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Huang MH, Doyle L, Burnham A, Fry DK, Shea K. Predictors of positive outcomes following resistive inspiratory muscle training in non-ambulatory persons with advanced multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173211058862. [PMID: 35634011 PMCID: PMC9134439 DOI: 10.1177/20552173211058862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Inspiratory muscle training (IMT) using a threshold device improves
inspiratory muscle strength. What factors influence the IMT outcome has not
been examined. Objective To identify predictors of the positive outcome following IMT in persons with
advanced multiple sclerosis (PwAMS). Methods Inclusion criteria were non-ambulatory PwAMS, Expanded Disability Status
Scale (EDSS) ≥6.5, age >18 years, no acute medical conditions, current
non-smokers, and ability to consent. Participants (n = 38)
performed daily inspiratory exercises using a resistive threshold device for
10 weeks. Baseline measurements included age, sex, body mass index, year
post multiple sclerosis diagnosis, comorbidities, EDSS, Modified Fatigue
Impact Scale-5, and oral Symbol Digit Modality Test. The percentage of
completed prescribed exercise trials (Trials%) during the 10-week
intervention was calculated. Age- and sex-adjusted predicted values of
maximum inspiratory pressure (MIP%pred) and maximum expiratory pressure
(MEP%pred) were obtained before and after the 10-week intervention. Backward
multivariable regression analyses for the primary outcome (MIP%pred) were
conducted. Results After controlling for the initial MIP%pred, perceived fatigue at the baseline
and Trial% were significant and independent predictors of MIP%pred after
IMT. Conclusion Less fatigue at the baseline and higher adherence to the prescribed exercise
repetitions were positive predictors of the positive outcome following IMT
in PwAMS.
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Affiliation(s)
- Min Hui Huang
- Physical Therapy Department, College of Health Sciences, University of Michigan-Flint, Flint, MI, USA
| | - Lisa Doyle
- Doctor of Physical Therapy Program, Franklin Pierce University, Manchester, NH, USA
| | | | - Donna K. Fry
- College of Health Sciences, University of Michigan-Flint, Flint, MI, USA
| | - Keelin Shea
- Doctor of Physical Therapy Program, Franklin Pierce University, Manchester, NH, USA
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Schlagheck ML, Joisten N, Walzik D, Wolf F, Neil-Sztramko SE, Bansi J, Rademacher A, Zimmer P. Systematic Review of Exercise Studies in Persons with Multiple Sclerosis: Exploring the Quality of Interventions According to the Principles of Exercise Training. Neurol Ther 2021; 10:585-607. [PMID: 34520000 PMCID: PMC8571450 DOI: 10.1007/s40120-021-00274-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The objective of this systematic review is to explore the application and reporting of (i) the principles of exercise training in exercise trials, (ii) the components of exercise prescription, and (iii) the adherence towards the prescribed programmes in randomised controlled trials (RCTs) in persons with multiple sclerosis (pwMS). METHODS The MEDLINE, CINAHL, SPORTDiscus, PubMed and Embase electronic databases were searched from 1 January 2000 to 16 October 2020. RCTs comprising at least 3 weeks of aerobic and/or resistance exercise intervention in pwMS that reported at least one physiological outcome and were published in peer-reviewed journals were eligible for inclusion. RESULTS Out of 52 RCTs included in this review, 58 intervention arms were examined. None applied more than four principles of exercise training. Specificity was addressed by 85%, progression by 33%, overload by 59%, initial values by 26%, reversibility by 0% and diminishing returns by 2% of trials. Fifty-two percent of trials reported all components of exercise prescription, and 3% of trials reported the level of adherence to the prescribed exercise. CONCLUSION This systematic review reveals that exercise training principles were not respected in the majority of included RCTs. The weak quality of reported exercise interventions limits the interpretation of the studies' results and potentially leads to an underestimation of 'exercise as medicine' in pwMS. Also, the vague descriptions of exercise prescription and adherence impede the reproducibility of results. Future studies must attend to all principles of exercise training and provide transparent information on the prescribed and performed programmes to develop specific and valid exercise recommendations for pwMS. SYSTEMATIC REVIEW REGISTRATION CRD42020162671, 28/04/2020, PROSPERO.
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Affiliation(s)
- Marit L Schlagheck
- Department of "Performance and Health (Sports Medicine)", Institute of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227, Dortmund, Germany
| | - Niklas Joisten
- Department of "Performance and Health (Sports Medicine)", Institute of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227, Dortmund, Germany.
| | - David Walzik
- Department of "Performance and Health (Sports Medicine)", Institute of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227, Dortmund, Germany
| | - Florian Wolf
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jens Bansi
- Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Valens, Switzerland
| | - Annette Rademacher
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Philipp Zimmer
- Department of "Performance and Health (Sports Medicine)", Institute of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227, Dortmund, Germany
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Flachenecker P, Bures AK, Gawlik A, Weiland AC, Kuld S, Gusowski K, Streber R, Pfeifer K, Tallner A. Efficacy of an Internet-Based Program to Promote Physical Activity and Exercise after Inpatient Rehabilitation in Persons with Multiple Sclerosis: A Randomized, Single-Blind, Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124544. [PMID: 32599767 PMCID: PMC7344392 DOI: 10.3390/ijerph17124544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022]
Abstract
Background: Multimodal rehabilitation improves fatigue and mobility in persons with multiple sclerosis (PwMS). Effects are transient and may be conserved by internet-based physical activity promotion programs. Objective: Evaluate the effects of internet-based physical activity and exercise promotion on fatigue, quality of life, and gait in PwMS after inpatient rehabilitation. Methods: PwMS (Expanded Disability Status Scale (EDSS) ≤ 6.0, fatigue: Würzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) ≥ 32) were randomized into an intervention group (IG) or a control group (CG). After rehabilitation, IG received 3 months of internet-based physical activity promotion, while CG received no intervention. Primary outcome: self-reported fatigue (WEIMuS). Secondary outcomes: quality of life (Multiple Sclerosis Impact Scale 29, MSIS-29), gait (2min/10m walking test, Tinetti score). Measurements: beginning (T0) and end (T1) of inpatient rehabilitation, 3 (T2) and 6 (T3) months afterwards. Results: 64 of 84 PwMS were analyzed (IG: 34, CG: 30). After rehabilitation, fatigue decreased in both groups. At T2 and T3, fatigue increased again in CG but was improved in IG (p < 0.001). MSIS-29 improved in both groups at T1 but remained improved at T2 and T3 only in IG. Gait improvements were more pronounced in IG at T2. Conclusions: The study provides Class II evidence that the effects of rehabilitation on fatigue, quality of life, and gait can be maintained for 3–6 months with an internet-based physical activity and exercise promotion program.
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Affiliation(s)
- Peter Flachenecker
- Neurological Rehabilitation Center Quellenhof, 75323 Bad Wildbad, Germany; (A.K.B.); (A.-C.W.); (K.G.)
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
- Correspondence: (P.F.); (A.T.)
| | - Anna Karoline Bures
- Neurological Rehabilitation Center Quellenhof, 75323 Bad Wildbad, Germany; (A.K.B.); (A.-C.W.); (K.G.)
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Angeli Gawlik
- Department of Health & Social Psychology, German Sport University Cologne, 50933 Cologne, Germany;
- Department of Sport Science and Sport, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (R.S.); (K.P.)
| | - Ann-Christin Weiland
- Neurological Rehabilitation Center Quellenhof, 75323 Bad Wildbad, Germany; (A.K.B.); (A.-C.W.); (K.G.)
| | - Sarah Kuld
- Faculty of Economics, University of Bayreuth, 95447 Bayreuth, Germany;
| | - Klaus Gusowski
- Neurological Rehabilitation Center Quellenhof, 75323 Bad Wildbad, Germany; (A.K.B.); (A.-C.W.); (K.G.)
| | - René Streber
- Department of Sport Science and Sport, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (R.S.); (K.P.)
| | - Klaus Pfeifer
- Department of Sport Science and Sport, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (R.S.); (K.P.)
| | - Alexander Tallner
- Department of Sport Science and Sport, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (R.S.); (K.P.)
- Correspondence: (P.F.); (A.T.)
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Orban A, Garg B, Sammi MK, Bourdette DN, Rooney WD, Kuehl K, Spain RI. Effect of High-Intensity Exercise on Multiple Sclerosis Function and Phosphorous Magnetic Resonance Spectroscopy Outcomes. Med Sci Sports Exerc 2019; 51:1380-1386. [PMID: 31205251 PMCID: PMC6594188 DOI: 10.1249/mss.0000000000001914] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We determined if a high-intensity aerobic exercise program would be safe, improve expected fitness and clinical outcomes, and alter exploratory phosphorous magnetic resonance spectroscopy (P MRS) outcomes in persons with multiple sclerosis (PwMS). METHODS This open-label prospective pilot study compared two cohorts of ambulatory PwMS matched for age, sex and V˙O2max. Cohorts underwent 8 wk of high-intensity aerobic exercise (MS-Ex, n = 10) or guided stretching (MS-Ctr, n = 7). Aerobic exercise consisted of four 30-min sessions per week while maintaining ≥70% maximal HR. Changes in cardiorespiratory fitness, clinical outcomes, and P MRS of tibialis anterior (TA) muscle and brain were compared. Cross-sectional P MRS comparisons were made between all MS participants and a separate matched healthy control population. RESULTS The MS-Ex cohort achieved target increases in V˙O2max (mean, +12.7%; P = <0.001, between-group improvement, P = 0.03). One participant was withdrawn for exercise-induced syncope. The MS-Ex cohort had within-group improvements in fat mass (-5.8%; P = 0.04), lean muscle mass (+2.6%; P = 0.02), Symbol Digit Modalities Test (+15.1%; P = 0.04), and cognitive subscore of the Modified Fatigue Impact Scale (-26%; P = 0.03), whereas only the physical subscore of the Modified Fatigue Impact Scale improved in MS-Ctr (-16.1%; P = 0.007). P MRS revealed significant within-group increases in MS-Ex participants in TA rate constant of phosphocreatine (PCr) recovery (+31.5%; P = 0.03) and adenosine triphosphate/PCr (+3.2%; P = 0.01), and near significant between-group increases in TA PCr recovery rate constant (P = 0.05) but no significant changes in brain P MRS after exercise. Cross-sectional differences existed between MS and healthy control brain PCr/inorganic phosphate (4.61 ± 0.44, 3.93 ± 0.19; P = 0.0019). CONCLUSIONS High-intensity aerobic exercise in PwMS improved expected cardiorespiratory and clinical outcomes but provoked one serious adverse event. The P MRS may serve to explore underlying mechanisms by which aerobic exercise exerts cerebral benefits.
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Affiliation(s)
- Anna Orban
- Oregon Health & Science University, Neurology, Portland, OR
| | - Bharti Garg
- Oregon Health & Science University, Health Promotion & Sports Medicine, Portland, OR
| | - Manoj K Sammi
- Oregon Health & Science University, Advanced Imaging Research Center, Portland, OR
| | | | - William D Rooney
- Oregon Health & Science University, Advanced Imaging Research Center, Portland, OR
| | - Kerry Kuehl
- Oregon Health & Science University, Health Promotion & Sports Medicine, Portland, OR
| | - Rebecca I Spain
- Oregon Health & Science University, Neurology, Portland, OR.,Portland VA Medical Center, Neurology, Portland, OR
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Baird JF, Motl RW. Response Heterogeneity With Exercise Training and Physical Activity Interventions Among Persons With Multiple Sclerosis. Neurorehabil Neural Repair 2018; 33:3-14. [PMID: 30585528 DOI: 10.1177/1545968318818904] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Multiple sclerosis (MS) is a heterogeneous disease, both in its pathology and symptomology. This poses a challenge for the medical management and rehabilitation of MS; however, physical activity and exercise training are rehabilitation approaches that have demonstrated beneficial effects on many of the burdensome consequences of MS such as mobility impairment and fatigue. Given the heterogeneous course of MS, it is possible that outcomes of physical activity and exercise training interventions demonstrate heterogeneity both in the magnitude and pattern of change, but there has been little focus on response heterogeneity with these interventions among persons with MS. In this narrative review, a search of the existing literature was performed to identify studies that reported individual participant data, which was used to describe the variability in the response to physical activity and exercise training interventions among persons with MS. Inter-individual variability seemingly occurs across outcomes and modalities, which underscores the consideration of factors that might influence response heterogeneity. Factors related to MS disease characteristics, nervous system damage, and the degree of MS-related disability might influence individual responsiveness. Large-scale studies that permit the examination of heterogeneity and its predictors will inform future research on the area of physical activity and exercise training in MS, and lead to the development of individually tailored rehabilitation approaches that will more effectively elicit change.
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Affiliation(s)
| | - Robert W Motl
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
INTRODUCTION Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function. First, the efficacy of dalfampridine, currently the only Food and Drug Administration approved symptomatic pharmacologic agent that improves walking in persons with MS is described. Next, a review of the efficacy of non-pharmacologic therapies for improving walking, including exercise training, physical therapy, and gait training is given. Last, guidance on future research on mobility in MS is provided by emphasizing the importance of combinatory treatment approaches that include multiple intervention modalities, as the best treatment plan likely involves a comprehensive, multidisciplinary approach. Expert commentary: There has been an increased effort to develop symptom-specific treatments in MS that directly target mobility disability; however, more research is needed to determine the efficacy of these rehabilitative strategies alone and together for improving walking in persons with MS.
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Affiliation(s)
- Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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