Inflammation and physical activity in multiple sclerosis patients. A systematic review and meta-analysis

OBJECTIVES

Due to the inflammatory nature of multiple sclerosis (MS), the most widely used therapeutic approach targets the immune response but can comprise side effects (e.g. secondary immunosuppression). For these reasons, among non-pharmaceutical interventions without known side effects, physical activity (PA) gained importance because it is feasible, safe and a supportive complementary treatment strategy to alleviate symptoms in MS subjects. Consequently, the main aim of this systematic review is to analyze the effect of PA protocols, as a complementary therapy, on inflammatory status in MS patients.

METHODS

Four electronic databases (PubMed, Embase, CINAHL, and Cochrane CENTRAL) were systematically searched up to 01 June 2023 (Prospero Protocol ID=CRD42021244418). The refined search strategy was based on three concepts: "MULTIPLE SCLEROSIS" AND "PHYSICAL ACTIVITY" AND "INFLAMMATION".

RESULTS

three main findings emerged: 1) untrained subjects showed a negative modulation of inflammatory biomarkers concentrations when compared to trained people (-0.74, 95 %C.I.-1.16, -0.32); 2) training modulated positively inflammatory biomarkers (+0.47, 95 %C.I. 0.24,0.71); 3) Aerobic PA protocol enhance higher positive influence on inflammation.

CONCLUSIONS

Persistent, low-grade inflammation in MS could be upregulated by non-pharmacological complementary therapies, in particular by regular aerobic PA that could reduce and positively modulate inflammation.

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

Stroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: - 2.1 ± 2.3 vs. IC: - 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.

Biomechanical, physiological and anthropometrical predictors of performance in recreational runners

Background

The maximal running speed (VMAX) determined on a graded treadmill test is well-recognized as a running performance predictor. However, few studies have assessed the variables that predict VMAX in recreationally active runners.

Methods

We used a mathematical procedure combining Fick's law and metabolic cost analysis to verify the relation between (1) VMAX versus anthropometric and physiological determinants of running performance and, (2) theoretical metabolic cost versus running biomechanical parameters. Linear multiple regression and bivariate correlation were applied. We aimed to verify the biomechanical, physiological, and anthropometrical determinants of VMAX in recreationally active runners. Fifteen recreationally active runners participated in this observational study. A Conconi and a stead-steady running test were applied using a heart rate monitor and a simple video camera to register the physiological and mechanical variables, respectively.

Results

Statistical analysis revealed that the speed at the second ventilatory threshold, theoretical metabolic cost, and fat-mass percentage confidently estimated the individual running performance as follows: VMAX = 58.632 + (-0.183 * fat percentage) + (-0.507 * heart rate percentage at second ventilatory threshold) + (7.959 * theoretical metabolic cost) (R2 = 0.62, p = 0.011, RMSE = 1.50 km.h-1). Likewise, the theoretical metabolic cost was significantly explained (R2 = 0.91, p = 0.004, RMSE = 0.013 a.u.) by the running spatiotemporal and elastic-related parameters (contact and aerial times, stride length and frequency, and vertical oscillation) as follows: theoretical metabolic cost = 10.421 + (4.282 * contact time) + (-3.795 * aerial time) + (-2.422 * stride length) + (-1.711 * stride frequency) + (0.107 * vertical oscillation).

Conclusion

Critical determinants of elastic mechanism, such as maximal vertical force and vertical and leg stiffness were unrelated to the metabolic economy. VMAX, a valuable marker of running performance, and its physiological and biomechanical determinants can be effectively evaluated using a heart rate monitor, treadmill, and a digital camera, which can be used in the design of training programs to recreationally active runners.

Determinants of Dual-task Gait Speed in Older Adults with and without Parkinson's Disease

Mobility difficulties for people with Parkinson's disease (PwPD) are more pronounced when they perform a simultaneous cognitive task while walking. Although it is known that neurodegeneration results in widespread motor and brain impairments, few studies have comprehensively examined possible physical and mental determinants of dual task walking in PwPD. In this cross-sectional study, we aimed to investigate if and how muscle strength (sit-to-stand 30-sec test), cognition (mini-mental state examination) and functionality (timed up and go test) affect walking performance (10-meter walking test) with and without arithmetic dual task from older adults with and without Parkinson's disease. Walking speed was reduced by 16% and 11% with arithmetic dual task for PwPD (from 1.07±0.28 to 0.91±0.29 m.s-1, p<0.001) and older adults (from 1.32±0.28 to 1.16±0.26 m.s-1, p=0.002) compared to essential walking. The cognitive state was similar among the groups, but it was only associated with the dual-task walking speed in PwPD. In PwPD, lower limb strength was the better predictor of speed, whereas mobility was more related to it in older adults. Therefore, future exercise interventions aiming to improve walking in PwPD should consider these findings to maximize their effectiveness.

Effects of aging on arm coordination at different walking speeds

BACKGROUND

Previous work has shown that the mean continuous relative phase and coordination variability of lower limbs are modified in older adults when walking.

RESEARCH QUESTION

Here, we propose to understand the extent to which such control mechanisms for upper limbs are present during gait. Specifically, we seek to understand if aging and gait speed constraints influence the interjoint control of upper limbs during walking.

METHODS

This observational study evaluated thirty-three participants, divided into older (n = 20, age 66.4 ± 4.3 years; mass: 77.2 ± 14.2 kg; height: 165 ± 9.20 cm) and young adults (n = 13, age 29.5 ± 4.7 years; mass 75.5 ± 9.6 kg; height: 172 ± 6.24 cm) were asked to walk at 0.28, 0.83, 1.38 m.s^-1 on a level treadmill while their segmental movements were simultaneously registered with 3D motion capture system. We calculated the mean continuous relative phase and coordination variability (continuous relative phase variability) in elbow-shoulder and shoulder-hip pairs, and a generalized estimating equation was used to test the main and interaction effects of age and speed.

RESULTS

Older adults had a reduced continuous relative phase (more in-phase coordination) of upper limbs at whole stance for elbow-shoulder, at loading response for shoulder-hip, at mid-stance and terminal stance for elbow-shoulder and shoulder-hip in comparison to young adults at different speeds (p < 0.05). The coordination variability of upper limbs was greater (higher continuous relative phase variability) in older than young adults at 0.28 and 1.38 m.s^-1.

SIGNIFICANCE

These findings substantiate the altered motor control role of upper limbs in gait aging, suggesting that lower self-selected speed may be related to the reduced ability to control arm movement during the intermediate phases of gait.

Barriers to exercise and the role of general practitioner: A cross-sectional survey among people with multiple sclerosis

Introduction

Regular exercise is strongly recommended for people with MS (pwMS), but recent studies still describe them as sedentary and insufficiently active. The purpose of this study is to identify the major barriers that prevent pwMS from exercising and underline the importance of the general practitioner (GP) in promoting an active lifestyle.

Materials and methods

We performed a multicenter cross-sectional study using a self-administered questionnaire among pwMS. Data about demographics, the disease, current exercise practice, barriers, previous GP's advice to practice, and motivation were collected.

Results

A total of 741 pwMS (age 55.6 ± 12.5 years, 66% females) completed the survey. Most responders (75.3%) did not practice any exercise. Fatigue was the most limiting factor to attending and/or starting an exercise program, followed by travel and/or moving issues, and the lack of time. Only 25.5% of participants received GP's advice to practice exercise, but 48.6% of them attended an exercise program. A greater likelihood of practice was evidenced for people that received the GP's advice than those who had not received it (OR 2.96; p &lt; 0.001). Finally, among those who did not practice exercise but received advice from GPs, 69 out of 99 (69.7%) were motivated to start an exercise program.

Conclusion

Fatigue and physical issues are the main barriers to exercise for pwMS, but also other factors not related to the disease seem to be relevant, like travel issues and lack of time. Although few participants received advice to exercise from their general practitioner, his role proved effective in encouraging the practice.

Effect of steady-state aerobic exercise intensity and duration on the relationship between reserves of heart rate and oxygen uptake

Background

The percentages of heart rate (%HRR) or oxygen uptake (%V̇O₂R) reserve are used interchangeably for prescribing aerobic exercise intensity due to their assumed 1:1 relationship, although its validity is debated. This study aimed to assess if %HRR and %V̇O₂R show a 1:1 relationship during steady-state exercise (SSE) and if exercise intensity and duration affect their relationship.

Methods

Eight physically active males (age 22.6 ± 1.2 years) were enrolled. Pre-exercise and maximal HR and V̇O₂ were assessed on the first day. In the following 4 days, different SSEs were performed (running) combining the following randomly assigned durations and intensities: 15 min, 45 min, 60% HRR, 80% HRR. Post-exercise maximal HR and V̇O₂ were assessed after each SSE. Using pre-exercise and post-exercise maximal values, the average HR and V̇O₂ of the last 5 min of each SSE were converted into percentages of the reserves (%RES), which were computed in a 3-way RM-ANOVA (α = 0.05) to assess if they were affected by the prescription parameter (HRR or V̇O₂R), exercise intensity (60% or 80% HRR), and duration (15 or 45 min).

Results

The %RES values were not affected by the prescription parameter (p = 0.056) or its interactions with intensity (p = 0.319) or duration and intensity (p = 0.117), while parameter and duration interaction was significant (p = 0.009). %HRRs and %V̇O₂Rs did not differ in the 15-min SSEs (mean difference [MD] = 0.7 percentage points, p = 0.717), whereas %HRR was higher than %V̇O₂R in the 45-min SSEs (MD = 6.7 percentage points, p = 0.009).

Conclusion

SSE duration affects the %HRR-%V̇O₂R relationship, with %HRRs higher than %V̇O₂Rs in SSEs of longer duration.

Effects of Combined Endurance and Resistance Training in Women With Multiple Sclerosis: A Randomized Controlled Study

Purpose: To test the hypothesis that combined resistance and endurance training would improve muscle strength, fatigue, depression, and quality of life in persons with MS.

Methods: Twenty-seven women with MS were randomly assigned to either control (CON, n = 13) or the experimental (EXP, n = 14) group. The participants in the EXP group trained twice a week for 12 weeks, followed by 12 weeks of detraining. Both CON and EXP groups were tested before and after 12 weeks of the intervention period, as well as 12 weeks after training cessation (follow-up), where measures of muscle strength, fatigue, depression, and quality of life were evaluated.

Results: There were significant changes in maximal voluntary isometric contraction (MVIC), 1RM leg extension, and 1RM chest press following the intervention period in the EXP group (P < 0.05), but not in the CON group (P > 0.05). These changes persisted after 12 weeks of detraining. Similar findings were found for fatigue, depression, and physical and mental composites of quality of life.

Conclusion: These results suggest that combined exercise training, at a minimum, prevents the disease-related deterioration of muscular performance and quality of life and well-being in persons with MS.

Effects of the COVID-19 Pandemic on Job Activity, Dietary Behaviours and Physical Activity Habits of University Population of Naples, Federico II-Italy

Coronaviruses (CoVs) are a large family of respiratory viruses that can cause mild to moderate illness. The new variant COVID-19 has started to spread rapidly since December 2019, posing a new threat to global health. To counter the spread of the virus, the Italian government forced the population to close all activities starting from 9 March 2020 to 4 May 2020. In this scenario, we conducted a cross-sectional study on a heterogeneous sample (average age of 28 ± 12 years, 62.6% females) of the University of Naples Federico II (Italy). The aim of the study was to describe the lifestyle change in the university population during quarantine for the COVID 19 pandemic. Participants compiled an online survey consisting of 3 sections: socio-demographic data, dietary behaviours, physical activity habits and psychological aspects. The different results by gender are: 90.8% of females continued to work from home (81.9% were students); 34.8% increased their physical activity; and, only 0.8% prefer ready meals. Whereas, the same percentage of men continued to work from home (90%), but only 72.1% were students (p < 0.001 vs. females), only 23.9% increased physical activity (p < 0.001) and 1.7% favous ready meals. Our data shows that the male population was more affected by isolation and quarantine reporting more unfavourable behavioural changes.

School self-efficacy is affected by gender and motor skills: findings from an Italian study

Background

Perceived school self-efficacy (SE) is an important variable in students’ activities as it affects their motivation and learning. Further, self-efficacy might represent a good predictor of performance, persistence and perseverance. Motor skills and other physical health determinants are extensively debated and linked to cognitive function in children of developmental age. However, inconclusive evidence supports a definitive relationship between perceived school SE and motor skills among schoolchildren. We conducted a cross-sectional study on 6–11-year-old schoolchildren to evaluate the extent by which perceived school SE and physical health determinants were related.

Methods

A SE questionnaire and motor performance battery tests were administered to primary school pupils recruited from 154 sampled schools of northwest Italy. Perceived SE at school was assessed via 12 items from the Caprara’s questionnaire. Motor performance scores were obtained from motor skill tests: 4 × 10 m shuttle run test, SRT; standing broad jump, SBJ; six-minute walking test, 6MWT.

Results

A total of 3,962 children (M = 2,019; F = 1943) were studied and 68% were normal weight. Overall, a 58% of the sample perceived a high SE, while, as to gender differences, a greater percentage of females perceived high levels of school SE with respect to any other level (χ² = 38.93, p < 0.0001). Results from multinomial logistic regression analysis revealed that: (i) females perceived higher SE compared to males; (ii) children who performed better in SRT and 6MWT showed higher levels of perceived school SE; (iii) no significant effect was registered for the body weight. Alternative strategies are encouraged to enhance SE through physical education: structured interventions might enhance both complex motor skills and high-order cognitive skills, like SE, in young children.

Correction: Six minute walk distance and reference values in healthy Italian children: A cross-sectional study

[This corrects the article DOI: 10.1371/journal.pone.0205792.].

Six minute walk distance and reference values in healthy Italian children: A cross-sectional study

The 6-minute walking test (6MWT) is a simple assessment tool to evaluate exercise capacity. The result of the test is the distance that a subject can walk at a constant and normal pace within 6 minutes (6MWD) and reflects the aerobic/fitness performance related to walking function. Use of 6MWT has been relevant to assess exercise tolerance either in healthy children or in patients with, heart, lung and metabolic diseases. Our aim was to find 6MWT reference values in healthy Italian children. The 6MWT was performed in 5614 children aged 6–11 years recruited from primary Italian schools. Age related reference percentiles of the covered distance were gender-modeled. A linear and quadratic regression model was used to predict 6MWT performance. Males walked longer distances than females, respectively 598.8±83.9 m vs 592.1±77.6 m (p = 0.0016). According to the regression analysis, 6MWD was positively related to age, gender and height, while it was negatively related to body weight [(6MWD = -160.16 + 93.35× age (years) -4.05× age²(years) +7.34× gender (m) +2.12× weight (kg) −2.50× height (cm)]. Reference values were established for the 6MWT in healthy children. The age related 6MWD percentiles provided a useful tool in the assessment of capacity in 6–11 year children, in fact they may be helpful to evaluate the effect of a given treatment or rehabilitation program and represent a feasible measure as to prevention within the primary school context. It was found a substantial difference from other countries for 6mwd values. In our study, factors such as age, weight and height were relevant for the prediction of 6MWD, similarly to other studies. Therefore, these variables should be taken into account in context of exercise performance.

A systematic review of cognitive effects of exercise in depression

OBJECTIVE

The aim of the present systematic review and meta-analysis was to evaluate the impact of physical exercise on cognitive symptoms in depressed adult patients.

METHODS

Systematic literature search was performed in Web of Science™ and CINAHL from inception to August 2016. Two reviewers independently selected randomized trials evaluating the effect of exercise on cognitive functions in patients with a validated diagnosis of depression. Outcome measures included global cognition and different cognitive domains (speed of processing, attention/vigilance, working memory, verbal and visual memory, and reasoning).

RESULTS

Eight trials met inclusion criteria (637 patients). A fixed-effects model showed absence of beneficial effect on global cognition (Hedges' g = 0.07, 95% CI -0.08 to 0.24, I²  = 0%) as well as on specific cognitive domains. Sensitivity analyses did not show an impact of exercise in studies with shorter intervention duration compared to longer trials (between group heterogeneity Q = 3.564, df = 1, P = 0.059), single session per week compared to multiple sessions (Q = 2.691, df = 1, P = 0.101) and low exercise intensity compared with moderate/high intensity (Q = 2.952, df = 1, P = 0.086).

CONCLUSION

Our meta-analysis did not observe a substantial benefit of physical exercise on cognitive symptoms in depression.

Psychophysiological Responses to Group Exercise Training Sessions: Does Exercise Intensity Matter?

Group exercise training programs were introduced as a strategy for improving health and fitness and potentially reducing dropout rates. This study examined the psychophysiological responses to group exercise training sessions. Twenty-seven adults completed two group exercise training sessions of moderate and vigorous exercise intensities in a random and counterbalanced order. The %HRR and the exertional and arousal responses to vigorous session were higher than those during the moderate session (p<0.05). Consequently, the affective responses to vigorous session were less pleasant than those during moderate session (p<0.05). These results suggest that the psychophysiological responses to group exercise training sessions are intensity-dependent. From an adherence perspective, interventionists are encouraged to emphasize group exercise training sessions at a moderate intensity to maximize affective responses and to minimize exertional responses, which in turn may positively affect future exercise behavior.

Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis

OBJECTIVE

To assess the efficacy and safety of endoscopic resection of large colorectal polyps.

DESIGN

Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed.

RESULTS

50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%).

CONCLUSIONS

Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.

Does reactivity to accelerometers occur in a single trial? Brief report in a sample of young adults

This study aimed to test acute reactivity during a physical activity in an outdoor setting and to verify the relative perceived performance. In all, 38 volunteers wore accelerometers or not and completed two 20-minute sessions of self-selected pace physical activity. Covered distance, exertional responses, and perceived efficacy were recorded at the end of every session. Relevant finding of this study has been that reactivity to accelerometers also occurs in acute condition. Consequently, this condition leads to a better performance and a greater perceived exertion. Moreover, this situation seems to occur in a state of awareness.

Deep breathing acutely improves arterial dysfunction in obese children: evidence of functional impairment?

BACKGROUND AND AIMS

Similarly to diabetes type 2, patients with obesity show insulin resistance and autonomic and vascular abnormalities associated with increased morbidity and mortality. We tested whether arterial dysfunction in obese children may have a functional nature, reversible with appropriate interventions (e.g., by reduction of sympathetic activity), or else results from anatomic arterial modifications (likely irreversible). For this purpose, we tested whether deep breathing (an intervention known to transiently reduce sympathetic activity) could acutely improve arterial function, hence showing a functional abnormality.

METHODS AND RESULTS

A total of 130 obese children and 67 age-matched healthy normal-weight control children were recruited. Arterial function was measured by augmentation index (AIx), by direct analysis of blood pressure contour, and by pulse wave velocity (PWV), during spontaneous and controlled breathing. The markers of metabolic syndrome were evaluated at baseline. AIx showed increased values in obese male participants as compared with the control group. Slow breathing acutely reduced Aix in obese children, to a greater extent than in normal-weight control children. Similarly, the blood pressure contour showed higher values in obese children that were significantly attenuated by slow breathing. Baseline PWV was not altered in obese participants. The markers of metabolic syndrome correlated with AIx and PWV.

CONCLUSIONS

Obese subjects showed impaired arterial function. The acute improvement in vascular abnormalities with reduction in sympathetic activity indicates that this alteration was largely functional, likely related to initial autonomic dysfunction and to metabolic abnormalities. As a consequence, this study provides a rationale for strategies aiming at preventing arterial function deterioration in the early ages.

Core percolation and onset of complexity in boolean networks

The determination and classification of fixed points of large Boolean networks is addressed in terms of a constraint-satisfaction problem. We develop a general simplification scheme that, removing all those variables and functions belonging to trivial logical cascades, returns the computational core of the network. The transition line from an easy to a complex regulatory phase is described as a function of the parameters of the model, identifying thereby both theoretically and algorithmically the relevant regulatory variables.