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Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals

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Abstract

Purpose

To evaluate the feasibility of a combined upper limb and breathing exercise for a home-based program and to explore its effect on primary fatigue and quality of life in ambulatory and non-ambulatory individuals with multiple sclerosis (MS) in a short time.

Method

Nineteen individuals with MS were assigned into semi-controlled pre-post feasibility study based on Expanded Disability Status Scale (EDSS) status and divided into two groups: exercise (five ambulatory, five non-ambulatory; EDSS 1.0–8.0) and related control with no exercise (four ambulatory, five non-ambulatory; EDSS 1.0–7.5). Exercise group performed combined upper limb and breathing exercise in a controlled group (2 days/week, 60 min/session) accompanied by independent home exercise (3 days/week, ≥ 20 min/session). Participants underwent measures of fatigue impact (Modified Fatigue Impact Scale (MFIS) and quality of life (RAND Medical outcomes study 36-item short-form health survey (SF-36)) before and after a 4-week period.

Results

The MFIS (physical, psychosocial, total) showed statistically significant group-by-time interaction in ambulatory (p = 0.033, d = 1.60; p = 0.039, d = 1.59; p = 0.033, d = 1.62) and non-ambulatory individuals (p = 0.009, d = 2.42; p = 0.018, d = 1.96; p = 0.0008, d = 3.92). Physical functioning (SF-36) showed statistically significant group-by-time interaction in ambulatory (p = 0.014, d = 2.14) but no significance in non-ambulatory (p = 0.368, d = 0.68) individuals. Despite the absent statistical significance, there were large intervention effects on MFIS cognitive scores for ambulatory (d = 1.28) and non-ambulatory (d = 1.47), and on other SF-36 scores for ambulatory (general health: d = 1.76 and pain: d = 1.02) and non-ambulatory (physical limitation: d = 1.03 and emotional well-being: d = 0.94) individuals.

Conclusion

Our 4-week program reduced some aspects of fatigue and improved some aspects of quality of life in a small group of ambulatory and non-ambulatory individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.

Trial registration

Name of the registry: The Impact of Exercise Training on Living Quality in Multiple Sclerosis. Registration: The study was registered at www.clinicaltrial.gov on July 14, 2017. First participant enrollment: August 28, 2017. URL: 602-01/17-01-147; Trial registration ID: NTC03222596.

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Abbreviations

CNS:

Central nervous system

EDSS:

Expanded Disability Status Scale

HE:

Home exercise

MS:

Multiple sclerosis

MSSC:

MS Society Center

MFIS:

Modified Fatigue Impact Scale

QOL:

Quality of life

SF-36:

Medical Outcomes Study 36-Item Short-Form Health Survey

UL:

Upper limb

References

  1. Ramagopalan SV, Dobson R, Meier UC, Giovannoni G (2010) Multiple sclerosis: risk factors, prodromes, and potential causal pathways. Lancet Neurol 9:727–739

    Article  PubMed  Google Scholar 

  2. Qureshi M, Al-Suhaimi EA, Wahid F, Shehzad O, Shehzad A (2018) Therapeutic potential of curcumin for multiple sclerosis. Neurol Sci 39:207–214

    Article  PubMed  Google Scholar 

  3. Motl RW, McAuley E, Snook EM, Gliottoni RC (2009) Physical activity and quality of life in multiple sclerosis: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 14:111–124

    Article  PubMed  PubMed Central  Google Scholar 

  4. Smeltzer SC, Utell MJ, Rudick RA, Herndon RM (1988) Pulmonary function and dysfunction in multiple sclerosis. Arch Neurol 45:1245–1249

    Article  CAS  PubMed  Google Scholar 

  5. Klefbeck B, Hamrah Nedjad J (2003) Effect of inspiratory muscle training in patients with multiple sclerosis. Arch Phys Med Rehabil 84:994–999

    Article  PubMed  Google Scholar 

  6. Hough A (1996) Physiotherapy in respiratory care: a problem-solving approach to respiratory and cardiac management, 2nd edn. Chapman & Hall, London, pp 1–163

    Book  Google Scholar 

  7. Ray AD, Udhoji S, Mashtare TL, Fisher NM (2013) A combined inspiratory and expiratory muscle training program improves respiratory muscle strength and fatigue in multiple sclerosis. Arch Phys Med Rehabil 94:1964–1970

    Article  PubMed  Google Scholar 

  8. Hentati E, Ben Sassi S, Nabli F, Mabrouk T, Zouari M, Hentati F (2018) Disability progression in multiple sclerosis: a Tunisian prospective cohort study. Neurol Sci 39:879–884

    Article  PubMed  Google Scholar 

  9. Afkar A, Ashouri A, Rahmani M, Emami Sigaroudi A (2017) Effect of exercise therapy on quality of life of patients with multiple sclerosis in Iran: a systematic review and meta-analysis. Neurol Sci 38:1901–1911

    Article  PubMed  Google Scholar 

  10. Motl RW, Sandroff BM (2015) Benefits of exercise training in multiple sclerosis. Curr Neurol Neurosci Rep 15:62

    Article  PubMed  Google Scholar 

  11. Lamers I, Maris A, Severijns D, Dielkens W, Geurts S, Van Wijmeersch B, Feys P (2016) Upper limb rehabilitation in people with multiple sclerosis: a systematic review. Neurorehabil Neural Repair 30:773–793

    Article  PubMed  Google Scholar 

  12. Ploughman M, Harris C, Wallack EM, Drodge O, Beaulieu S, Mayo N (2015) Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis. PeerJ 2(3):e1158

    Article  Google Scholar 

  13. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  CAS  PubMed  Google Scholar 

  14. Cramer H, Lauche R, Azizi H, Dobos G, Langhorst J (2014) Yoga for multiple sclerosis: a systematic review and meta-analysis. PLoS One 9:e112414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ford H, Trigwell P, Johnson M (1998) The nature of fatigue in multiple sclerosis. J Psychosom Res 45:33–38

    Article  CAS  PubMed  Google Scholar 

  16. Ortiz-Rubio A, Cabrera-Martos I, Rodríguez-Torres J, Fajardo-Contreras W, Díaz-Pelegrina A, Valenza MC (2016) Effects of a home-based upper limb training program in patients with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil 97:2027–2033

    Article  PubMed  Google Scholar 

  17. Sandroff BM, Balto JM, Klaren RE, Sommer SK, DeLuca J, Motl RW (2016) Systematically developed pilot randomized controlled trial of exercise and cognition in persons with multiple sclerosis. Neurocase 22:443–450

    Article  PubMed  Google Scholar 

  18. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  CAS  PubMed  Google Scholar 

  19. Vertesi A, Lever JA, Molloy DW, Sanderson B, Tuttle I, Pokoradi L, Principi E (2001) Standardized mini-mental state examination. Use and interpretation. Can Fam Physician 47:2018–2023

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Larson R (2013) Psychometric properties of the modified fatigue impact scale. Int J MS Care 15:15–20

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF (1994) Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 18:S79–S83

    Article  PubMed  Google Scholar 

  22. Lins L, Carvalho FM (2016) SF-36 total score as a single measure of health-related quality of life: scoping review. SAGE Open Med 4:2050312116671725

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hays RD, Morales LS (2001) The RAND-36 measure of health-related quality of life. Ann Med 33:350–357

    Article  CAS  PubMed  Google Scholar 

  24. Rutledge T, Loh C (2004) Effect sizes and statistical testing in the determination of clinical significance in behavioral medicine research. Ann Behav Med 27:138–145

    Article  PubMed  Google Scholar 

  25. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  26. Kaymaz D, Candemir İÇ, Ergün P, Demir N, Taşdemir F, Demir P (2018) Relation between upper-limb muscle strength with exercise capacity, quality of life and dyspnea in patients with severe chronic obstructive pulmonary disease. Clin Respir J 12:1257–1263

    Article  PubMed  Google Scholar 

  27. Morris G, Berk M, Walder K, Maes M (2015) Central pathways causing fatigue in neuro-inflammatory and autoimmune illnesses. BMC Med 13:28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Grubić-Kezele T, Blagojević Zagorac G, Jakovac H, Domitrović R, Milin C, Radošević-Stašić B (2013) Hepatic expression of metallothionein I/II, glycoprotein 96, IL-6, and TGF- β in rat strains with different susceptibilities to experimental autoimmune encephalomyelitis. Clin Dev Immunol 2013:750406

    Article  Google Scholar 

  29. Grubić Kezele T, Blagojević Zagorac G, Jakovac H, Domitrović R, Radošević-Stašić B (2017) Hippocampal expressions of metallothionein I/II and glycoprotein 96 in EAE-prone and EAE-resistant strains of rats. Histol Histopathol 32:137–151

    PubMed  Google Scholar 

  30. Enns MW, Bernstein CN, Kroeker K, Graff L, Walker JR, Lix LM, Hitchon CA, El-Gabalawy R, Fisk JD, Marrie RA, CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease (2018) The association of fatigue, pain, depression and anxiety with work and activity impairment in immune mediated inflammatory diseases. PLoS One 13(6):e0198975

  31. Motl RW, Gosney JL (2008) Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis. Mult Scler 14:129–135

    Article  CAS  PubMed  Google Scholar 

  32. Clarke R, Coote S (2015) Perceptions of participants in a group, community, exercise programme for people with multiple sclerosis. Rehabil Res Pract 2015:123494

    PubMed  PubMed Central  Google Scholar 

  33. Marck CH, De Livera AM, Weiland TJ, Jelinek PL, Neate SL, Brown CR, Taylor KL, Khan F, Jelinek GA (2017) Pain in people with multiple sclerosis: associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life. Front Neurol 8:461

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ferraro D, Plantone D, Morselli F, Dallari G, Simone AM, Vitetta F, Sola P, Primiano G, Nociti V, Pardini M, Mirabella M, Vollono C (2018) Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurol Sci 39:445–453

    Article  PubMed  Google Scholar 

  35. Marzoli SB, Criscuoli A (2018) Pain in optic neuropathies. Neurol Sci 39:25–31

    Article  PubMed  Google Scholar 

  36. Perciavalle V, Blandini M, Fecarotta P, Buscemi A, Di Corrado D, Bertolo L, Fichera F, Coco M (2017) The role of deep breathing on stress. Neurol Sci 38:451–458

    Article  PubMed  Google Scholar 

  37. Coco M (2017) The brain behaves as a muscle? Neurol Sci 38:1865–1868

    Article  PubMed  Google Scholar 

  38. El-Sayes J, Harasym D, Turco CV, Locke MB, Nelson AJ (2018) Exercise-induced neuroplasticity: a mechanistic model and prospects for promoting plasticity. Neuroscientist 25:65–85

  39. Eisch AJ, Petrik D (2012) Depression and hippocampal neurogenesis: a road to remission? Science 338:72–75

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Barry A, Cronin O, Ryan AM, Sweeney B, O'Toole O, Allen AP, Clarke G, O'Halloran KD, Downer EJ (2018) Impact of short-term cycle ergometer training on quality of life, cognition and depressive symptomatology in multiple sclerosis patients: a pilot study. Neurol Sci 39:461–469

    Article  PubMed  Google Scholar 

  41. Tacchino A, Brichetto G, Zaratin P, Battaglia MA, Ponzio M (2017) Multiple sclerosis and rehabilitation: an overview of the different rehabilitation settings. Neurol Sci 38:2131–2138

    Article  PubMed  Google Scholar 

  42. Incerti CC, Argento O, Magistrale G, Ferraro E, Caltagirone C, Pisani V, Nocentini U (2017) Adverse working events in patients with multiple sclerosis. Neurol Sci 38(349):352

    Google Scholar 

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Acknowledgements

We want to thank the volunteers and the Multiple Sclerosis Society in Rijeka, Croatia, for the accomplished results, Martina Budanko, PT, and Dijana Ivanišević, BEcon, for assistance and support with recruiting participants.

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Authors and Affiliations

  1. Department of Physiology and Immunology, University of Rijeka Faculty of Medicine, B. Branchetta 20, 51000, Rijeka, Croatia

    Tanja Grubić Kezele

  2. Department of Physiotherapy, University of Rijeka Faculty of Health Studies, Rijeka, Croatia

    Matea Babić

  3. Department of Neurosurgery, Clinical Hospital Center, Rijeka, Croatia

    Dinko Štimac

Authors
  1. Tanja Grubić Kezele
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  2. Matea Babić
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  3. Dinko Štimac
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Correspondence to Tanja Grubić Kezele.

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All subjects signed written informed consent and the study was approved by the local ethical committee (602-01/17-01-147) and registered in the ClinicalTrials.gov (www.clinicaltrial.gov).

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Grubić Kezele, T., Babić, M. & Štimac, D. Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals. Neurol Sci 40, 733–743 (2019). https://doi.org/10.1007/s10072-019-3707-0

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