Research: Exercise and Physiotherapy for MS

Using exercise and physical therapy for recovery from the effects of MS, and for maintaining physical function.
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Petr75
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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Tue Nov 12, 2019 11:40 am

2019 Sep 13
Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy
Immunomodulatory Effects of Exercise in Experimental Multiple Sclerosis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753861/

Abstract

Multiple Sclerosis (MS) is a demyelinating and neurodegenerative disease. Though a specific antigen has not been identified, it is widely accepted that MS is an autoimmune disorder characterized by myelin-directed immune attack. Pharmacological treatments for MS are based on immunomodulatory or immunosuppressant drugs, designed to attenuate or dampen the immune reaction, to improve neurological functions. Recently, rehabilitation has gained increasing attention in the scientific community dealing with MS. Engagement of people with MS in exercise programs has been associated with a number of functional improvements in mobility, balance, and motor coordination. Moreover, several studies indicate the effectiveness of exercise against fatigue and mood disorders that are frequently associated with the disease. However, whether exercise acts like an immunomodulatory therapy is still an unresolved question. A good tool to address this issue is provided by the study of the immunomodulatory effects of exercise in an animal model of MS, including the experimental autoimmune encephalomyelitis (EAE), the Theiler's virus induced-demyelinating disease (TMEV-IDD) and toxic-demyelinating models, cuprizone (CPZ), and lysolecithin (LPC). So far, despite the availability of different animal models, most of the pre-clinical data have been gained in EAE and to a lesser extent in CPZ and LPC. These studies have highlighted beneficial effects of exercise, suggesting the modulation of both the innate and the adaptive immune response in the peripheral blood as well as in the brain. In the present paper, starting from the biological differences among MS animal models in terms of immune system involvement, we revise the literature regarding the effects of exercise in EAE, CPZ, and LPC, and critically highlight the advantages of either model, including the so-far unexplored TMEV-IDD, to address the immune effects of exercise in MS.

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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Sat Nov 23, 2019 3:29 am

2019 Dec
Department of Neuroscience, Carleton University, Ottawa, Canada
A systematic review of aerobic and resistance exercise and inflammatory markers in people with multiple sclerosis.
https://www.ncbi.nlm.nih.gov/pubmed/31703029

Abstract
Inflammation is a driver in the demyelination process in patients with multiple sclerosis (MS) and can influence disability levels. Both single and repeated bouts of exercise can decrease inflammatory markers in people with MS (PwMS). This systematic review evaluates whether exercise can influence inflammation and disability in individuals with MS. Experimental studies were reviewed that had to meet the following eligibility requirements: a sample of PwMS, an intervention of exercise (either aerobic, resistance, or a combination of each), and an outcome that included at least one inflammatory (cytokine) reaction. The main outcome measure was an evaluation of inflammation, as indicated by a change in any cytokine level. Other measures included muscle strength, balance, flexibility, walking ability, disability statues, and quality of life (QOL). A total of nine studies were included in the final review. Exercise interventions included predominantly cycling, although a few resistance training trials were mentioned. Small decreases were found in IL-17 and IFN-γ after exercise. Functional outcome measures and perceived disability status were improved posttraining. We conclude that while interventions such as exercise may impact QOL, they do not have a significant influence on inflammation associated with MS. Exercise is an accessible alternative that not only helps to decrease impairments but also limit the restrictions associated with participation in society. While functional outcomes after exercise improved, these improvements may not be attributable to changes in levels of cytokines or inflammatory markers.

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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Sat Nov 23, 2019 4:23 am

2019 Nov 1
Physical Therapy Department, College of Health Sciences, University of Michigan-Flint
Effects of inspiratory muscle training in advanced multiple sclerosis
https://www.ncbi.nlm.nih.gov/pubmed/31707233

Abstract
BACKGROUND:
Respiratory training using Threshold Inspiratory Muscle Trainer (IMT) has not been examined adequately in multiple sclerosis (MS). The primary objective in this study of persons with advanced MS was to investigate the training effect of IMT. The secondary objective was to evaluate the retention of IMT benefits.
METHODS:
This study was a repeated measures within-subject design (before-after trial).. Participants were recruited from a long-term care facility specialized in progressive neurologic conditions. Thirty-six non-ambulatory persons with advanced MS volunteered. Inspiratory muscle exercise using the threshold IMT were performed daily for 10 weeks at 3 sets of 15 repetitions per day. Resistance was progressed weekly based on perceived rate of exertion and symptoms. Primary outcome measures were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) that were measured at baseline, after 5 and 10 weeks of IMT exercises (training period), and at 4 and 8 weeks after the IMT training ended (retention). Linear mixed-effect regression models with time (i.e. weeks from baseline) as the fixed factor and participants as the random effect factor were applied separately to test each hypothesis. Effect size was calculated using partial eta square (η2p). Two-tailed significance level was p < 0.05.
RESULTS:
Participants were 60.5 ± 8.6 years old. Expanded Disability Status Scale was 8.5 ± 0.4. Baseline MIP were 25.9 ± 16.4 cmH2O (33.2% %± 19.8% of predicted values) and MEP were 23.5 ± 15.7 cmH2O (25.8% %± 14.4% of predicted values). Compared to the baseline, MIP increased significantly to 30.1 ± 17.9 cmH2O (38.9% %± 22.4% of predicted values) and 30.6 ± 17.6 cmH2O (39.6% %± 22.3% of predicted values) after 5 (p < 0.05) and 10 weeks (p < 0.05) of IMT exercises. MIP improvements were retained in an 8-week washout period. MEP did not differ significantly by time.
CONCLUSION:
In persons with advanced MS, 10-week IMT training increased inspiratory muscle strength. This study is the first to demonstrate the retention of benefits following daily IMT exercises at 8 weeks after training ended.

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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Wed Dec 04, 2019 3:00 am

2019 Nov 21
Department of Education, Psychology, Philosophy, University of Cagliari, Italy
The Relationships between Physical Activity, Self-Efficacy, and Quality of Life in People with Multiple Sclerosis.
https://www.ncbi.nlm.nih.gov/pubmed/31766489

Abstract
Regular physical activity (PA) can enhance the physical and mental health of people with Multiple Sclerosis (MS) because of its impact on muscular strength, mobility, balance, walking, fatigue, pain and health-related quality of life (HRQoL). Previous studies have hypothesized that the relationship between PA and HRQoL is mediated by self-efficacy. The aim of this research is to evaluate whether self-efficacy in goal setting and self-efficacy in the management of symptoms, mediate the relationship between PA and HRQoL, in a similar way to exercise self-efficacy. A sample of 28 participants with MS (18 females) and different levels of physical activity have been recruited and completed the following measures: a) physical activity (GLTEQ); b) health-related quality of life (SF-12); c) self-efficacy in the management of Multiple Sclerosis (SEMS) and, d) exercise self-efficacy (EXSE). The statistical analysis highlighted that self-efficacy in goal setting mediated the relationship between PA and mental health better than exercise self-efficacy. Our findings suggest that self-efficacy in goal setting can contribute to the adoption and maintenance of regular physical activity for long-lasting times, supporting and increasing the mental quality of life of people suffering from MS.

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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Sun Dec 29, 2019 11:56 am

2019 Dec 23
University of Pécs, Faculty of Health Sciences, Department of Diagnostic Imaging, Pécs, Hungary
Exercise Effects on Multiple Sclerosis Quality of Life and Clinical-Motor Symptoms
https://www.ncbi.nlm.nih.gov/pubmed/31876670

Abstract
INTRODUCTION:
Different therapies can improve clinical and motor symptoms of multiple sclerosis (MS) similarly but studies comparing the effects of different exercise therapies on clinical and motor outcomes are scant. We compared the effects of exergaming (EXE), balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group (CON) on clinical and motor symptoms and quality of life (QoL) in people with MS (PwMS).
METHODS:
PwMS (n=68, 90% females; age: 47.0y, Expanded Disability Status Scale: 5 to 6) were randomized to 5 groups. Before and after the interventions (5x/week for 5 weeks) PwMS were tested for: MS-related clinical and motor symptoms (Multiple Sclerosis Impact Scale-29; MSIS-29, primary outcome), QoL (EQ-5D), symptoms of depression, gait and balance ability (Tinetti Assessment Tool, TAT), static and dynamic balance and fall risk (Berg Balance Scale (BBS), walking capacity (six-minute walk test, 6MWT), and standing posturography on a force platform.
RESULTS:
EXE, BAL, and CYC improved MSIS-29 scores similarly. EXE and CYC improved QoL and walking capacity similarly but more than BAL. Only EXE improved gait and balance scores (TAT). EXE and BAL improved fall risk and standing balance similarly but more than CYC. PNF and CON revealed no changes. EQ-5D moderated the exercise effects on MSIS-29 scores only in EXE. Changes in QoL and changes in MSIS-29 scores correlated R=0.73 only in EXE.
CONCLUSION:
In conclusion, BAL and CYC but EXE in particular, but not PNF, can improve clinical and motor symptoms and QoL in PwMS (EDSS: 5 to 6), expanding the evidence-based exercise options to reduce mobility limitations in PwMS.

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wiki https://en.wikipedia.org/wiki/Exergaming

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Petr75
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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Mon Jan 13, 2020 11:58 pm

2019 Dec 21
Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial.
https://www.ncbi.nlm.nih.gov/pubmed/31924591

Abstract
BACKGROUND:
Balance disorders, fatigue, and walking impairments are the most common symptoms of multiple sclerosis (MS), which lead to a decrease in quality of life. To cope with these disability-increasing symptoms, it is important to select and regularly apply appropriate rehabilitation approaches. In recent years, virtual reality approaches have been suggested as a potentially useful tool in rehabilitation. Exergaming systems are used in the treatment of symptoms associated with MS, but there are few randomized controlled studies investigating the efficacy of these systems.
OBJECTIVE:
To investigate and compare the effects of exercise training with two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis (PwMS).
METHODS:
Forty-seven volunteer PwMS were included in the study and randomized to the group I (Nintendo Wii Fit), group II (Balance Trainer), and group III (control group). The participants in the study groups underwent an exercise program under the supervision of a physiotherapist on 2 days a week for 8 weeks. Outcome measures were the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT), Fatigue Severity Scale (FSS), and Multiple Sclerosis International Quality of Life Questionnaire (MusiQol), which were performed before and after the treatment.
RESULTS:
Forty-two participants completed the study protocol. All parameters evaluated in group I and II showed statistically significant improvement after treatment. Changes in all outcome measures were found to be superior in group I compared with group III. Similarly, all measures except the 6MWT were found to be superior in group II compared with group III. Changes in BBS and MusiQol were found to be superior in group I compared with group II.
CONCLUSION:
In comparison with no intervention, exergaming with Nintendo Wii Fit and Balance Trainer improves balance, increases functionality, reduces fatigue severity, and increases quality of life in PwMS.

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Re: Research: Exercise and Physiotherapy for MS

Post by Petr75 » Sat Jan 25, 2020 6:29 am

2020 Jan 22
Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Canada
Vigorous Cool Room Treadmill Training to Improve Walking Ability in People With Multiple Sclerosis Who Use Ambulatory Assistive Devices: A Feasibility Study
https://pubmed.ncbi.nlm.nih.gov/3196913 ... ity-study/

Abstract

Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16 °C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids.
Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT.
Results: Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6.
Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.
Trial registration: The study was approved by the Newfoundland and Labrador Health Research Ethics Board (reference number: 2018.088) on 11/07/2018 prior to the enrollment of first participant (retrospectively registered at ClinicalTrials.gov: NCT04066972. Registered on 26 August 2019.

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