College of Physical Therapy and Occupational Therapy, Federal University of Pará, Belém, Pará, Brazil
Pilates for Rehabilitation in Patients With Multiple Sclerosis: A Systematic Review of Effects on Cognition, Health-Related Physical Fitness, General Symptoms and Quality of Life
Objective: The aims of this systematic review is to analyze the effectiveness of Pilates intervention programs on cognitive function, health-related physical fitness, general symptoms, physical function, quality of life, and the impact Pilates can have on activities of daily living in Multiple Sclerosis (MS) patients. This review also aims to provide a synthesis of the most commonly used protocols regarding exercise parameters, such as periodicity and treatment duration.
Data sources: Systematic review of the literature was carried out following the PRISMA guidelines (PROSPERO no. CRD42017070004). A literature search was undertaken for studies that investigated the effects of Pilates training on MS patients, using databases included PubMed, Medline, Scopus and the Physiotherapy Evidence Database (PEDro) up to May 2018.
Study selection: Three researchers independently reviewed the titles and abstract of each article to screen the papers in relation to the inclusion criteria.
Data extraction: Data were extracted by three researchers independently. The eligible articles were read in full and their levels of evidence were evaluated using the PEDro scale.
Data synthesis: Forty-two papers were found during the research phase. Duplicated (n = 23) or incomplete articles (n = 1) were excluded. Studies were also eliminated from the sample based on methodological approach (study design) quality assessment (n = 6). Twelve studies were ultimately selected and analyzed.
Conclusions: The majority of the studies analyzed showed positive results after Pilates training intervention and concluded that Pilates intervention is safe and effective for the treatment of dysfunction of balance, strength, quality of life, cognition, physical performance, walking and posture parameters on MS patients. The articles investigated in this review provide a scientific basis to support Pilates as an option for rehabilitation programs for MS patients.
Department of Biological Sciences in Sport and Health, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
The effect of 6 weeks of high intensity interval training on myelin biomarkers and demyelination in experimental autoimmune encephalomyelitis model
Exercise has been shown to increase myelin biomarkers such as klotho and PLP and improve clinical and pathological symptoms using the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis (MS). In the present study, we evaluated whether 6 weeks of high-intensity interval training (HIIT) prior to induction of EAE increase klotho and/or PLP and attenuate the severity of symptoms and/or disease progression in EAE model. Our data demonstrate that HIIT increased klotho and PLP and decreased disability. These proteins are associated with maintaining myelination and further research is required to examine potential clinical relevance.
Department of Sport Sciences, Shahrekord University, Shahrekord, Iran
Effect of combined exercise training on pentraxins and pro- inflammatory cytokines in people with multiple sclerosis as a function of disability status
Objectives: There is some evidence for beneficial effects of exercise on cytokines in people with multiple sclerosis (MS), but it is unclear if such effects differ by disability status (i.e., stage of the disease). This study investigated the effect of combined exercise training on pentraxins and pro- inflammatory cytokines in people with multiple sclerosis as a function of disability status.
Methods: This randomized control trial included 94 women with MS who were randomly assigned into exercise or control conditions with randomization stratified by Expanded Disability Status Scale (EDSS) scores of low (EDSS < 4.5), moderate (4.5 ≤ EDSS ≤ 6), or high (EDSS ≥ 6.5) disability. The exercise program lasted 12 weeks and comprised resistance, endurance, Pilates, balance and stretch exercises performed? days/week; the control condition involved a waitlist control. We measured resting levels of inflammatory factors, functional capacity, and lipid profile before and after the 12-week intervention period.
Results: Combined exercise training significantly decreased hs-CRP (p = 0.029) and IL-6 (p = 0.001) and increased PTX-3 (p = 0.001) and IFN-ƴ (p = 0.001), but there was no significant change in Fibrin D-dimer (FDD) (p = 0.876) compared with control, and those effects were independent of disability status. 1RM for lat pull-down, knee extension, and seated row and 6MWT (i.e., walking further) significantly increased and TUG performance significantly decreased (i.e., faster performance) (all, p < 0.001) after combined exercise compared with control, and this too was independent of disability status.
Conclusions: Exercise may stimulate anti-inflammatory effects in MS, and this is generally not influenced by disability status. Exercise training may be an adjuvant for disease-modifying therapy among people with MS, and such effects might not be moderated by disability status.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.Department of Biomedical Sciences, University of Sassari, Italy.
Contralateral Strength Training as Preparation for Direct Strength Training in a Patient With Unilateral Foot Drop Because of Multiple Sclerosis: A Case Report
https://academic.oup.com/ptj/advance-ar ... m=fulltext
Direct strength training (DST) is effective in managing unilateral weakness in people with multiple sclerosis (MS). Its feasibility, however, is considerably reduced if one limb is too compromised to train. In this case, contralateral strength training (CST) of the unaffected side to induce a strength transfer to the untrained homologous muscles can help to establish a strength baseline in the weaker limb, eventually allowing direct training. Limited effects for CST, however, have been reported on patient’s functioning. We tested the effects on dynamometric, electromyographic and functional outcomes of a sequential combination of CST and DST of the ankle dorsiflexors in a case of MS-related foot-drop.
Methods (Case Description)
A 56-year-old man diagnosed with relapsing-remitting MS, who exhibited severe weakness of the right dorsiflexors impairing functional dorsiflexion. The intervention consisted of a 6-week CST of the unaffected dorsiflexors followed by two consecutive 6-week DST cycles targeting the weaker dorsiflexors.
At baseline, the participant could not dorsiflex his right ankle but could do so after CST. Maximal strength of the affected dorsiflexors increased by 80% following CST, by 31.1% following DST-1 and by further 44.6% after DST-2. Neuromuscular recruitment was found progressively increased, with the largest changes occurring after DST-1. Improvements in mobility and walking speed were also detected, although plantarflexors’ spasticity on the Modified Ashworth Scale increased from 1+ to 2.
In this case the sequential combination of CST and DST proved a feasible approach to manage severe unilateral weakness in a patient who was not able, at least initially, to dorsiflex his weaker ankle. In this perspective, CST may prime a minimum gain in strength necessary to allow subsequent direct training.
Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study
Background: There is scarce data as to the association between physical activity and the volumes of subcortical brain regions in people with multiple sclerosis (PwMS).
Objective: To compare the volumetric measures of subcortical brain structures in physically active and insufficiently active PwMS.
Methods: This cross-sectional study comprised 153 PwMS (39.3 ± 12.0 years, 68.0% female) who had undergone a complete neurological examination, computerized cognitive evaluation and brain MRI (using a high-resolution scanner). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Regions of interest included the hippocampus, amygdala, brain stem, basal ganglia, thalamus, accumbens nucleus, putamen, caudate and pallidum. Two MRI metrics, total volume (mm3) and estimated percentile of the subcortical region according to adjusted normative population, were calculated for each individual and brain region. Based on scores obtained from the Godin Leisure-Time Exercise Questionnaire, the cohort was subsequently divided into two groups, physically active (n = 77) and insufficiently active (n = 76).
Results: The left hippocampus estimated percentile point significantly differentiated between active and insufficiently active PwMS (48.5 (S.D. = 32.2) vs. 36.4 (S.D. = 29.8 ); p = 0.004), even after controlling for disability (p = 0.011) and cognition (p = 0.021). The right hippocampal estimated percentile point was also significantly different between groups (46.7 (S.D. = 30.6 ) vs. 34.6 (S.D. = 30.8 ); p = 0.004). Subcortical volume of the right hippocampus explained 19.4% of the variance between the groups (p = 0.008), even after controlling for disability (p = 0.013) and cognition (p = 0.020).
Conclusions: Our results provide evidence that PwMS who regularly participate in leisure-time physical activities maintain their hippocampal volume, regardless of their disability and cognitive capabilities.
Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Aerobic Exercise Induces Functional and Structural Reorganization of CNS Networks in Multiple Sclerosis: A Randomized Controlled Trial
Objectives: Evidence from animal studies suggests that aerobic exercise may promote neuroplasticity and could, therefore, provide therapeutic benefits for neurological diseases such as multiple sclerosis (MS). However, the effects of exercise in human CNS disorders on the topology of brain networks, which might serve as an outcome at the interface between biology and clinical performance, remain poorly understood. Methods: We investigated functional and structural networks in patients with relapsing-remitting MS in a clinical trial of standardized aerobic exercise. Fifty-seven patients were randomly assigned to moderate-intensity exercise for 3 months or a non-exercise control group. We reconstructed functional networks based on resting-state functional magnetic resonance imaging (MRI) and used probabilistic tractography on diffusion-weighted imaging data for structural networks. Results: At baseline, compared to 30 healthy controls, patients exhibited decreased structural connectivity that was most pronounced in hub regions of the brain. Vice versa, functional connectivity was increased in hubs. After 3 months, we observed hub independent increased functional connectivity in the exercise group while the control group presented a loss of functional hub connectivity. On a structural level, the control group remained unchanged, while the exercise group had also increased connectivity. Increased clustering of hubs indicates a better structural integration and internal connectivity at the top of the network hierarchy. Conclusion: Increased functional connectivity of hubs contrasts a loss of structural connectivity in relapsing-remitting MS. Under an exercise condition, a further hub independent increase of functional connectivity seems to translate in higher structural connectivity of the whole brain.
Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial
Background: Cognitive impairment is common in patients with multiple sclerosis (MS). The effects of different exercise trainings on cognitive functions in patients with MS are promising. However, the effects are not yet clear in MS patients with cognitive impairment. This study aimed to investigate the effect of combined exercise training on different cognitive functions in MS patients with cognitive impairment.
Methods: Relapsing-remitting and mild disabled MS patients with cognitive impairment were randomly assigned to two groups: Exercise Group (EG, n:17) and the Control Group (CG, n:17). The EG received a combined exercise training consisting of aerobic and Pilates training in three sessions per week for 8 weeks while the CG performed the relaxation exercises at home. Cognitive functions, walking capacity, fatigue, mood, and quality of life were assessed at baseline and after eight weeks using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Six-Minute Walk Test (6-MWT), Fatigue Impact Scale (FIS), Beck's Depression Inventory (BDI) and MS Quality of Life-54 (MSQoL-54), respectively.
Results: This study showed significant group-by-time interactions on long-term verbal memory, walking capacity, cognitive fatigue, and physical quality of life in favor of the EG (p<0.003). Moreover, verbal memory, visuospatial memory, verbal fluency, information processing speed, walking capacity, fatigue, and quality of life improved in the EG (p<0.05) while only verbal memory increased in the CG (p<0.05). Furthermore, the change in visuospatial memory was associated with the change in mental quality of life (r:0.352, p: 0.041) while the change in verbal fluency (r: -0.362, p:0.035) and processing speed (r: -0.356, p:0.039) were associated with the change in mood.
Conclusion: Combined exercise training has beneficial effects on different cognitive functions in mild disabled RRMS patients with cognitive impairment. In addition, there is a mutual relationship in improvements in cognitive functions, mood, and quality of life after exercise.
Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana
A multi-modal virtual reality treadmill intervention for enhancing mobility and cognitive function in people with multiple sclerosis: Protocol for a randomized controlled trial
Background: Gait and cognitive impairments are common in individuals with Multiple Sclerosis (MS) and can interfere with everyday function. Those with MS have difficulties executing cognitive tasks and walking simultaneously, a reflection of dual-task interference. Therefore, dual-task training may improve functional ambulation. Additionally, using technology such as virtual reality can provide personalized rehabilitation while mimicking real-world environments. The purpose of this randomized controlled trial is to establish the benefits of a combined cognitive-motor virtual reality training on MS symptoms compared to conventional treadmill training.
Methods: This study will be a single-blinded, two arm RCT with a six-week intervention period. 144 people with MS will be randomized into a treadmill training alone group or treadmill training with virtual reality group. Both groups will receive 18 sessions of training while walking on a treadmill, with the virtual reality group receiving feedback from the virtual system. Primary outcome measures include dual-task gait speed and information processing speed, which will be measured prior to training, one-week post-training, and three months following training.
Discussion: This study will provide insight into the ability of a multi-modal cognitive-motor intervention to reduce dual-task cost and to enhance information processing speed in those with MS. This is one of the first studies that is powered to understand whether targeted dual-task training can improve MS symptoms and increase functional ambulation. We anticipate that those in the virtual reality group will have a significantly greater increase in dual-task gait speed and information processing speed than those achieved via treadmill training alone.
Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
Voluntary wheel running stimulates the expression of Nrf-2 and interleukin-10 but suppresses interleukin-17 in experimental autoimmune encephalomyelitis
Multiple sclerosis is an inflammatory and neurodegenerative disease of the central nervous system in which the immune cells attack the myelin sheath of the nerves, leading to axonal damage, inflammation, immune cell infiltration, and demyelination of the brain and spinal cord. These detrimental changes cause some impairments, such as depression, motor deficit, and cognitive dysfunction, affecting the quality of life in MS patients and their social activities. The present study assessed the impact of 6-week voluntary exercise prior to disease onset on the expression of Nrf-2, IL-10, IL-17, as well as the degree of lymphocyte infiltration in the spinal cord and disease severity in the chronic period of the EAE (30 days post-induction). The results showed that voluntary wheel running stimulated the expression of Nrf-2 and IL-10, while decreased the expression of IL-17, the rate of lymphocyte infiltration, and the severity of EAE at the chronic period of the disease. Thus, alterations in lifestyle, such as regular exercise, may modulate inflammation and disease severity in patients with MS.
Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
Brain activity changes following neuroproprioceptive "facilitation, inhibition" physiotherapy in multiple sclerosis: a parallel group randomized comparison of two approaches
Background: Imaging methods bring new possibilities for describing the brain plasticity processes that underly the improvement of clinical function after physiotherapy in people with multiple sclerosis (pwMS). Although these processes have been described mainly in connection with task oriented physiotherapy and aerobic training, they haven't been properly verified in neuroproprioceptive "facilitation, inhibition" (facilitation) approaches.
Aim: The study determined whether facilitation physiotherapy could enhance brain plasticity, compared two facilitation methods, and looked for any relation to clinical improvement in pwMS.
Design: The study was designed as parallel group (38 outpatients) randomized comparison of two kinds of physiotherapeutic interventions referred to healthy controls.
Population: The study had 80 participants (38 pwMS and 42 healthy controls).
Methods: PwMS were divided into two groups and underwent a two-month physiotherapy program - Vojta reflex locomotion (VRL) or Motor Program Activating Therapy (MPAT), (1 hour, twice a week). Functional Magnetic Resonance Imaging (fMRI) and clinical examination was performed before and after therapy. Healthy controls underwent one fMRI examination.
Results: Physiotherapy in pwMS leads to extension of brain activity in specific brain areas (cerebellum, suplementary motor areas and premotor areas) in connection with the improvement of the clinical status of individual patients after therapy (p=0.05). Greater changes (p=0.001) were registered after MPAT than after VRL. The extension of activation was a shift to the examined activation of healthy controls, whose activation was higher in the cerebellum and secondary visual area (p=0.01).
Conclusions: Neuroproprioceptive "facilitation, inhibition" physiotherapy may enhance brain activity and could involve processes connected with the processing of motion activation.
Clinical rehabilitation impact: The study showed that facilitation approach can modulate brain activity. This could be useful for developing of effective physiotherapeutic treatment in MS.
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