis: A Systematic Review

BACKGROUND

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that primarily targets the myelin of axons. Extremities are frequently affected, resulting in a negative impact on both activities of daily living (ADL) and quality of life. In recent years, there has been increasing interest in the potential benefits of exercise and blood flow restriction training (BFRT) programs as a therapeutic tool in people with neurological disorders. The aim of the present systematic review was to know the clinical effects of BFRT programs in people with MS.

METHODS

A systematically comprehensive literature search was conducted and registered in PROSPERO prior to its execution under the reference number CRD42024588963. The following data sources were used: Pubmed, Scopus, Web of Science (WOS) and the Cochrane Library. The following data were extracted from the papers: study design, sample, interventions, dosage, outcome measures and results. To assess the methodological quality of the papers included, the Quality Index of Downs and Black was used. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, the Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains.

RESULTS

Seven articles with a total of 71 participants were included in the review. Of the seven articles, five papers studied the effectiveness of BFRT combined with strengthening exercises and two papers studied the effect of BFRT combined with aerobic exercise. Of the five articles that analyzed BFRT combined with strengthening exercises, only two presented a control group. Both performed a low-load resistance training in combination with BFRT with four series, 30/15/15/15 repetitions and a rest of 1 min between the series and 3 min between the exercises. The control groups to which they were compared performed a high intensity strengthening exercise protocol which had the same exercises, sets, rests and duration of the protocol as the experimental groups. For those two papers which investigated the effects of BFRT combined with aerobic training, exercise was performed in two sessions per week for a period of 8 and 6 weeks, respectively. In both studies, the experimental protocol began with a warm-up phase and ended with a cool-down phase, and there were differences in cuff management. All these investigations found positive effects in the interventions that combined exercise with BFRT. The characteristics, outcome measures, effects of the interventions and the assessment of the methodological quality of the included studies and risk of bias are shown in the tables.

CONCLUSIONS

BFRT in people with MS appears to be effective and safe for people with MS. BFRT might show positive clinical effects on strength, hypertrophy and balance outcomes. Nevertheless, future research should be conducted with better methodological quality to ensure the potential benefits of BFRT in people with MS since the studies analyzed present a high risk of bias and methodological limitations.

Preconditioning Exercise Inhibits Neuron Ferroptosis and Ameliorates Brain Ischemia Damage by Skeletal Muscle-Derived Exosomes via Regulating miR-484/ACSL4 Axis

Aims: Although there is evidence that patients with stroke who exercise regularly before stroke have a better prognosis than those who do not exercise, the detailed mechanism remains unclear. Moreover, neuronal death plays a central role in neurological dysfunction caused by ischemic stroke. Thus, we investigated whether exercise could reduce stroke-induced neuronal death and its associated mediators in the current study. Results: Ferroptosis was the most dominant form of programmed cell death in neurons. Preconditioning exercise before stroke improved the neurological function and decreased the infarct area in rats with ischemic stroke. Preconditioning exercise attenuated stroke-induced ferroptosis by reducing lipid peroxidation (LPO) production, upregulating glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11), and downregulating acyl-CoA synthetase long-chain family member 4 (ACSL4). High-throughput sequencing and dual luciferase reporter assays revealed that exercise-induced exosomal miR-484 inhibits Acsl4 expression. Moreover, we showed that exercise-induced exosomal miR-484 is mainly derived from skeletal muscle, and the neuroprotective effect of preconditioning exercise is suppressed by inhibiting miR-484 production in skeletal muscle. Innovation: This study suggested that neuronal ferroptosis is the most dominant form of programmed cell death in a hypoxic environment. Moreover, we showed that the ferroptosis pathway is a potential therapeutic target in ischemic stroke and that preconditioning exercise could be an effective antioxidant intervention for cerebral ischemia. Conclusion: Our work revealed that preconditioning exercise before stroke exerts neuroprotective effects against brain ischemia by skeletal muscle-derived exosomal miR-484 via inhibiting ferroptosis. Antioxid. Redox Signal. 41, 769-792.

Exercise as medicine in Parkinson's disease

Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.

Effects of exercise on post-stroke cognitive function: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

A growing body of research examining the effect of exercise on cognitive function in stroke patients, while findings of available studies were conflicting.

OBJECTIVES

We aimed to estimate the effect of exercise on cognitive function in stroke patients.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, Cochrane, and Scopus electronic databases, through 13 March 2023. The three-level restricted maximum likelihood random effects model was used to synthesize the data.

RESULTS

Twenty-five studies met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in stroke patients (Cohen's d = 0.37, 95% CI, 0.16 to 0.58, p < 0.01, I2  = 22.12%). Subgroup analysis showed that exercise significantly improved memory. In addition, aerobic exercise, exercise conducted 12 weeks or more, 3 times or more per week, less than 60 minutes per session, less than 180 minutes per week, and up to 12 months post-stroke increased cognitive function significantly.

CONCLUSIONS

Exercise improved cognitive function in stroke patients. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in aerobic exercise at least 3 times per week for 30-60 minutes, with a goal of 180 minutes per week being achieved by increasing the frequency of exercise. Exercise initiated within 12 months post-stroke and continued for 12 weeks or more is most beneficial for improving cognitive function.

Estimation of minimal clinically important difference for 6-minute walking distance in patients with acute stroke using anchor-based methods and credibility instruments

BACKGROUND AND PURPOSE

Stroke impairs a patient's ability to walk. In patients with acute stroke, a 6-min walking distance (6MWD) is recommended to assess walking function. Minimal clinically important difference (MCID) is used to determine the effectiveness of rehabilitation; however, the MCID for 6MWD has not been adequately validated. This study aimed to estimate the MCID of 6MWD, a measure of walking endurance, in patients with acute stroke using anchor-based methods.

METHODS

Based on the change in 6MWD from baseline to the follow-up measurement 2 weeks later, the MCID was estimated using anchor-based methods (receiver operator operating characteristic curves, predictive and adjustment models) with a patient- and therapist-rated global rating of change scale (p-GRC, t-GRC) as external anchors. The accuracy of "meaningful change" was estimated from the area under the curve. Using MCID's credibility instruments, the credibility of each anchor was evaluated. Using the credibility instrument, high credibility was defined as satisfying 3/5 of the Core criteria and 6/9 of all criteria.

RESULTS

The analysis included 58 patients. The MCID for each anchor was 78.7-100.0 m for p-GRC, and 95.2-99.5 m for t-GRC. The p-GRC demonstrated excellent accuracy (area under the curve >0.8). With p-GRC as anchors, over 50% of patients showed improvement. The p-GRC satisfied the core criterion of 3/5 and all criteria of 6/9 on the reliability instrument. The t-GRC demonstrated low reliability and satisfied the core criterion of 2/5 and all criteria of 3/9.

DISCUSSION

Since the percentage of improved groups exceeded 50%, the adjusted model was useful in the anchor-based method. Therapists may not accurately capture patient fatigue and subjective symptoms, potentially affecting the correlation between the 6MWD change score and the t-GRC and, consequently, the reliability instrument. The p-GRC showed high accuracy and reliability; therefore, the MCID was estimated to be 78.7 m.

Consultative, Proactive Physical Therapy in Early Multiple Sclerosis

BACKGROUND

Exercise training may be the most effective nonpharmacological symptomatic treatment for patients with multiple sclerosis (MS). Physical therapy (PT) can facilitate increased exercise through education, individualized exercise routines, goal setting, and supportive resources. However, traditional PT focuses on function restoration rather than proactive measures to prevent the advancement of morbidity. We present the application of a proactive physical therapy (PAPT) approach for individuals with MS.

METHODS

Neurologists referred patients to PT shortly after their MS diagnosis. Patients completed a shared decision-making-based evaluation of their current functional level, received education on exercise guidelines and goal-setting support, and established an exercise routine of an appropriate intensity. The patient and physical therapist communicated via email and telephone at 1 and 3 months. Assessments included physical function, Fatigue Severity Scale (FSS), and self-reported exercise at 6 months.

RESULTS

Three patients were referred directly to PAPT, and 1 transitioned from restorative PT. At 6 months, 3 patients reported regular aerobic, strengthening, and flexibility participation that met or exceeded established exercise recommendations. Two of 3 patients demonstrated clinically meaningful changes in functional outcome measures (eg, 10-meter Walk Test), a third patient remained stable in all functional outcome measures. Three patients reported significant improvements on the FSS at 6 months. The fourth patient did not complete the 6-month follow-up due to pregnancy complications but reported meeting guidelines at 3 months.

CONCLUSIONS

A PAPT model of care is feasible and effective for patients who have been newly diagnosed with MS. With minimal PT visits, patients met established exercise guidelines and maintained or improved physical function.

Effects of Rehabilitation Training on Cognitive Function in Parkinson's Disease with Subjective Cognitive Decline

Purpose

To characterize Subjective Cognitive Decline (SCD) in Parkinson's disease (PD) and its progression, as well as to assess the impact of rehabilitation training programs on cognitive function in PD patients.

Patients and Methods

The study involved 42 patients diagnosed with PD. Participants underwent evaluation using a neuropsychological protocol and were subsequently classified into two groups: those with SCD (PD-SCD+, n= 22) or those without (PD-SCD-, n= 20). After an average follow-up period of 3.0 years (2.7-4.6 years), cognitive assessments were reiterated with the same group of subjects. Following the re-assessment, all 42 patients participated in a six-month rehabilitation training program, concluding with the reevaluation of cognitive performance.

Results

In the follow-up assessment, it was observed that PD-SCD+ experienced a more pronounced annual decline in cognitive function, as measured by the Chinese-Beijing version of Montreal Cognitive Assessment (BJ-MoCA) test and semantic fluency, compared to PD-SCD-. A stepwise logistic regression analysis identified low MMSE scores (P< 0.001), elevated HAMD scores (P= 0.008), male gender (P= 0.026), and the presence of SCD (P= 0.022) associated with diminished language skills in PD patients. Both groups of PD patients exhibited improvements in BJ-MoCA scores after participating a six-month rehabilitation training program. Particularly notable is the statistically significant improvement in language skills observed in patients with PD-SCD+ compared to PD-SCD- patients following rehabilitation training.

Conclusion

As PD progresses, individuals with PD-SCD+ tend to experience more pronounced cognitive decline compared to those with PD-SCD-. Semantic fluency emerges as a crucial component for assessing the cognitive subset of PD, potentially serving as an indicator of cognitive decline in individuals with PD. Evidence suggests that rehabilitation training is a viable intervention for individuals diagnosed with PD. This intervention not only improves various cognitive domains but also leads to more substantial enhancements in language skills.

High-Intensity Exercise Training Impact on Cardiorespiratory Fitness, Gait Ability, and Balance in Stroke Survivors: A Systematic Review and Meta-Analysis

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes.

Best practice exercise for emerging depression in multiple sclerosis: A systematic review and meta-analysis

OBJECTIVE

To examine the effects of instructor-led exercise on depression symptoms in adults with multiple sclerosis, with a focus on moderating factors to treatment response.

DATA SOURCES

Cochrane Library, Embase, PEDro, PsycINFO and PubMed databases were searched until 21 April 2024.

REVIEW METHODS

The reporting quality of included studies assessed (PEDro and TESTEX scales). Hedges' g effect sizes were calculated and pooled using random and mixed-effects modelling.

RESULTS

Twenty-two independent studies (k), representing 785 participants with relapsing remitting or progressive MS, were included. Individual studies varied in their reporting quality (PEDro range: 3-8) and did not routinely detail exercise parameters (TESTEX range: 5-13). Nonetheless, exercise reduced core symptoms of depression (gw = .52, CI: .30-.73, P < .01). Treatment effects were, however, not maintained once training had ceased (gw = -.53, CI: -.80 to .24, P ≤ .01, k = 5). Both aerobic and non-aerobic exercise groups experienced a significant (P < .01) reduction in depression scores. Larger gains were noted by those with better ambulation at baseline (P = .03).

CONCLUSION

Regular exercise can help to stabilise mood for people living with multiple sclerosis, regardless of session frequency or duration. Treatment efficacy could be maximised by addressing potential barriers for those with limited mobility, including exercise type, delivery and intensity. Protocol registered on Open Science Framework [https://osf.io/zfymq/].

Cardiorespiratory fitness, atrial fibrillation and stroke: a review of the evidence in 2024

INTRODUCTION

The body of evidence linking cardiorespiratory fitness (CRF) levels with the risk of atrial fibrillation (AF) and stroke - two interconnected cardiovascular conditions - is not entirely consistent. Furthermore, specific CRF thresholds beyond which the risk of AF or stroke might not decrease are not well defined.

AREAS COVERED

This review summarizes research evidence on the role of CRF in the development of AF and stroke including dose-response relationships in general population participants, explores the biological mechanisms through which CRF may exert its effects, assesses the potential implications for clinical care and population health, identifies gaps in the current evidence, and suggest directions for future research. MEDLINE and Embase were searched from inception until July 2024 to identify observational longitudinal and interventional studies as well as systematic reviews and meta-analyses related to these study designs.

EXPERT OPINION

In the general population, increasing levels of CRF, achieved through consistent physical activity, can significantly reduce the likelihood of developing AF and stroke. The findings also advocate for a tailored approach to exercise prescriptions, acknowledging the plateau in benefits for AF risk beyond certain CRF levels, while advocating for higher intensity or prolonged activity to further reduce stroke risk.

Walking performance differs between people with multiple sclerosis who perform distinct types of exercise

Aim: To determine whether walking performance differed between people with multiple sclerosis (MS) who performed distinct types, volumes and intensities of exercise.Materials & methods: Forty-five people with relapsing-remitting MS performed two trials of the 2-min walk test, one at a preferred speed and another at a fast speed. Gait metrics were measured by wireless inertial sensors. Participants reported the type (aerobic, resistance), volume and intensity of exercise performed.Results: Walking speed reserve and gait variability were better in participants who performed combined aerobic and resistance exercises compared with those who performed aerobic-only exercise.Conclusion: Walking performance differs in people with mild MS disability based on the type and volume of exercise performed.

Effectiveness of an institution-based adapted physical activity programme versus a home-based self-management programme for chronic poststroke adults: protocol for a randomised controlled study

INTRODUCTION

Physical activity (PA) protects the cardiovascular system and reduces the risk of stroke recurrence. However, most stroke survivors have significantly lower daily PA levels than those recommended. Adapted PA programmes provide a useful means of increasing the daily PA levels of this population. PA programmes designed to encourage people walking have been found to be more effective than no intervention. Some programmes have been applied in institutional settings while others are done on an independent basis. The aim of this study will be to compare the two methods in terms of their impact on the daily walking rates of subjects with spastic hemiparesis following a chronic stroke. Secondary outcomes will include effects on walking ability, endurance, balance, quality of life and motivation for exercise.

METHODS AND ANALYSIS

This French single-centre randomised (1:1), controlled, two-arm, parallel, single-blind study will include 40 adults with chronic stroke spastic hemiparesis who are able to walk for 6 min. The primary outcome will be the participants' daily activity measured via the number of steps performed per day using a Stepwatch device. We expect to establish that the institution-based programme will be more effective than a self-managed programme as a means of increasing the PA of chronic stroke subjects.

ETHICS AND DISSEMINATION

The protocol was approved by an independent National Ethics Committee (Comité de Protection des personnes Est IV). Participants will be asked to provide their signed informed consent prior to the study. The results will be disseminated via publications in the scientific literature, oral and poster presentations by partners at international scientific meetings and associations of patients.

TRIAL REGISTRATION

NCT06061770.

Stepping towards health: a scoping review of square-stepping exercise protocols and outcomes in older adults

BACKGROUND

Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults.

METHODS

We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis.

RESULTS

A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson's disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function.

CONCLUSION

This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects.

Bicycling for Rehabilitation of Persons With Parkinson Disease: A Scoping Review

BACKGROUND AND PURPOSE

Exercise is beneficial for persons with Parkinson disease (PwPD). The overarching purpose of this scoping review was to provide guidance to clinicians and scientists regarding current evidence for bicycling exercise for PwPD. A scoping review was conducted to examine the heterogeneous literature on stationary bicycling for PwPD to reduce motor symptoms and body function structure impairments, improve activities and motor performance, and reduce disease severity.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. PubMed, CINAHL, and PEDro were searched from inception to January 23, 2023. Articles reporting original data on relevant outcome measures were included. Search results were screened and articles were extracted. Data were analyzed quantitatively with percentages of significant and clinically meaningful findings and qualitatively to extract themes.

RESULTS

Bicycling was categorized using bicycle types (assisted, nonassisted) and training modes (speed, aerobic, force). A high percentage of the 34 studies showed statistical significance for reducing motor symptoms (83%), body function structure impairments (78%), disease severity (82%), and improving activities (gait 72%, balance 60%). Clinically meaningful findings were achieved in 71% of the studies for reduction in disease severity and in 50% for improving gait.

DISCUSSION AND CONCLUSIONS

The literature on bicycling for PwPD has evolved from speed to aerobic studies. The terminology describing types of bicycling was simplified. Of all the outcomes reported, reduction of disease severity achieved the highest frequency of clinical meaningful improvements. Bicycling was comparable with other forms of aerobic training for walking speed and endurance. Opportunities for translation to practice and research are presented.

Muscle activity and hypoalgesia in blood flow restricted versus unrestricted effort-matched resistance exercise in healthy adults

This study assessed muscle activity (root mean square, RMS, and median frequency, MDF) to evaluate the acute response to blood flow restriction (BFR) resistance exercise (RE) and conventional moderate intensity (MI) RE. We also performed exploratory analyses of differences based on sex and exercise-induced hypoalgesia (EIH). Fourteen asymptomatic individuals performed four sets of unilateral leg press with their dominant leg to volitional fatigue under two exercise conditions: BFR RE and MI RE. Dominant side rectus femoris (RF) and vastus lateralis (VL) muscle activity were measured using surface electromyography (sEMG) through exercise. RMS and MDF were calculated and compared between conditions and timepoints using a linear mixed model. Pressure pain thresholds (PPT) were tested before and immediately after exercise and used to quantify EIH. Participants were then divided into EIH responders and nonresponders, and the differences on RMS and MDF were compared between the two groups using Hedges' g. RMS significantly increased over time (RF: p = 0.0039; VL: p = 0.001) but not between conditions (RF: p = 0.4; VL: p = 0.67). MDF decreased over time (RF: p = 0.042; VL: p < 0.001) but not between conditions (RF: p = 0.74; VL: p = 0.77). Consistently lower muscle activation was found in females compared with males (BRF, RF: g = 0.63; VL, g = 0.5. MI, RF: g = 0.72; VL: g = 1.56), with more heterogeneous findings in MDF changes. For BFR, EIH responders showed greater RMS changes (Δ RMS) (RF: g = 0.90; VL: g = 1.21) but similar MDF changes (Δ MDF) (RF: g = 0.45; VL: g = 0.28) compared to nonresponders. For MI, EIH responders demonstrated greater increase on Δ RMS (g = 0.61) and decrease on Δ MDF (g = 0.68) in RF but similar changes in VL (Δ RMS: g = 0.40; Δ MDF: g = 0.39). These results indicate that when exercising to fatigue, no statistically significant difference was observed between BFR RE and conventional MI RE in Δ RMS and Δ MDF. Lower muscle activity was noticed in females. While exercising to volitional fatigue, muscle activity may contribute to EIH.

Allied health professionals knowledge and clinical practice in telehealth exercise behavioural change for multiple sclerosis

BACKGROUND

The growing importance of telehealth in multiple sclerosis (MS) necessitates an understanding of current practices and training needs of health professionals. We aimed to evaluate the knowledge, preparedness, and training preferences of Australian allied health professionals (AHPs) in telehealth exercise therapy and exercise behavioural change for MS patients to inform the development of educational training.

METHODS

An online survey was completed by 58 Australian AHPs, including 34 physiotherapists, 14 exercise physiologists, and 10 occupational therapists, focusing on their current practices, preparedness, and training preferences in telehealth exercise and behavioural change for MS. The survey included multiple-choice, Likert scale, and free-text response questions. Data were analysed using binary and multinomial logistic regressions.

RESULTS

Not all AHPs were aware of MS exercise guidelines (67% awareness), with exercise physiologists showing the highest familiarity. There was a significant understanding of the difference between physical activity and exercise, though definitions often lacked clarity. Most AHPs (91%) employed behavioural change strategies in their practice, especially goal-setting (95%), identifying facilitators (67%), and reinforcing progress (66%). While most (72%) felt prepared in promoting exercise to MS clients, there were differences in confidence levels concerning the prescription, modification, and teaching of telehealth exercise programs, with occupational therapists have significant less confidence in those domains compared to other AHPs. Most AHPs expressed interest in additional training, with a preference for online workshops focusing on exercise prescription for MS, behaviour change, and telehealth delivery methods.

CONCLUSION

In our Australian AHP sample we identified that a quarter to a third of AHPs in MS care may not be confident or prepared to promote telehealth exercise and behavioural change to people with MS. Moreover, the findings highlight some disparity in knowledge and confidence levels amongst different AHPs concerning exercise therapy for MS, indicating the need for tailored multidisciplinary training programs. Such programs should address profession-specific educational gaps and training preferences, ensuring effective and safe telehealth exercise prescription in MS care.

The Effect of the Team Members Teaching Design vs. Regular Lectures method on the Self-efficacy of the Multiple sclerosis Patients in Iran. Randomised Controlled Trial

Objective

This study was conducted with the aim of the effect of team members teaching design (TMTD) vs. regular Lectures method on the self-efficacy of the multiple sclerosis patients.

Methods

This research is a randomized controlled trial study. In this study, 48 multiple sclerosis persons of members of Jahrom MS Society participated. The persons were selected by simple random sampling and then divided into three groups of: TMTD (n=16), regular lecture method (n=16), and control (n=16), by random allocation method. In the intervention groups, six training sessions were held twice a week; control group did not receive education. Data was collected by the MS self-efficacy questionnaire of Rigby et al. in the before, immediately and one month after the intervention.

Results

Patients in three intervention and control groups were similar in terms of demographic variables. The results of the repeated measurement test before, immediately and one month after the intervention showed that the mean of the all dimensions of self-efficacy in two intervention groups had increased significantly (p<0.05). While these changes were not significant in the control group (p ≥ 0.05). Also, there was a significant difference in the mean of the all dimensions of self-efficacy between the intervention groups of TMTD and regular lectures.

Conclusion

Based on the findings, TMTD compared to regular lectures method had a more significant effect on improving the self-efficacy of multiple sclerosis patients. Therefore, it is recommended that nursing use this educational approach to increase patients' self-efficacy.

Lifestyle management and brain MRI metrics in female Australian adults living with multiple sclerosis: a feasibility and acceptability study

BACKGROUND

Limited studies of multiple sclerosis (MS) exist whereby magnetic resonance imaging (MRI) of the brain with consistent imaging protocols occurs at the same time points as collection of healthy lifestyle measures. The aim of this study was to test the feasibility, acceptability and preliminary efficacy of acquiring MRI data as an objective, diagnostic and prognostic marker of MS, at the same time point as brain-healthy lifestyle measures including diet.

METHODS

Participants living with relapsing remitting MS partook in one structural MRI scanning session of the brain, completed two online 24-hour dietary recalls and demographic and self-reported lifestyle questionnaires (e.g. self-reported disability, comorbidities, physical activity, smoking status, body mass index (BMI), stress). Measures of central tenancy and level of dispersion were calculated for feasibility and acceptability of the research protocols. Lesion count was determined by one radiologist and volumetric analyses by a data analysis pipeline based on FreeSurfer software suite. Correlations between white matter lesion count, whole brain volume analyses and lifestyle measures were assessed using Spearman's rank-order correlation coefficient.

RESULTS

Thirteen female participants were included in the study: eligibility rate 90.6% (29/32), recruitment rate 46.9% (15/32) and compliance rate 87% (13/15). The mean time to complete all required tasks, including MRI acquisition was 115.86 minutes ( ± 23.04), over 4 days. Conversion to usual dietary intake was limited by the small sample. There was one strong, negative correlation between BMI and brain volume (rs = -0.643, p = 0.018) and one strong, positive correlation between physical activity and brain volume (rs = 0.670, p = 0.012) that were both statistically significant.

CONCLUSIONS

Acquiring MRI brain scans at the same time point as lifestyle profiles in adults with MS is both feasible and accepted among adult females living with MS. Quantification of volumetric MRI data support further investigations using semi-automated pipelines among people living with MS, with pre-processing steps identified to increase automated feasibility. This protocol may be used to determine relationships between elements of a brain-healthy lifestyle, including dietary intake, and measures of disease burden and brain health, as assessed by T1-weighted and T2-weighted lesion count and whole brain volume, in an adequately powered sample.

TRIAL REGISTRATION

The study protocol was retrospectively registered in the Australia New Zealand Clinical Trials Registry (ACTRN12624000296538).

Functional electrical stimulation combined with voluntary cycling accentuates VO2 response in people with severe multiple sclerosis: A pilot study

BACKGROUND

Lower limb muscle weakness and reduced balance due to disease progression in multiple sclerosis (MS) may make robust aerobic exercise difficult. Functional electrical stimulation (FES) cycling combined with voluntary cycling may allow people with severe MS to enhance the intensity of aerobic exercise. The aim of this study was to investigate the cardiorespiratory, power, and participant-reported perceptions during acute bouts of FES cycling, voluntary cycling, and FES cycling combined with voluntary cycling (FES assist cycling).

METHODS

Participants with severe MS (Expanded Disability Status Scale [EDSS] ≥ 6.0) undertook three exercise trials on a leg cycle ergometer. Trial 1 involved 30 min of FES cycling; Trial 2 involved two 10-minute bouts of voluntary cycling separated by 10 min rest; and Trial 3 was a combination of trials 1 and 2 (FES assist cycling). Outcome measures included VO2 (volume of oxygen consumption), cycle power output, heart rate, RPE, and post-exercise perceptions of pain and fatigue.

RESULTS

Ten people with severe MS participated (9 female; age 52.4 ± 9.98 y; EDSS 7.1 ± 0.6). The average VO2 during the 30-minute trials was significantly higher for FES assist cycling compared to voluntary cycling (429.7 ± 111.0 vs 388.5 ± 101.0 mL/min, 95% CI 23.4 to 113.0 mL/min, p = 0.01), with a large effect size (Hedges' g = 1.04). Participants reported similar rates of perceived exertion at the end of FES cycling (13 ± 2), voluntary cycling (14 ± 2), and FES assist cycling (15 ± 1); p = 0.14. Self-reported pain was higher during both FES cycling (5.4 vs 0.3; 95% CI 3.4 to 6.7, p = 0.01, Hedges' g = 2.07) and FES assist cycling (4.2 vs. 0.3; 95% CI 2.3 to 5.5, p = 0.01, Hedges' g = 1.71) than voluntary cycling, both with large effect sizes. There was no difference in self-reported fatigue at the end of each trial (p = 0.21).

CONCLUSION

This study found FES assist cycling produced significantly higher VO2 values than voluntary cycling, although the clinical significance of these differences is unknown. Participants performed FES assist cycling at a self-reported RPE consistent with moderate to vigorous intensity, however it was considered light-intensity exercise when expressed by METS. FES assist cycling was no more fatiguing post-exercise than the other modes.

Aerobic exercise on the treadmill combined with transcranial direct current stimulation on the gait of people with Parkinson's disease: A protocol for a randomized clinical trial

Gait impairments negatively affect the quality of life of people with Parkinson's disease (PwPD). Aerobic exercise (AE) is an alternative to alleviate these impairments and its combination with transcranial direct current stimulation (tDCS) has demonstrated synergistic effects. However, the effect of multitarget tDCS application (i.e., motor, and prefrontal cortices simultaneously) combined with physical exercise on gait impairments is still little known. Thus, the proposed randomized clinical trial will verify the acute effects of AE combined with tDCS applied on motor and prefrontal cortices separately and simultaneously on gait (spatial-temporal and cortical activity parameters) in PwPD. Twenty-four PwPD in Hoehn & Yahr stages I-III will be recruited for this crossover study. PwPD will practice AE on treadmill simultaneously with the application of anodal tDCS during four intervention sessions on different days (∼ one week of interval). Active tDCS will be applied to the primary motor cortex, prefrontal cortex, and both areas simultaneously (multitarget), with an intensity of 2 mA for 20 min. For sham, the stimulation will remain at 2 mA for 10 s. The AE will last a total of 30 min, consisting of warm-up, main part (20 min with application of tDCS), and recovery. Exercise intensity will be controlled by heart rate. Spatial-temporal and cortical activity parameters will be acquired before and after each session during overground walking, walking with obstacle avoidance, and walking with a cognitive dual task at self-preferred velocity. An accelerometer will be positioned on the fifth lumbar vertebra to obtain the spatial-temporal parameters (i.e., step length, duration, velocity, and swing phase duration). Prefrontal cortex activity will be recorded from a portable functional near-infrared spectroscopy system and oxygenated and deoxygenated hemoglobin concentrations will be analyzed. Two-way ANOVAs with repeated measures for stimulation and moment will be performed. The findings of the study may contribute to improving gait in PwPD. Trial registration: Brazilian Clinical Trials Registry (RBR-738zkp7).

Study protocol: exercise training for treating major depressive disorder in multiple sclerosis

BACKGROUND

Major depressive disorder (MDD) is prevalent, yet sub-optimally treated among persons with multiple sclerosis (MS). We propose that exercise training may be a promising approach for treating depression in persons with MS who have MDD. Our primary hypothesis predicts a reduction in depression severity immediately after an exercise training intervention compared with minimal change in an attention control condition, and the reduction will be maintained during a follow-up period.

METHODS

This study involves a parallel-group, assessor-blinded RCT that examines the effect of a 4-month home-based exercise training intervention on depression severity in a sample of persons with MS who have MDD based on the MINI International Neuropsychiatric Interview. The primary outcomes of depression severity are the Patient Health Questionnaire-9 and Hamilton Depression Rating Scale. Participants (N = 146) will be recruited from within 200 miles of the University of Illinois at Chicago and randomized (1:1) into either a home-based exercise training condition or control condition with concealed allocation. The exercise training and social-contact, attention control (i.e., stretching) conditions will be delivered remotely over a 4-month period and supported through eight, 1:1 Zoom-based behavioral coaching sessions guided by social-cognitive theory and conducted by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data at 0, 4 and 8 months using treatment-blinded assessors, and data analyses will involve intent-to-treat principles.

DISCUSSION

If successful, the proposed study will provide the first Class I evidence supporting a home-based exercise training program for treating MDD in persons with MS. This is critical as exercise training would likely have positive secondary effects on symptoms, cognition, and quality of life, and provide a powerful, behavioral approach for managing the many negative outcomes of MDD in MS. The program in the proposed research is accessible and scalable for broad treatment of depression in MS, and provides the potential for integration in the clinical management of MS.

TRIAL REGISTRATION

The trial was registered on September 10, 2021 at clinicaltrials.gov with the identifier NCT05051618. The registration occurred before we initiated recruitment on June 2, 2023.

Breaking boundaries: the transformative role of exercise in managing multiple sclerosis

Multiple sclerosis (MS) is a prevalent cause of physical disability in adults, with inflammation-induced demyelination and neurodegeneration contributing to its etiology. This comprehensive review explores the multifaceted benefits of exercise in managing MS, including improvements in aerobic capacity, balance, muscle strength, immune and hormonal functions and mood. Various exercise modalities, such as aerobic, resistance, flexibility, and balance training, are discussed, along with tailored protocols for MS patients. Recommended exercise strategies are: aerobic exercise: 2-3x/week; 10-30 minutes (40 %-60 % of maximum heart rate (HRmax), HIIT: 1x/week, five 30-90-second intervals at 90 %-100 % HRmax, Resistance training: 2-3x/week, 5-10 exercises; 1-3 sets for each exercise, 8-15 repetitions/set. The review also examines the impact of exercise on neuroplasticity, cardiovascular responses, cytokine modulation, stress hormone regulation, brain structure, and function and fatigue perception. Emphasizing the importance of exercise in enhancing the quality of life for individuals with MS, the review proposes exercise prescriptions and highlights the promising link between physical activity, brain health, and improved hormonal and immune status in MS patients. This review aims to inform future research and guide clinical practices for effective MS management.

Updated Systematic Review and Quantitative Synthesis of Physical Activity Levels in Multiple Sclerosis

OBJECTIVE

This article provided an updated quantitative synthesis of physical activity levels in persons with multiple sclerosis compared with controls and other clinical populations.

DESIGN

A systematic search through PubMed, Scopus, and PsycINFO was conducted for articles published between August 2016 and July 2022. Articles that included a group comparison of at least one measurement of physical activity between adults with multiple sclerosis and controls or other clinical populations were included in the meta-analysis.

RESULTS

Twenty-four studies met the inclusion criteria and yielded a total of 119 comparisons. There was a moderate difference in physical activity levels between persons with multiple sclerosis and controls (effect size = -0.56, P < 0.01), but no significant difference between persons with multiple sclerosis and other clinical populations (effect size = 0.01, P = 0.90). The pooled effect sizes comparing multiple sclerosis with controls ( Q104 = 457.9, P < 0.01) as well as with clinical populations ( Q13 = 108.4, P < 0.01) were heterogeneous. Moderating variables included sex, disability status, measurement method, outcome, intensity, and application of a multiple sclerosis-specific cut-point.

CONCLUSIONS

Physical activity levels remain significantly lower in persons with multiple sclerosis compared with controls, but the magnitude of difference has become smaller over the past decade. There is a need for continued development of effective physical activity programs that can reach the greater community with multiple sclerosis.

Effect of self-regulating fatigue on health-related quality of life of middle-aged and elderly patients with recurrent stroke: a moderated sequential mediation model

Although the association between self-regulation of fatigue and health-related quality of life (HRQoL) has been confirmed, the potential mechanism remains unclear. This study aimed to explore the role of health literacy, health behavior, and exercise frequency in the relationship among middle-aged and elderly patients with recurrent stroke. A cross-sectional survey was conducted. A total of 176 patients completed the survey, in which self-regulation of fatigue, HRQoL, health literacy and health behavior were measured by questionnaires. Based on Bootstrap analyses, a moderating sequential mediation model using PROCESS software was constructed with health literacy and health behavior as mediators and exercise frequency as the moderator. Of the participants, the mean age was 65.44 ± 12.43 years. Self-regulation of fatigue was found to affect HRQoL indirectly through two significant mediation pathways: (1) health literacy (β=-0.11, 95%CI = -0.20, -0.03), which accounted for 28.79% of the total effect, and (2) health literacy and health behavior (β=-0.02, 95%CI = -0.05, -0.00), which accounted for 4.80% of the total effect. Exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Specifically, the interaction term between self-regulating fatigue and exercise frequency significantly predicted HRQoL (β = 0. 25, t = 2.55, p < 0.05). These findings highlight the role of health literacy and health behavior as sequential mediators of the relationship between self-regulating fatigue and HRQoL. Moreover, exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Encouraging patients with recurrent stroke to increase exercise frequency appropriately might improve HRQoL for patients with poor health literacy and health behavior.

Acute effects of different Tai Chi practice protocols on cardiac autonomic modulation

Tai Chi serves as an effective exercise modality for enhancing autonomic regulation. However, a majority of existing studies have employed the single routine (SR) protocol as the basis for health interventions. The extent to which the gong routine application (GRA) protocol achieves similar levels of exercise load stimulation as traditional single practice routines remains uncertain. Therefore, this study the distinct characteristics of autonomic load stimulation in these different protocols, thus providing a biological foundation to support the development of Tai Chi health promotion intervention programs. we recruited a cohort of forty-five university students to participate in the 15 min GRA protocol and SR protocol. We collected heart rate and heart rate variability indicators during periods of rest, GRA protocol, and SR protocol utilizing the Polar Scale. Additionally, we assessed the mental state of the participants using the BFS State of Mind Scale. In summary, the autonomic load is lower in the GRA protocol compared to the SR protocol, with lower sympathetic activity but higher parasympathetic activity in the former. Results are specific to college students, additional research is necessary to extend support for frail older adults. It is advised to incorporate GRA protocol alongside SR protocol in Tai Chi instruction. This approach is likely to enhance Tai Chi skills and yield greater health benefits.

Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial

INTRODUCTION

Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS.

OBJECTIVE

To investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period.

MATERIALS AND METHODS

A double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period.

RESULTS

25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p < 0.001) and post-treatment to follow-up (p = 0.034). The Likert-type satisfaction questionnaire obtained a mean score of 89.10 (± 8.54) out of 100 points.

CONCLUSIONS

Upper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks resulted in significant improvements in the intra-group analysis for UL coordination and manual dexterity in favor of the experimental group. The experimental group showed excellent satisfaction to the treatment.

Impact of Early Mobilization on Patients With Acute Ischemic Stroke Treated With Thrombolysis or Thrombectomy: A Randomized Controlled Trial

BACKGROUND

Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients' performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown.

OBJECTIVE

To investigate the effect of EM on AIS treated with IVT or MT.|.

METHODS

We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge.

MAIN OUTCOMES MEASURES

The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center.

RESULTS

Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.

Dose Response to Upper Extremity Stroke Rehabilitation Varies by Individual: Early Indicators of Treatment Response

BACKGROUND

Dose response has remained a priority area in motor rehabilitation research for decades, prompting several large randomized trials and meta-analyses. These between-subjects comparisons have revealed equivocal relationships between the duration of motor practice and rehabilitation response. Prior reliance on time-consuming clinical assessments made it infeasible to capture within-subjects dose response, as tracking the dose-response trajectory of an individual requires dozens of repeated administrations.

METHODS

This secondary observational cohort analysis of existing data from the gaming arms of the VIGoROUS multisite trial (Video Game Rehabilitation for Outpatient Stroke) describes the rehabilitation dose response of 80 participants with mild-moderate chronic stroke. The 3-dimensional joint position data were captured via the Kinect v2 optical sensor as participants completed a prescribed 15 hours of in-home unsupervised game-based motor practice. Kinematic dose response trajectories were fitted from hundreds to thousands of in-game repetitions for 4 separate upper extremity movements for each participant.

RESULTS

Of 75 participants with sufficient data for dose-response analysis, 85% showed improved motor capacity for at least 1 movement. Dose response was bimodal; 42% required <5 hours of motor practice before reaching a plateau in movement kinematics, whereas 55% required >10 and 34% required >30 hours. We could predict with 93% accuracy whether or not an individual would ultimately respond to game-based motor practice within 5 hours of gameplay.

CONCLUSIONS

Dose response varies considerably between individuals. About half of chronic stroke patients benefit from higher doses of motor practice than the current standard of care. Individualized dose-response data from motion capture rehabilitation gaming can guide clinical decision-making early on in treatment.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02631850.

Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis

Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45-65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson's disease

Background: Brain-Derived Neurotrophic Factor (BDNF) serum levels are reduced in patients with Parkinson's Disease (PD). Objectives: This study aimed to assess the effect of exercise intensity, volume and type on BDNF levels in patients with PD. Methods: We searched clinicaltrials.gov, CINAHL, Embase, PubMed, Scopus, Web of Science for both controlled and non-controlled studies in patients with PD, published between 2003 and 2022, which assessed Brain-Derived Neurotrophic Factor before and after different exercise protocols. Exercise intensity was estimated using a time-weighted average of Metabolic Equivalent of Task (MET), while exercise volume was estimated by multiplying MET for the duration of exercise. Exercise types were classified as aerobic, resistance, balance and others. We computed two distinct standardized measures of effects: Hedges' g to estimate differences between experimental and control group in pre-post intervention BDNF changes, and Cohen's d to measure pre-post intervention changes in BDNF values for each study arm. Meta-regression and linear regression were used to assess whether these effect measures were associated with intensity, volume and type. PROSPERO registration number: CRD42023418629. Results: Sixteen studies (8 two-arm trials and 8 single-arm trials) including 370 patients with PD were eligible for the systematic review. Selected studies had a large variability in terms of population and intervention characteristics. The meta-analysis showed a significant improvement in BDNF levels in the exercise group compared to the control group, Hedges' g = 0.70 (95% CI: 0.03, 1.38), with substantial heterogeneity (I2 = 76.0%). Between-group differences in intensity were positively associated with change in BDNF in a subset of 5 controlled studies. In the analysis which included non-controlled studies, intensity and total exercise volume were both positively associated with BDNF change. No difference was found according to exercise type. Conclusion: Exercises of greater intensity may increase BDNF levels in patients with PD, while the role of volume of exercise needs to be further explored.

EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS

Objective

To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention.

Design Patients and Methods

Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke.

Results

The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index.

Discussion and Conclusion

Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.

Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients

(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability.

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.

Effects of a Remote Multimodal Intervention Involving Diet, Walking Program, and Breathing Exercise on Quality of Life Among Newly Diagnosed People with Multiple Sclerosis: A Quasi-Experimental Non-Inferiority Pilot Study

Background

Interventions involving diet, physical activity, and breathing exercises are shown to be beneficial in managing both fatigue and quality of life (QoL) related to MS; however, the impact of such interventions among people newly diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) who decline disease-modifying therapies (DMTs) is unknown.

Methods

A 12-month prospective quasi-experimental non-inferiority trial recruited people newly diagnosed with CIS or RRMS who voluntarily declined DMTs (health behavior group; HB, n = 29) or followed standard of care (SOC, n = 15). Participants in the HB group were remotely coached on the study diet, moderate-intensity walking, and breathing exercises. All participants completed questionnaires validated to assess MS symptoms, including perceived mental and physical QoL (MSQOL54); fatigue (Fatigue Severity Scale, FSS; and Modified Fatigue Impact Scale, MFIS); mood (Hospital Anxiety and Depression Scale, HADS); and cognitive function (Perceived Deficits Questionnaire, PDQ).

Results

During the 12 months, the HB group experienced improvement in scores for mental QoL (MSQOL54 - Mental, 0.24, 95% CI 0.01, 0.47; p = 0.04), fatigue (Total MFIS, -7.26, 95% CI -13.3,-1.18; p = 0.02), and perceived cognitive function (Total PDQ, PDQ-Attention, PDQ-Promemory, and PDQ-Planning, p ≤ 0.03 for all). A between-group difference was observed only for PDQ-Planning (p = 0.048). Non-inferiority analysis revealed that the 12-month changes in means for the HB group were not worse than those for the SOC group with respect to fatigue (FSS, p = 0.02), mood (HDS-Anxiety, p = 0.02; HADS-Depression, p < 0.0001), physical QoL (MSQOL54 - Physical, p = 0.02), or cognitive dysfunction (Total PDQ, p = 0.01).

Conclusion

The multimodal lifestyle intervention for individuals newly diagnosed with CIS or RRMS, who voluntarily decline DMTs, did not yield patient-reported outcomes worse than those observed in the SOC group regarding perceived mental quality of life, mood, fatigue, and cognitive function.

Trial Registration

clinicaltrials.gov identifier: NCT04009005.

The Life After Stroke In Northern Sweden Study (LASINS): Methodology, cohort demographics and initial results

BACKGROUND

To advance rehabilitation we need a comprehensive understanding of functioning and disability of people after stroke.

OBJECTIVE

To present an overview of the methodology of the Life After Stroke In Northern Sweden Study, compare participants and non-participants regarding gender and age, and describe baseline sociodemographics, stroke characteristics and the participants' self-rated degree of recovery.

METHODS

Data were collected through a study specific questionnaire, from the participants' medical records and with internationally established self-assessment tools focusing on sleep disturbances, depressive symptoms, fatigue, physical activity, and remaining physical and cognitive impairments, activity limitations, participation restrictions and life satisfaction.

RESULTS

Of 301 potential participants, 160 comprise the final sample (response rate 53%; 86 men and 74 women, mean age 73 years±11, mean time since stroke onset 35 months±11; 18- 61). Most participants had an ischemic stroke (87%), were retired (84%), cohabitant (63%) and walked independently (71%). The mean self-rated degree of recovery was 75 (SD±24; 0- 100).

CONCLUSIONS

These baseline data together with forthcoming studies will describe stroke-related impairments, activity limitations, participation restrictions and life satisfaction more than one year after stroke, and deepen our understanding of factors of importance for a healthy and successful life after stroke.

Feasibility, Outcomes, and Perceptions of a Virtual Group Exercise Program in Multiple Sclerosis

BACKGROUND AND PURPOSE

Individuals with multiple sclerosis (MS) frequently report low physical activity and psychosocial support due to concerns with transportation, time, finances, access to services, and lack of caregiver support. These barriers can be addressed by online group interventions; however, utility of such programs in individuals with MS has not been examined yet. The purpose of this retrospective study was, therefore, to ( a ) investigate the feasibility, safety, and outcomes of a virtual group exercise program in individuals with MS, and ( b ) explore the participant perceptions after the program.

METHODS

Retrospective data from the medical records of 17 individuals with MS (mean [SD] age = 53.5 [12.3] years, body mass index = 28.2 [7.2]) who completed the virtual 13-week group exercise program, pre- and posttraining functional status questionnaires, and the end-of-program feedback were extracted. The exercise program included aerobic, resistance, balance, and flexibility training components recommended for people with MS. Feasibility, safety, outcomes, and participant perceptions were determined by adherence to the prescribed daily exercise dosage, number of adverse events, within-group differences in self-reported functional status, and thematic analysis of the participant feedback, respectively.

RESULTS

Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes ( P < 0.05) in functional status posttraining. Several themes on the perceived barriers, facilitators, and suggestions for improvement were identified.

DISCUSSION AND CONCLUSIONS

A virtual 13-week group exercise program can be feasible, safe, effective, and well received by individuals with MS. Future research should investigate the dose-response effectiveness of telehealth and compare various telehealth models of exercise training using large randomized controlled trials.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A434 , which demonstrates an overview of the study).

What type of physical exercise works best to improve movement and quality of life for people with Parkinson's disease? - A Cochrane Review summary with commentary

BACKGROUND

Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural instability. Many studies document the effects of exercise-based interventions, but the benefit of different exercise types remains unclear.

OBJECTIVE

To provide a commentary on the Cochrane Review by Ernst et al. on the effectiveness of different types of physical exercise regarding motor signs, Quality of Life (QoL), and the occurrence of adverse events.

METHODS

A systematic search was performed in CENTRAL, MEDLINE, Embase, and other databases. The search was performed also in trial registries, conference proceedings, and reference list of identified studies.

RESULTS

The review included 154 RCTs (with 7837 participants). The network meta-analyses (NMAs) on the severity of motor signs and QoL included data from 60 (2721 participants) and 48 (3029 participants) trials, respectively. The evidence from the NMA suggests that dance, gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs, and multi-domain training probably has a small beneficial effect on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. In addition, aqua-based training probably has a large beneficial effect on QoL, and mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL.

CONCLUSIONS

Current evidence supports the promotion of physical exercise among people with PD, identifying only small differences between exercises in influencing the severity of motor signs and QoL.