Recently, several studies have examined whether low‐volume sprint interval training (SIT) may improve aerobic and metabolic function. The objective of this study was to systematically review the ...existing literature regarding the aerobic and metabolic effects of SIT in healthy sedentary or recreationally active adults. A systematic literature search was performed (Bibliotek.dk, SPORTDiscus, Embase, PEDro, SveMed+, and Pubmed). Meta‐analytical procedures were applied evaluating effects on maximal oxygen consumption (VO2max). Nineteen unique studies four randomized controlled trials (RCTs), nine matched‐controlled trials and six noncontrolled studies were identified, evaluating SIT interventions lasting 2–8 weeks. Strong evidence support improvements of aerobic exercise performance and VO2max following SIT. A meta‐analysis across 13 studies evaluating effects of SIT on VO2max showed a weighted mean effects size of g = 0.63 95% CI (0.39; 0.87) and VO2max increases of 4.2–13.4%. Solid evidence support peripheral adaptations known to increase the oxidative potential of the muscle following SIT, whereas evidence regarding central adaptations was limited and equivocal. Some evidence indicated changes in substrate oxidation at rest and during exercise as well as improved glycemic control and insulin sensitivity following SIT. In conclusion, strong evidence support improvement of aerobic exercise performance and VO2max following SIT, which coincides with peripheral muscular adaptations. Future RCTs on long‐term SIT and underlying mechanisms are warranted.
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BFBNIB, FSPLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background and purpose
The purpose of this study was to perform a systematic review of the literature on the effects of exercise on depressive symptoms in patients with multiple sclerosis (MS), as ...well as to apply meta‐analytical procedures to the results.
Methods
A systematic search covering eight databases was conducted. The included studies were randomized controlled trials applied to people with definite MS who completed a structured exercise intervention which were compared to any comparator, including other forms of exercise. The outcomes included a primary measure of depression/depressive symptoms or an instrument with a clearly defined depression subscale.
Results
Fifteen randomized controlled trial studies were identified including a total of 331 exercising subjects and 260 controls. The average Physiotherapy Evidence Database (PEDro) score was 5.6 ± 1.3 points. Only one study applied depressive symptoms as the primary outcome. Four studies showed positive effects of exercise on depressive symptoms. An in‐depth analysis of the studies revealed that the baseline level of depressive symptoms, patient disability level, choice of depression instrument and exercise intensity may influence the results. The meta‐analysis included 12 studies reflecting a total of 476 subjects. The standardized mean difference across studies was g = −0.37, 95% confidence interval (−0.56; −0.17), and the null hypothesis of homogeneity within the sample could not be rejected (Q = 12.05, df = 11, P = 0.36).
Discussion
Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with MS, but existing studies do not allow solid conclusions. Future well‐designed studies evaluating the effects of exercise on depressive symptoms and major depression disorder in MS are highly warranted.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Recently progressive resistance training (PRT) has been recognised as an effective tool in the rehabilitation of persons with multiple sclerosis (MS). The objective of this study was to ...systematically review the literature of PRT studies for persons with MS. A comprehensive literature search (PubMed, SveMed+, Embase, Cochrane, PEDro, SPORTDiscus and Bibliotek.dk) was conducted. Identified papers were rated according to the PEDro-scale. Sixteen studies were included and scored between 3 and 8 of 11 total points on the PEDro-scale, showing a general lack of blinding. Strong evidence regarding the beneficial effect of PRT on muscle strength was observed. Regarding functional capacity, balance and self-reported measures (fatigue, quality of life and mood) evidence is less strong, but the tendency is overall positive. Indications of an effect on underlying mechanisms such as muscle morphological changes, neural adaptations and cytokines also exist, but the studies investigating these aspects are few and inconclusive. PRT has a positive effect on muscle strength for persons with MS. Heterogeneous results exist regarding the effect on functional capacity and self-reported measures probably because of differences in training protocols, samples sizes, type and severity of MS. The area of underlying mechanisms deserves more attention in future research.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract Background Multiple sclerosis (MS) is a chronic disease in the central nervous system which causes a number of physical symptoms including impairments of muscle mechanical function (muscle ...strength, muscle power and explosive muscle strength (~ rate of force development, RFD)). However, a full overview of the existing knowledge regarding muscle mechanical function in persons with MS (PwMS) is still pending. Objectives To systematically review 1) the psychometric properties of isokinetic dynamometry testing in PwMS, and 2) studies comparing muscle mechanical function in PwMS to matched healthy controls (HC). In addition, a meta-analysis will evaluate 3) the effects of progressive resistance training on muscle mechanical function in PwMS. Methods A systematic literature search was performed in eight databases. To be included in the review, the study had to 1) enroll participants with a confirmed diagnosis of MS; 2) assess muscle mechanical function 3) had undergone peer-review. The psychometric properties of isokinetic dynamometry were reviewed with respect to validity, reliability, and responsiveness. Comparison of muscle strength between PwMS and HC was performed across contraction velocities, contraction modes and muscle groups, as were the rate of force development. The effects of progressive resistance training on muscle mechanical function were evaluated in a meta-analysis using a random effects model and standardized mean difference (SMD). Results A total of four, twenty-four, and ten studies were identified for aim 1, 2, and 3, respectively. High Intraclass correlations coefficients (range: 0.87–0.99) for isokinetic dynamometry was reported when assessing knee extensor and knee flexor muscle strength independent of contraction velocity. Compared to match HC, PwMS display impaired muscle strength, power and explosive muscle strength. Muscle strength impairments were most pronounced during maximal moderate to fast dynamic muscle contractions of the lower extremities. Progressive resistance training has a small but significant effect on muscle mechanical function in PwMS (SMD = 0.45, 95% CI: 0.18–0.72, p = 0.001). Conclusions The present review showed that 1) isokinetic dynamometry has a high reliability in PwMS; 2) muscle strength, power and rate of force development is impaired in PwMS compared to HC, and muscle strength impairments are most pronounced during maximal moderate to fast dynamic muscle contractions of the lower extremities; and 3) progressive resistance training can improve muscle mechanical function in PwMS. Future studies should evaluate progressive resistance training designed to optimize maximal moderate to fast dynamic muscle contractions of the lower extremities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
To test the hypothesis that lower extremity progressive resistance training (PRT) can improve muscle strength and functional capacity in patients with multiple sclerosis (MS) and to evaluate whether ...the improvements are maintained after the trial.
The present study was a 2-arm, 12-week, randomized controlled trial including a poststudy follow-up period of 12 weeks. Thirty-eight moderately impaired patients with MS were randomized to a PRT exercise group (n = 19) or a control group (n = 19). The exercise group completed a biweekly 12-week lower extremity PRT program and was afterward encouraged to continue training. After the trial, the control group completed the PRT intervention. Both groups were tested before and after 12 weeks of the trial and at 24 weeks (follow-up), where isometric muscle strength of the knee extensors (KE MVC) and functional capacity (FS; combined score of 4 tests) were evaluated.
KE MVC and FS improved after 12 weeks of PRT in the exercise group (KE MVC: 15.7% 95% confidence interval 4.3-27.0, FS: 21.5% 95% confidence interval 17.0-26.1; p < 0.05), and the improvements were better than in the control group (p < 0.05). The improvements of KE and FS in the exercise group persisted at follow-up after 24 weeks. Also, the exercise effects were reproduced in the control group during the 12-week posttrial PRT period.
Twelve weeks of intense progressive resistance training of the lower extremities leads to improvements of muscle strength and functional capacity in patients with multiple sclerosis, the effects persisting after 12 weeks of self-guided physical activity.
The present study provides level III evidence supporting the hypothesis that lower extremity progressive resistance training can improve muscle strength and functional capacity in patients with multiple sclerosis.
This review summarizes the existing knowledge regarding the effects of physical exercise in patients suffering from multiple sclerosis (MS). Furthermore, recommendations are given regarding exercise ...prescription for MS patients and for future study directions. Previously, MS patients were advised not to participate in physical exercise. During recent years, it has been increasingly acknowledged that exercise benefits MS patients. The requirement for exercise in MS patients is emphasized by their physiological profile, which probably reflects both the effects of the disease per se and the reversible effects of an inactive lifestyle. To date the effects of exercise have only been studied in moderately impaired MS patients with an EDSS score of less than 7. Evidence exists for recommending participation in endurance training at low to moderate intensity, as the existing literature demonstrates that MS patients can both tolerate and benefit from this training modality. Also, resistance training of moderate intensity seems to be well tolerated and to have beneficial effects on MS patients, but the methodological quality of the existing evidence is in general low and the number of studies is limited. Only two studies have evaluated the effects of combined resistance- and endurance training, making solid conclusions regarding this training modality impossible.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point ...when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background and purpose
Brain derived neurotrophic factor (BDNF) is suggested to play a neuroprotective role in multiple sclerosis (MS). However, the BDNF response to long‐term exercise in MS remains ...unknown. Our objective was to compare resting BDNF profiles of healthy controls (HCs) and persons with relapsing−remitting MS (RRMS) and to investigate the impact of a 24‐week exercise intervention on serum BDNF release in MS.
Methods
At baseline, blood BDNF levels were assessed in MS (n = 22, mean Expanded Disability Status Scale 2.6 ± 0.2, mean age 43 ± 2 years) and HCs (n = 19, mean age 47 ± 1 year). Next, persons with MS were randomized to an exercise intervention group (EX, n = 15) or a sedentary control group (SED, n = 7) completing a 24‐week randomized controlled trial. In persons with MS, muscle strength, exercise tolerance and body composition were assessed, as compliance measures, at baseline and after 24 weeks.
Results
At baseline, the BDNF concentration of persons with RRMS was 21% lower than HCs. Following 24 weeks of intervention, changes in BDNF concentrations differed significantly between EX and SED. In particular, within EX BDNF concentrations increased 13.9% ± 8.8%, whereas it decreased 10.5% ± 4.1% within SED. Furthermore, 24 weeks of exercise induced changes in the compliance measures between EX and SED. In addition, within EX muscle strength, exercise tolerance and lean tissue mass improved, whereas these remained stable within SED.
Conclusion
In conclusion, BDNF concentration of persons with RRMS was lower compared to HCs and increased after 24 weeks of exercise in persons with MS, compared to the non‐exercise MS control group.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The severity of walking impairment in persons with multiple sclerosis (pwMS) at different levels on the expanded disability status scale (EDSS) is unclear. Furthermore, it is unclear if the EDSS is ...differently related to performed- and perceived walking capacity tests.
To quantify walking impairment and perceived impact of MS on walking according to EDSS scores and to examine the relations between these parameters in pwMS.
EDSS was collected by neurologists and walking was assessed by the timed 25ft walk test (T25FWT), two minute walk test (2MWT), six minute walk test (6MWT) and the 12-item MS walking scale (MSWS-12) in 474 PwMS with mild (EDSS 1–4: n=200) to moderate (EDSS 4.5–6.5: n=274) MS. Magnitude of walking impairment was calculated and related to EDSS.
Compared to predicted values in healthy controls, walking speed was reduced by 41.5±25.8% in the 6MWT for the total MS group and by 21.8±20.2% and 55.8±19.1% in the mild and moderate MS subgroups, respectively. The EDSS score showed the strongest relationship to the 2MWT and the 6MWT in the total MS group (r=−0.76, p<0.0001), to the MSWS-12 score in the mild MS group (r=0.56, p<0.0001), and to the 2MWT in the moderate MS group (r=−0.50, p<0.0001).
In pwMS (EDSS scores 1–6.5), walking speed is on average reduced by ~40% when compared to predicted values in healthy controls, and impairments are already present at early disease stages, suggesting early initiation of rehabilitation. The 2MWT and 6MWT show the strongest relationship to EDSS, but the MSWS-12 identify impairments more gradually at low EDSS scores.
•Persons with MS walk 40% slower than expected based on predicted reference values.•Walking impairments are present early in MS, and early rehabilitation is necessary.•Long walking tests (6MWT, 2MWT) show the best correlation with EDSS score.•The MSWS-12 identify impairments in persons with mild MS more gradually.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background: Fatigue occurs in the majority of patients with multiple sclerosis (MS) and therapeutic possibilities are few. Exercise therapy is a therapeutic option but no studies have systematically ...reviewed the existing literature evaluating the effect of exercise therapy on MS fatigue.
Objective: To determine the effect of exercise therapy on MS fatigue by systematically reviewing the literature.
Methods: A comprehensive literature search (PubMed, SweMed +, Embase, Cochrane, CINAHL, PEDro, Sport Discuss and Bibliotek.dk) was conducted.
Results: Studies evaluating the effect of exercise therapy on MS fatigue show heterogeneous results and only few studies have evaluated MS fatigue as the primary outcome. The heterogeneous findings seem to be related to the selected study population, which in many studies are non-fatigued. Most studies that have included fatigued patients with MS show positive effects, although it is not clear whether any exercise modalities are superior to others because there are no comparative studies regarding different exercise interventions.
Conclusion: Exercise therapy has the potential to induce a positive effect on MS fatigue, but findings are heterogeneous probably because many studies have applied non-fatigued study populations. Furthermore, only few studies have evaluated MS fatigue as the primary outcome measure, emphasizing the need for future studies within this field.
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