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Bonde-Jensen F, Dalgas U, Hvid LG, Langeskov-Christensen M. Validity and reliability of linear encoder muscle power testing in persons with Parkinson's disease. Clin Rehabil 2024; 38:678-687. [PMID: 38193269 DOI: 10.1177/02692155231224987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To investigate the construct validity ON medication and the reliability both ON and OFF medication of linear encoder muscle power testing in persons with Parkinson's disease (pwPD). DESIGN A study using baseline data from one randomized controlled trial (study 1) and one cohort study (study 2). SETTING University exercise lab. PARTICIPANTS Study 1: 35 healthy controls and 70 pwPD. Study 2: 20 pwPD. INTERVENTION Study 1: baseline data. Study 2: 4 chair rise tests (2 ON and 2 OFF medication), in a randomized order, separated by 4 to 16 days. MAIN MEASURES Linear encoder data were collected from a chair rise test. Known groups validity and convergent validity (i.e., construct validity) were assessed by comparing peak power between pwPD and healthy controls and associations between peak power and functional performance (i.e., 6-Min Walk Test, Timed Up and Go Test, Six-Spot Step Test), respectively. Reliability was assessed as day-to-day variation and by intraclass correlation coefficients. RESULTS Peak power was comparable between pwPD and healthy controls (-7.2%, p = 0.17), but lower in moderately impaired pwPD compared to mildly impaired pwPD (-27%, p < 0.01) and healthy controls (-23%, p < 0.01). Moderate to strong associations were observed between peak power and functional performance (r2 = 0.44-0.51). Day-to-day variation ON and OFF medication were 1.0 and 1.3 W/kg, respectively, while intraclass correlation coefficients were 0.95 (0.87;0.98) and 0.93 (0.82;0.97), respectively. CONCLUSION Linear encoder muscle power testing shows inconsistent known groups validity, acceptable convergent validity ON medication, and excellent day-to-day reliability ON and OFF medication in pwPD.
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Affiliation(s)
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish Multiple Sclerosis Hospitals, Ry and Haslev, Denmark
| | - Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
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Bonde-Jensen F, Dalgas U, Langeskov-Christensen M. Are physical activity levels, cardiorespiratory fitness and peak power associated with Parkinson's disease severity? J Neurol Sci 2024; 460:122996. [PMID: 38615406 DOI: 10.1016/j.jns.2024.122996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Increased physical activity (PA) may slow Parkinson's disease (PD) progression. Associations between markers of PA and PD severity could justify further studies evaluating interventions increasing PA levels in PD. The objectives of the present study were to assess associations between PA, cardiorespiratory fitness (VO2-max), and muscle peak power and measures of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Parkinson's disease questionnaire-39 (PDQ-39), and the four PD hallmark motor symptoms (rigidity, bradykinesia, postural instability, and tremor). METHODS Data from 105 people with PD were used. PA was measured for seven consecutive days using accelerometers. Peak power was measured with a linear encoder during a chair rise test, while VO2-max was directly assessed during a graded bicycle test. Analyses included simple and multiple linear regression and hurdle exponential regression. RESULTS PA was weakly to moderately associated with MDS-UPDRS II + III, rigidity, bradykinesia, and postural instability, as well as PDQ-39 mobility and activities of daily living sub-scores. VO2-max and peak power were weakly to moderately associated with MDS-UPDRS III, bradykinesia, and postural instability, while peak power was further weakly associated with the MDS-UPDRS II. Lastly, VO2-max was associated with PDQ-39 mobility and activities of daily living sub-scores. CONCLUSION PA, VO2-max, and peak power were associated with PD severity, thus highlighting the potential benefits of a physically active lifestyle. Furthermore, PA and VO2-max were associated with PDQ-39 sub-scores. This calls for confirmation of the potential effect of PA on quality of life in PD.
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Affiliation(s)
- Frederik Bonde-Jensen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark.
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - Martin Langeskov-Christensen
- Department of Neurology, Viborg Regional Hospital, Heibergs Alle 2, 8800 Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus N, Denmark
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Langeskov-Christensen M, Franzén E, Grøndahl Hvid L, Dalgas U. Exercise as medicine in Parkinson's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332974. [PMID: 38418216 DOI: 10.1136/jnnp-2023-332974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
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.
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Affiliation(s)
- Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Schlagheck ML, Bansi J, Langeskov-Christensen M, Zimmer P, Hvid LG. Cardiorespiratory fitness (V̇O 2peak) across the adult lifespan in persons with multiple sclerosis and matched healthy controls. J Sci Med Sport 2024; 27:10-15. [PMID: 37951825 DOI: 10.1016/j.jsams.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Cardiorespiratory fitness (measured as peak oxygen uptake; V̇O2peak) is a well-established health predictor in the general population and in persons with multiple sclerosis (pwMS). We aimed to investigate differences in V̇O2peak between age groups and the prevalence of V̇O2peak impairments across the adult lifespan in pwMS compared to age- and sex-matched healthy controls (HC). DESIGN Cross-sectional study. METHODS Data from 469 pwMS (EDSS range 1.0-7.0), who carried out graded cardiopulmonary exercise testing during their rehabilitation stay at the Valens clinic from 07/2010 to 10/2022, were retrospectively analyzed. Data from 21,063 HC were extracted from previously published studies containing normative reference values. RESULTS With advanced age (i.e., across age groups), a continuous deterioration of V̇O2peak was observed in both pwMS and HC. Within all age groups, V̇O2peak was reduced in pwMS compared to HC with deficits ranging from 29 % to 40 % for females (p < .05), and from 30 % to 41 % for males (p < .05). However, no age ∗ group interaction was observed in neither males (p = .626) nor females (p = .557). With V̇O2peak impairments defined as values below the 5th percentile of HC, a high prevalence was observed in pwMS, with values ranging from 48 % to 100 % across age groups. CONCLUSIONS The present data provide evidence for a parallel deterioration of V̇O2peak in pwMS and matched controls with advancing age, coinciding with a high prevalence of impairments in V̇O2peak already present in young adulthood in pwMS. Understanding the extent of impairments as well as the age trajectories of cardiorespiratory fitness in pwMS is crucial for designing optimal rehabilitative and preventive interventions.
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Affiliation(s)
- Marit L Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany.
| | - Jens Bansi
- Department of Research and Development, Kliniken Valens, Switzerland; OST - Eastern Swiss University of Applied Sciences, Department of Health, Switzerland
| | - Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; Department of Neurology, Viborg Regional Hospital, Denmark. https://twitter.com/LangekovMartin
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany. https://twitter.com/P_Zimmer
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark. https://twitter.com/HvidLars
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Jensen FB, Dalgas U, Brincks J, Langeskov-Christensen M. Validity and reliability of VO 2-max testing in persons with Parkinson's disease. Parkinsonism Relat Disord 2023; 109:105324. [PMID: 36827950 DOI: 10.1016/j.parkreldis.2023.105324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/18/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Direct whole body assessment of maximal oxygen consumption (VO2-max test) is considered the gold standard when assessing cardiorespiratory fitness (VO2-max) in healthy people. VO2-max is also an important health and performance indicator for persons with Parkinson's disease (pwPD) and is often used when prescribing exercise and evaluating aerobic exercise interventions. However, no study has examined the content validity of the VO2-max test in pwPD as well as the test-retest reliability (i.e., day-to-day variation) in both the ON and OFF medication state. Therefore, the present study investigated the content validity and test-retest reliability of the VO2-max test in pwPD both ON and OFF medication. METHODS Twenty pwPD completed four VO2-max tests (two tests ON and two tests OFF medication), in a randomized order, separated by four to sixteen days. The first tests ON and OFF medication were used to assess content validity based on attainment of five pre-defined end-criteria (one primary and four secondary). Reliability was examined by intraclass correlation coefficients (ICC) and the day-to-day variation of the two ON and OFF medication tests. RESULTS In pwPD, 50% and 60% attained the primary end-criterion ON and OFF medication, respectively. A higher proportion (i.e., 70-90%) attained the secondary end-criteria both ON and OFF medication with no difference between medication states. Day-to-day variations were 1.2 and 1.8 ml O2/kg/min, while ICC2.1 were 0.97 (95%-CI: 0.92; 0.99) and 0.96 (95%-CI: 0.90; 0.98) ON and OFF medication, respectively. CONCLUSION The VO2-max test has an acceptable content validity and excellent day-to-day reliability ON and OFF medication in pwPD.
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Affiliation(s)
- Frederik Bonde Jensen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark.
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - John Brincks
- Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Faculty of Health Science, VIA University College, Hedeager 2, 8200, Aarhus N, Denmark
| | - Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark; Department of Neurology, Viborg Regional Hospital, Heibergs Alle 2, 8800, Viborg, Denmark
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Hvid LG, Langeskov-Christensen M, Stenager E, Dalgas U. Exercise training and neuroprotection in multiple sclerosis. Lancet Neurol 2022; 21:681-682. [DOI: 10.1016/s1474-4422(22)00219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Thrue C, Hvid LG, Gamborg M, Dawes H, Dalgas U, Langeskov-Christensen M. Aerobic capacity in persons with Parkinson’s disease: a systematic review. Disabil Rehabil 2022:1-13. [DOI: 10.1080/09638288.2022.2094480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Cecilie Thrue
- Department of Public Health, Exercise Biology, Aarhus University, Aarhus, Denmark
| | - Lars G. Hvid
- Department of Public Health, Exercise Biology, Aarhus University, Aarhus, Denmark
| | - Mads Gamborg
- Department of Public Health, Exercise Biology, Aarhus University, Aarhus, Denmark
| | - Helen Dawes
- Faculty of Health and Life Sciences, Centre for Movement and Occupational Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ulrik Dalgas
- Department of Public Health, Exercise Biology, Aarhus University, Aarhus, Denmark
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Nygaard MKE, Langeskov-Christensen M, Dalgas U, Eskildsen SF. Cortical diffusion kurtosis imaging and thalamic volume are associated with cognitive and walking performance in relapsing-remitting multiple sclerosis. J Neurol 2021; 268:3861-3870. [PMID: 33829319 DOI: 10.1007/s00415-021-10543-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), pronounced neurodegeneration manifests itself as cerebral gray matter (GM) atrophy, which is associated with cognitive and physical impairments. Microstructural changes in GM estimated by diffusion kurtosis imaging (DKI) may reveal neurodegeneration that is undetectable by conventional structural MRI and thus serve as a more sensitive marker of disease progression. OBJECTIVE The primary objective was to investigate the relationships between morphological and diffusional properties in cerebral GM and physical and cognitive performance in relapsing-remitting MS (RRMS) patients. A secondary objective was to investigate the relationship between GM microstructure and white matter (WM) injury, estimated by the volume of WM lesions. METHODS Sixty-seven RRMS patients performed the brief repeatable battery of neuropsychological tests (BRB-N), the 6-minute walk test (6MWT), the six spot step test (SSST), and underwent MRI scans using structural and DKI protocols. GM volumetrics and DKI measurements were analyzed in the cortex and deep GM structures using a general linear model with demographics, physical- and cognitive performance as covariates. RESULTS Mean diffusivity (MD) in the cortex was associated with the SSST, 6MWT, information processing, global cognitive performance, and volume of WM lesions. In addition, thalamic volume was associated with SSST (r2 = 0.21, 6MWT (r2 = 0.18), information processing (r2 = 0.21), and WM lesion volume (r2 = 0.60). CONCLUSION Cortical diffusion and thalamic volume are associated with walking and cognitive performance in RRMS patients and are highly affected by the presence of WM lesions.
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Affiliation(s)
- Mikkel K E Nygaard
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, Building 1A, 8000, Aarhus C, Denmark.
| | | | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Simon F Eskildsen
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, Building 1A, 8000, Aarhus C, Denmark
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Langeskov-Christensen M, Grøndahl Hvid L, Nygaard MKE, Ringgaard S, Jensen HB, Nielsen HH, Petersen T, Stenager E, Eskildsen SF, Dalgas U. Efficacy of High-Intensity Aerobic Exercise on Brain MRI Measures in Multiple Sclerosis. Neurology 2020; 96:e203-e213. [PMID: 33262230 DOI: 10.1212/wnl.0000000000011241] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether 24 weeks of high-intensity progressive aerobic exercise (PAE) affects brain MRI measures in people with multiple sclerosis (MS). METHODS We conducted a randomized, controlled, phase 2 trial (with a crossover follow-up) including an exercise group (supervised PAE followed by self-guided physical activity) and a waitlist group (habitual lifestyle followed by supervised PAE). Mildly to severely impaired patients with MS aged 18-65 years were randomized (1:1). The primary outcome was percentage brain volume change (PBVC) after 24 weeks, analyzed using the intention-to-treat principle. RESULTS Eighty-six participants were recruited. PBVC did not change over the intervention period (mean between-group change +0.12%, 95% confidence interval [CI] -0.27 to 0.51, p = 0.55). In contrast, cardiorespiratory fitness (+3.5 mL O2/min/kg, 2.0 to 5.1, p < 0.01) and annualized relapse rate (0.00, 0.00-0.07 vs +0.45, 0.28 to 0.61, p < 0.01) improved in the exercise group. CONCLUSION These findings do not support a neuroprotective effect of PAE in terms of total brain atrophy in people with MS and it did not lead to a statistically significant difference in gray matter parenchymal fraction. PAE led to improvements in cardiorespiratory fitness and a lower relapse rate. While these exploratory findings cautiously support PAE as a potential adjunct disease-modifying treatment in MS, further investigations are warranted. CLINICALTRIALSGOV IDENTIFIER NCT02661555. CLASSIFICATION OF EVIDENCE This study provides Level I evidence that 24 weeks of high-intensity PAE did not elicit disease-modifying effects in PBVC in people with MS. Exploratory analyses showed that PAE may reduce relapse rate.
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Affiliation(s)
- Martin Langeskov-Christensen
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg.
| | - Lars Grøndahl Hvid
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Mikkel Karl Emil Nygaard
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Steffen Ringgaard
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Henrik Boye Jensen
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Helle Hvilsted Nielsen
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Thor Petersen
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Egon Stenager
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Simon Fristed Eskildsen
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
| | - Ulrik Dalgas
- From the Section for Sport Science, Department of Public Health (M.L.-C., L.G.H., U.D.), and Center of Functionally Integrative Neuroscience, Department of Clinical Medicine (M.K.E.N., S.F.E.), Aarhus University; MR Research Centre (S.R.) and Multiple Sclerosis Clinic, Department of Neurology (T.P.), Aarhus University Hospital; Brain and Nerve Diseases, Department of Neurology (H.B.J.), Lillebaelt Hospital, Kolding; Department of Regional Health Research (H.B.J.), Department of Neurobiology Research, Institute of Molecular Medicine (H.H.N.), BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research (H.H.N.), and Department of Regional Health Research (E.S.), University of Southern Denmark, Odense; Department of Neurology (H.H.N.), Odense University Hospital; and MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology (E.S.), Hospital of Southern Denmark, Sønderborg
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Langeskov-Christensen M, Hvid LG, Jensen HB, Nielsen HH, Petersen T, Stenager E, Hämäläinen P, Dalgas U. Efficacy of high-intensity aerobic exercise on cognitive performance in people with multiple sclerosis: A randomized controlled trial. Mult Scler 2020; 27:1585-1596. [PMID: 33232191 DOI: 10.1177/1352458520973619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment is highly prevalent in multiple sclerosis (MS). Progressive aerobic exercise (PAE) represents a promising approach toward preservation or even improvement of cognitive performance in people with MS (pwMS). OBJECTIVE To investigate the effects of PAE on the cognitive domains of information processing, learning and memory, and verbal fluency in pwMS. METHODS This randomized controlled trial included an exercise (n = 43, 24 weeks of supervised PAE, followed by self-guided physical activity) and a waitlist group (n = 43, 24 weeks of habitual lifestyle, followed by supervised PAE). Assessments included the Brief Repeatable Battery of Neuropsychological tests (BRB-N), self-reported mood, and cardiorespiratory fitness. Published reference data were used to compute Z-scores for BRB-N scores. Cognitive impairment was defined as one or more Z-scores ⩽ -1.5SD. RESULTS No between-group changes in the total group were observed in BRB-N scores following PAE. In the cognitively impaired subgroup (43% of the total group) the between-group point estimate suggested a potential clinical relevant improvement in the Symbol Digit Modalities Test (95% CI overlapping zero). Cardiorespiratory fitness increased in the total group and the cognitively impaired subgroup. CONCLUSION In the present representative MS group, 24 weeks of supervised PAE had no effect on any cognitive domain in the total group but potentially improved processing speed in the cognitively impaired subgroup.
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Affiliation(s)
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Henrik Boye Jensen
- Brain and Nerve Diseases, Lillebaelt Hospital, Kolding, Denmark/Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark/Department of Neurology, Odense University Hospital, Odense, Denmark/Brain Research - Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thor Petersen
- The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus C, Denmark
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Albrechtsen M, Langeskov-Christensen M, Jørgensen M, Dalgas U, Hansen M. Is diet associated with physical capacity and fatigue in persons with multiple sclerosis? –Results from a pilot study. Mult Scler Relat Disord 2020; 40:101921. [DOI: 10.1016/j.msard.2019.101921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/18/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
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Langeskov-Christensen M, Eskildsen S, Stenager E, Jensen HB, Nielsen HH, Petersen T, Hvid LG, Hämäläinen P, Marstrand L, Dalgas U. Correction: Langeskov-Christensen, M., et al. Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis-A Cross-Sectional Investigation. Journal of Clinical Medicine 2018, 7, 272. J Clin Med 2019; 8:jcm8050574. [PMID: 31035510 PMCID: PMC6572340 DOI: 10.3390/jcm8050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Søren Eskildsen
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
| | - Henrik Boye Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
- Brain and Nerve Diseases, Department of Neurology, Hospital Lillebaelt, 6000 Kolding, Denmark.
| | - Helle Hvilsted Nielsen
- The Multiple Sclerosis Clinic, Department of Neurology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Thor Petersen
- The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - Lars Grøndahl Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Lisbet Marstrand
- The Danish Multiple Sclerosis Centre, Department of Neurology, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
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Langeskov-Christensen M, Eskildsen S, Stenager E, Boye Jensen H, Hvilsted Nielsen H, Petersen T, Grøndahl Hvid L, Hämäläinen P, Marstrand L, Dalgas U. Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis-A Cross-Sectional Investigation. J Clin Med 2018; 7:jcm7090272. [PMID: 30208632 PMCID: PMC6162835 DOI: 10.3390/jcm7090272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022] Open
Abstract
(1) Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Staying physically fit may be associated with preservation of cognitive performance in persons with MS (pwMS); (2) Objective: To investigate the association between aerobic capacity and the cognitive domains of information processing, learning and memory, and verbal fluency as well as single and composite z-scores of the Brief Repeatable Battery of Neuropsychological tests (BRBNT) in pwMS; (3) Methods: All subjects first performed the BRBNT and then a maximal oxygen consumption (VO2-max) test on a bicycle ergometer as a measure of aerobic capacity. Simple and multiple (adjusting for age, sex, and education level) regression analyses were performed to evaluate the relationship between aerobic capacity and cognitive performance in different domains. Published international norms were used to compute z-scores for each individual and composite BRBNT score. Furthermore, cognitive impairment was defined as one or more z-scores ≤−1.5 standard deviation (SD) of healthy controls; (4) Results: Eighty-four subjects were included (44.9 ± 9 years, 16.3 ± 2 education years, Expanded Disability Status Scale (EDSS): 2.6 ± 1.4, MS-type (relapsing-remitting, primary progressive, or secondary progressive): 73/6/5, disease duration: 9.9 ± 7 years, VO2-max: 28.4 ± 7.0 mL O2/min/kg). No significant associations between aerobic capacity and cognitive performance in the individual BRBNT tests were found, except that a weak relationship was found between aerobic capacity and the composite processing speed z-score (R2 = 0.06, p = 0.02). The average global BRBNT z-score (−0.2 ± 0.66) was not associated with aerobic capacity. Comparison of the cognitively impaired group (34.5%) with the nonimpaired group (65.5%) showed lower aerobic capacity in the impaired group (25.9 ± 1 vs. 29.7 ± 1 mLO2/min/kg, p = 0.02); (5) Conclusions: Limited support was found for an association between performance in most cognitive domains and aerobic capacity in the present MS group with a third of patients showing signs of cognitive impairments.
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Affiliation(s)
| | - Søren Eskildsen
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
| | - Henrik Boye Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark/MS-Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Denmark, 6400 Sønderborg, Denmark.
- Brain and Nerve Diseases, Department of Neurology, Hospital Lillebaelt, 6000 Kolding, Denmark.
| | - Helle Hvilsted Nielsen
- The Multiple Sclerosis Clinic, Department of Neurology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Thor Petersen
- The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - Lars Grøndahl Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Lisbet Marstrand
- The Danish Multiple Sclerosis Centre, Department of Neurology, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
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Dalgas U, Langeskov-Christensen M, Skjerbæk A, Jensen E, Baert I, Romberg A, Santoyo Medina C, Gebara B, Maertens de Noordhout B, Knuts K, Béthoux F, Rasova K, Severijns D, Bibby B, Kalron A, Norman B, Van Geel F, Wens I, Feys P. Is the impact of fatigue related to walking capacity and perceived ability in persons with multiple sclerosis? A multicenter study. J Neurol Sci 2018; 387:179-186. [DOI: 10.1016/j.jns.2018.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
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Kierkegaard S, Langeskov-Christensen M, Lund B, Naal FD, Mechlenburg I, Dalgas U, Casartelli NC. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med 2016; 51:572-579. [PMID: 27845683 DOI: 10.1136/bjsports-2016-096618] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/23/2023]
Abstract
AIM To investigate pain, activities of daily living (ADL) function, sport function, quality of life and satisfaction at different time points after hip arthroscopy in patients with femoroacetabular impingement (FAI). DESIGN Systematic review with meta-analysis. Weighted mean differences between preoperative and postoperative outcomes were calculated and used for meta-analysis. DATA SOURCES EMBASE, MEDLINE, SportsDiscus, CINAHL, Cochrane Library, and PEDro. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that evaluated hip pain, ADL function, sport function and quality of life before and after hip arthroscopy and postoperative satisfaction in patients with symptomatic FAI. RESULTS Twenty-six studies (22 case series, 3 cohort studies, 1 randomised controlled trial (RCT)) were included in the systematic review and 19 in the meta-analysis. Clinically relevant pain and ADL function improvements were first reported between 3 and 6 months, and sport function improvements between 6 months and 1 year after surgery. It is not clear when quality of life improvements were first achieved. On average, residual mild pain and ADL and sport function scores lower than their healthy counterparts were reported by patients following surgery. Postoperative patient satisfaction ranged from 68% to 100%. CONCLUSIONS On average, patients reported earlier pain and ADL function improvements, and slower sport function improvements after hip arthroscopy for FAI. However, average scores from patients indicate residual mild hip pain and/or hip function lower than their healthy counterparts after surgery. Owing to the current low level of evidence, future RCTs and cohort studies should investigate the effectiveness of hip arthroscopy in patients with FAI. TRIAL REGISTRATION NUMBER CRD42015019649.
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Affiliation(s)
- Signe Kierkegaard
- Department of Orthopaedic Surgery, Horsens Hospital, Horsens, Denmark
| | | | - Bent Lund
- Department of Orthopaedic Surgery, Horsens Hospital, Horsens, Denmark
| | - Florian D Naal
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
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Langeskov-Christensen M, Kjølhede T, Stenager E, Jensen HB, Dalgas U. Can aerobic exercise alleviate flu-like symptoms following interferon beta-1a injections in patients with multiple sclerosis? J Neurol Sci 2016; 365:114-20. [DOI: 10.1016/j.jns.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/31/2016] [Accepted: 04/03/2016] [Indexed: 12/17/2022]
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Heine M, Wens I, Langeskov-Christensen M, Verschuren O, Eijnde BO, Kwakkel G, Dalgas U. Cardiopulmonary fitness is related to disease severity in multiple sclerosis. Mult Scler 2015; 22:231-8. [PMID: 26014607 DOI: 10.1177/1352458515581437] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. OBJECTIVE To investigate the association between disease severity and cardiopulmonary fitness. METHODS Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin. RESULTS The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation (r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R(2) = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg(-1)∙min(-1)); VO2peak = 36.622 - 5.433 (Sex (1=men)) - 0.124 (Age) - 2.082 (EDSS) + 2.737 (Belgium) + 8.674 (Denmark). CONCLUSION There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS.
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Affiliation(s)
- Martin Heine
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Inez Wens
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Bert O Eijnde
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
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Langeskov-Christensen M, Langeskov-Christensen D, Overgaard K, Møller AB, Dalgas U. Validity and reliability of VO2-max measurements in persons with multiple sclerosis. J Neurol Sci 2014; 342:79-87. [DOI: 10.1016/j.jns.2014.04.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/04/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
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