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Exercise and Multiple Sclerosis

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What are the physical and cognitive benefits of exercise on patients with multiple sclerosis? 1. Bayraktar D, Guclu-Gunduz A, Yazici G, et al. Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: a pilot study. NeuroRehabilitation. 2013; 33(3):431-7.
This research study was designed to examine the effects of Ai-Chi exercises in a swimming pool on balance and mobility in patients with multiple sclerosis (MS). Poor balance and decreased mobility is a common issue with MS, and the decline often limits daily activities. Researchers recruited twenty-three females affected by MS, and divided them into two groups. The exercise group performed Ai-Chi exercises for a 60 minute session twice a week for eight weeks. The control group did a home exercise program that only involved abdominal breathing and active range of motion exercises. Upon conclusion of the program, subjects were tested on static balance, functional mobility, fatigue, and muscle strength. The exercise group showed significant improvements across all measures, but the control group did not. This shows that the aquatic exercise program is a viable option to combat the negative effects of MS. A strength of this study was the use of aquatic therapy. The researchers stated that although this therapy is widely used, more studies need to be performed to gain more knowledge. Recording results on patients is concrete evidence that these programs work. This study was published in the NeuroRehabilitation journal, proving its credibility. I will be able to use information from this piece, and combine it with results from the other aquatic therapy studies, to support that exercise can be an alternative rehab model for MS. 2. Brichetto G, Piccardo E, Pedulla L, Battaglia MA, Tacchino A. Tailored balance exercises on people with multiple sclerosis: A pilot randomized, controlled study. Mult Scler. 2015; 21(8):1055-63.
This experiment focused on the potential benefits of using personalized balance exercises for subjects with MS. Typically, treatments are very general in nature and do not assess for each of the deficiencies a patient may have. Researchers divided 32 subjects into a personalized rehab group (PRG) and a traditional rehab group (TRG). Patients in the PRG received aid specific to their impairment. Those with bad or blurred vision performed exercises in front of a mirror to help them see their faults and correct them, and those with vertigo were provided rehabilitation to improve their gaze stability and postural control. The TRG simply performed exercises on a treadmill or standing still based on their physical ability. Upon completion of the study, patients in the PRG showed significant improvement on the Berg Balance Scale (BBS), as well as the composite test for equilibrium. The TRG showed improvement, but it was not nearly as significant. This shows that the tailored exercises targeting patients’ specific weaknesses were an effective treatment modality for MS. The uniqueness of this study focusing on the key issues of the subjects rather than generalizing their treatments is a huge strength of this research. This study comes from the Multiple Sclerosis Journal, clearly indicating its credibility in this field.
3. Castro-Sanchez AM, Mataran-Penarrocha GA, Lara-Palomo I, Saavedra-Hernandez M, Arroyo-Morales M, Moreno-Lorenzo C. Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial. Evid Based Complement Alternat Med. 2012; 2012:473963.
This study also researched the effects of Ai-Chi on MS symptoms, but this time the focus was more directed to its effects on pain, fatigue, and autonomy. Castro-Sanchez and her team of researchers got 73 patients with MS and divided them into an exercise group and a control group that only performed abdominal breathing exercises, just as the other study did. Patients underwent 40 sessions over 20 weeks, performing exercises in a heated pool to promote relaxation. Subjects’ pain was assessed using the visual analog scale (VAS) as well as pain questionairres, and fatigue was measured using the modified fatigue impact scale (MFIS). Upon completion of the study, improvements were seen in all categories of the study for the Ai-Chi group. The control group showed no significant improvements compared to baseline. It should be noted, however, that pain scores returned to baseline for most at a check-up ten weeks post-intervention. This shows that the key to exercise’s success is the continuance of the program. This was an interesting detail as it was the first to show that a 20 week program is not a cure-all solution to the effects of MS. It is important for subjects to continue rehab. This study presents a very strong sample size as well as a lengthy duration. I will be able to use their research as support for the use of exercise to combat pain, as well as to state that exercise must be performed consistently used in order for it to be beneficial.
4. Gorgas AM, Widener GL, Gibson-Horn C, Allen DD. Gait changes with balance-based torso-weighting in people with multiple sclerosis. Physiother Res Int. 2015; 20(1):45-53.
In this research study, researchers investigated the immediate effects of balance-based torso-weighting (BBTW) on the effects of balance and gait patterns in subjects with MS. Balance impairments tend to limit the ability to perform daily activities such as climbing or descending stairs, and also have a tendency to lead to falls. Twenty people with MS were challenged to walk as fast as they could across a short distance without any intervention. They then received the assistance of a strategically weighted vest based off their walking patterns and were asked to walk the same distance three more times. All variables of the patients’ gait patterns, such as cadence, velocity, and time spent with only single-limb support, improved. These results show that the weighted vest is immediately effective in combatting balance issues. A downfall of this research is the very limited data collected by only running three trials. However, this pilot study could lead to more in-depth research models that could potentially examine long-term results. These researchers are all involved in physical therapy departments at universities, and they also provide a significant list of references that establish their credibility. This research will be of some use, although it would have been more effective if a long term program had been used to see if the effects of the vest could promote muscular adaptations that improved gait patterns when walking without the vest.
5. Gutierrez RO, Galan Del Rio F, Cano de la Cuerda R, Alguacil Diego IM, Gonzalez RA, Page JC. A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation. 2013; 33(4):545-54.
These researchers studied the effects of virtual reality exercises on balance and postural control in people with MS. Although it is usually viewed simply as a video game, the XBOX Kinect system was used as a rehabilitation device. 50 patients were divided into a control group, that only received physical therapy, and an experimental group that utilized the Kinect. Forty, 40-minute sessions were performed over the course of 10 weeks. Upon completion of the study, general balance improved in both groups. However, visual preference, composite equilibrium scores, and reaction times significantly improved in the experimental group. It should be noted that the balance score on the BBS was also significantly higher in the experimental group. This shows that even the simple Kinect exercises can improve the symptoms of MS, and also supports the idea that some exercise is better than no exercise at all. A weakness of this study is the limited research supporting it, as this was the lone study found using these methods. However, it does have a 25-person sample size as well as 40 sessions of rehab to back its findings. These results will provide another alternative form of exercise that can be useful for MS that escapes the boundaries of traditional exercise. This study was also published in the NeuroRehabilitation journal, proving its credibility.
6. Kalron A, Fonkatz I, Frid L, Baransi H, Achiron A. The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial. J Neuroeng Rehabil. 2016; 13:13,016-0124-y.
In this research study, scientists looked into the effects of another virtual reality system on balance and mobility in subjects with MS. The computer assisted rehabilitation environment (CAREN) system uses virtual reality to simulate walking paths while the subject stands on a pressure pad to record results. 32 patients with MS were divided into an experimental group or a control group that performed simple stretching and exercises. Sessions were thirty minutes, and 12 sessions were performed over six weeks. Upon completion, subjects were tested on equilibrium, sway rate with eyes open, functional reach test, and fear of falls self-reported questionnaire. Significant improvements in each category were shown favoring the virtual reality group. These results show that the CAREN system is an effective treatment for balance. Although the fear of falling was a self-reported result, the improved scores show an increase in the quality of life as well as the ability to perform daily activities in patients. This continues to be a driving factor for the use of exercise, as depression is also a symptom of MS due to the limited mobility and feeling of helplessness. Researchers also found a high rate of user satisfaction with this treatment. This article was published in the Journal of NeuroEngineering and Rehabilitation, and also features a significant list of references that provide credibility. This information can be combined with the Kinect research to support the use of virtual reality exercises as a form of treatment.
7. Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis. Arch Phys Med Rehabil. 2012; 93(10):1701-8.
This was another research study examining the effects of aquatic training on fatigue and health-related quality of life in subjects with MS. Researchers recruited thirty-two women for the experiment and divided them into a control group and an experimental group. This study was based off a similar 4-week study, but lasted 8 weeks instead. 24 sessions were completed over the eight weeks, and each session was 60 minutes long. The aquatic sessions were led by an experience aquatic instructor that provided exercise programs. Upon completion of the study, the experimental group significantly improved scores on the modified fatigue impact scale (MFIS), as well as the quality of life questionnaire, which featured 54 separate components to asses both physical and mental health. The control groups showed improved scores, but they were not significant. The results also show greater improvement when compared to the results of the 4-week study, supporting the argument that the consistency of the exercise is a key to managing these degenerative symptoms. The length of this study and its ability to be compared to a shorter experiment are strengths of this research. This article was published by the American Congress of Rehabilitation Medicine, proving its credibility in this field.
8. Kucuk F, Kara B, Poyraz EC, Idiman E. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial. J Phys Ther Sci. 2016; 28(3):761-8.
The scope of research for this study was directed toward the outcomes of using clinical Pilates in MS. Researchers were examining the exercise’s effects on physical performance, cognition, and quality of life in subjects. Twenty subjects were divided into experimental and control groups, where the experimental group performed 16 sessions of Pilates over eight weeks that each lasted 60 minutes. Traditional exercises targeting strength and balance were performed by the control group. Upon completion of the program, the Pilates group showed significant improvements in cognitive composite scores, balance, fatigue scores, and quality of life when compared to baseline. The control group showed slight improvements, however they were not significant. The Pilates group also showed improvements in functional mobility and depression scores. These results all confirm the idea that exercise is a practical way to combat the symptoms of MS. A strength of this study is the wide range of results collected. This is the most informational study of all, and I will be able to compare its results with several other studies. This article will be a staple in my research that will allow me to keep coming back for more evidence supporting my argument. This experiment was published in the Journal of Physical Therapy Science and is unarguably credible.
9. Peruzzi A, Cereatti A, Della Croce U, Mirelman A. Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: a pilot study. Mult Scler Relat Disord. 2016; 5:91-6.
This research study used yet another virtual reality method to evaluate the gait patterns of subjects with MS. This experiment focused on the aspect of dual-task walking, or walking while navigating around objects. Eight subjects participated in 12 studies over six weeks that each lasted approximately 45 minutes. Tests required subjects to walk down a virtual path and navigate around projections such as trees and puddles. The test was designed to investigate deficiencies in gait aspects such as planning paths, obstacle avoidance, and foot clearance. Upon completion of the study, improvements were seen in walking speeds, stride lengths, and the ability to navigate obstacles. Besides making daily activities less strenuous, these tests also improved quality of life and fear of falling. These results were not expected, but instead went above and beyond what was hoped for. This virtual reality study also indicated an increase in user satisfaction, showing that patients appreciated the switch from traditional exercise modalities. A key weakness to this study is the very limited sample size. Although results were consistent for subjects, the data that was generated is not very well supported. However, this form of treatment does show promise and could be greatly expanded on if more tests were to be done. I will be able to combine this information with my other virtual reality studies to support the idea that many different forms of exercise can be utilized to aid with symptoms of MS. This article was published in the Multiple Sclerosis and Related Disorders journal and also features established scientists that are very credible in this area of health.
10. Razazian N, Yavari Z, Farnia V, et al. Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with Multiple Sclerosis. Med Sci Sports Exerc. 2016; 48(5):796-803.
This experiment focused on the effects of yoga and aquatic exercise on fatigue, depression, and paresthesia in patients with MS. This was unique that it compared two different types of exercise to a control group at the same time. 54 women with MS were divided into three groups: yoga, aquatic therapy, or control. The exercise groups performed 24, 60-minute sessions over eight weeks, and the control group met the same amount of times but was limited to no exercise and only the option of occupational therapy if desired. Fatigue, depression, and paresthesia scores significantly improved in the exercise groups, when compared to the non-exercise group, upon completion. Researchers found that the likeliness to experience or report severe depression was 35-fold higher in the control group compared to the exercise groups. When comparing the results of the exercise groups to each other, results were too close to determine which the better treatment option was. This continued to support the argument that any exercise is better than none at all. This article offered a couple notable strengths. First, it was able to show results for two types of exercise at once. This basically generates three separate studies as each exercise group can be compared to the control and they can also be compared to each other. Its other valuable strength is the sample size and duration of the exercises that allowed for substantial results to be collected with plenty of support. This will be another study that will be extremely valuable in the paper, and will also allow for statistical analysis of improvements. This study was published this year in the journal of Medicine & Science in Sports & Exercise, validating its credibility.

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