Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial

Özkul, Çağla; Güçlü-Gündüz, Arzu; Eldemir, Kader; Apaydin, Yasemin; Yazıcı, Gökhan; İrkeç, Ceyla

doi:10.1016/j.msard.2020.102419

Cited by 32 publications

(54 citation statements)

References 47 publications

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“…However, most studies have been carried out in patient populations that were not necessarily cognitively impaired at study entry, while at the same time "cognition" being a secondary outcome. Interestingly, a recent study including MS patients being cognitively impaired at baseline reported a beneficial effect on cognition following a physical exercise intervention (Ozkul et al, 2020). In the present multivariate regression analysis, increased physical activity level showed a trend towards an association with less impact of fatigue in the MFIS subdomain of cognitive functioning.…”

Section: Discussionsupporting

confidence: 42%

Associations between fatigue impact and lifestyle factors in people with multiple sclerosis – The Danish MS hospitals rehabilitation study

Johansson

Skjerbæk

Nørgaard

et al. 2021

Multiple Sclerosis and Related Disorders

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Background:The lack of medical treatment options to reduce fatigue in patients with multiple sclerosis (MS) emphasize the importance of identifying potential non-pharmacological modifiable factors, as this may help advance current treatment strategies. The aim of this study was to identify potential modifiable lifestyle factors as well as patient-and disease-related characteristics, that are associated with fatigue in a large sample of clinically well-characterized patients with MS.Methods: This study was a secondary analysis of a pragmatic randomized controlled trial of inpatient multidisciplinary rehabilitation in Denmark. MS patients aged 18 to 65 years and with a disease severity score ≤ 7.5 according to the Expanded Disability Status Scale participated. Data on patient-and disease-related characteristics, fatigue impact (Modified Fatigue Impact Scale (MFIS)), and on lifestyle factors (tobacco smoking, alcohol intake, and physical activity), were collected at baseline.A linear mixed model was used to compare MFIS total, physical, cognitive, and psychosocial scores across subgroups of selected characteristics. Regression analyses were used to examine associations between lifestyle factors and MFIS total, physical, cognitive, and psychosocial scores.Results: In the sample of 417 MS patients, median age was 51 years, 69% were female, median time since diagnosis was 8 years, with 41% having relapsing remitting MS.Higher MFIS total scores were observed in MS patients with shorter time since diagnosis, being a tobacco smoker, and not undertaking regular physical activity. Somewhat similar findings were observed for MFIS subscores (physical, cognitive, psychosocial), especially MFIS physical scores.In the multivariate analyses, physical activity was significantly associated with fatigue impact on total, physical and psychosocial functioning. Tobacco smoking was significantly associated with fatigue impact on psychosocial functioning. Alcohol intake was not associated with fatigue impact. None of the lifestyle factors were associated with fatigue impact on cognitive functioning. In the adjusted models time since diagnosis was significantly associated with fatigue impact on total, physical and cognitive functioning, as was disease severity with fatigue impact on physical and cognitive functioning.Conclusion: Physical activity showed the most pronounced associations with fatigue impact on physical and psychosocial functioning, while the impact on cognitive functioning showed a trend. Tobacco smoking contributed significantly to impact on psychosocial functioning, while alcohol intake did not contribute to fatigue impact. Introducing or supporting maintenance of physical activity/exercise and cessation of tobacco smoking seems to be a useful approach for rehabilitation services to help patients with MS manage fatigue.

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Section: Discussionsupporting

confidence: 42%

Associations between fatigue impact and lifestyle factors in people with multiple sclerosis – The Danish MS hospitals rehabilitation study

Johansson

Skjerbæk

Nørgaard

et al. 2021

Multiple Sclerosis and Related Disorders

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“…Processing speed, visuospatial memory, and verbal fluency were also improved in the group treated with combined exercises (p < 0.05). Conversely, the "control group", exposed to relaxation exercises at home alone, showed only an increase in verbal memory scores [136]. These studies showed how moderate/vigorous physical activity, practiced before and/or after the induction of the disease, positively influences the pathogenetic mechanisms involved in demyelination and neurodegeneration, which are hallmarks of the MS pathogenesis.…”

Section: Clinical Impact Of Exercise In Patients With Multiple Sclerosismentioning

confidence: 84%

The Role of Nutritional Lifestyle and Physical Activity in Multiple Sclerosis Pathogenesis and Management: A Narrative Review

et al. 2021

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Studies on the role of nutritional factors and physical activity (PA) in the pathogenesis of multiple sclerosis (MS) go back a long time. Despite the intrinsic difficulty of studying their positive or negative role in MS, the interest of researchers on these topics increased during the last few decades, since the role of diet has been investigated with the perspective of the association with disease-modifying drugs (DMD). The association of DMD, diets, and PA might have an additive effect in modifying disease severity. Among the various diets investigated (low-carbohydrate, gluten-free, Mediterranean, low-fat, fasting-mimicking, and Western diets) only low-carbohydrate, Mediterranean, and fast-mimicking diets have shown both in animal models and in humans a positive effect on MS course and in patient-reported outcomes (PROs). However, the Mediterranean diet is easier to be maintained compared to fast-mimicking and low-carbohydrate diets, which may lead to detrimental side effects requiring careful clinical monitoring. Conversely, the Western diet, which is characterized by a high intake of highly saturated fats and carbohydrates, may lead to the activation of pro-inflammatory immune pathways and is therefore not recommended. PA showed a positive effect both in animal models as well as on disease course and PROs in humans. Training with combined exercises is considered the more effective approach.

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“…Another 93 potential articles were removed after the title and abstract review. Forty-five full texts were reviewed, and twenty articles [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were used in the analysis based on inclusion and exclusion criteria. Figure 1 shows the PRISMA selection process flow chart [24].…”

Section: Resultsmentioning

confidence: 99%

“…Significant improvement compared with physician care [30] or with 1-h massage [38] • No significant differences between Pilates and rebound therapy [45] or aquatic therapy [47] Gait • Significant improvement [28,31,32,34,[36][37][38]40,43,44] • Significant improvement compared with standard physiotherapy care [31] or with home relaxation exercises [32] • No significant improvement [42] • Significant improvement in standardized exercises group compared to Pilates group [43] Physical-functional conditions • No significant improvement in post-intervention Pilates group, but there was in aerobic exercise group [42] (no difference between groups)…”

mentioning

confidence: 99%

Therapeutic Effects of the Pilates Method in Patients with Multiple Sclerosis: A Systematic Review

Fuentes

Silveira-Pereira²,

Ferradáns-Rodríguez³

et al. 2022

JCM

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The Pilates Method is a rehabilitation tool with verified benefits in pain management, physical function, and quality of life in many different physiotherapy areas. It could be beneficial for patients with multiple sclerosis (pwMS). The aim of the study was to summarize current evidence for the effectiveness of Pilates in pwMS. A comprehensive search of Cinahl, Scopus, Web of Science, PEDro, and PubMed (including PubMed Central and Medline) was conducted to examine randomized controlled trials (RCT) that included Pilates intervention in multiple sclerosis. The PEDro scale and the Cochrane risk-of-bias tool, RoB-2, were used to evaluate risk of bias for RCT. Twenty RCT (999 patients) were included. Ten were of good quality (PEDro), and seven had low risk of bias (RoB-2). Pilates improves balance, gait, physical-functional conditions (muscular strength, core stability, aerobic capacity, and body composition), and cognitive functions. Fatigue, quality of life, and psychological function did not show clear improvement. There was good adherence to Pilates intervention (average adherence ≥ 80%). Cumulative data suggest that Pilates can be a rehabilitation tool for pwMS. High adherence and few adverse effects were reported. Future research is needed to develop clinical protocols that could maximize therapeutic effects of Pilates for pwMS.

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Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial

Cited by 32 publications

References 47 publications

Associations between fatigue impact and lifestyle factors in people with multiple sclerosis – The Danish MS hospitals rehabilitation study

Associations between fatigue impact and lifestyle factors in people with multiple sclerosis – The Danish MS hospitals rehabilitation study

The Role of Nutritional Lifestyle and Physical Activity in Multiple Sclerosis Pathogenesis and Management: A Narrative Review

Therapeutic Effects of the Pilates Method in Patients with Multiple Sclerosis: A Systematic Review

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