Objectives: Yoga has been found to be effective for addressing problems with strength, flexibility, balance, gait, anxiety, depression, and concentration. Varying degrees of these problems occur in individuals with multiple sclerosis (MS). This study examined the effects of a comprehensive, 4-month yoga program on strength, mobility, balance, respiratory function, and quality of life for individuals with MS.
Methods: Twenty four individuals with MS participated in an intensive Ananda Yoga training followed by 17 weeks of home practice.
Results: Significant improvements in functional strength, balance, and peak expiratory flow and a trend toward improvements in mental health and quality of life outcomes were detected following the intervention.
Conclusions: The results of this exploratory study suggest that yoga can have a positive impact on physical functioning and quality of life for persons with mild to moderate MS.
Salgado BC, Jones M, Ilgun S, McCord G, Loper-Powers M, van Houten P.
Department of Physical Therapy, California State University, Sacramento, CA.
Sources: Int J Yoga Therap. 2013;23(2):27-38 & Pubmed PMID: 24165521 (08/11/13)
Aerobic exercise can boost memory in people with multiple sclerosis (MS) by up to 54 per cent, a new study has found.
The study led by Victoria Leavitt and James Sumowski, from Kessler Foundation, US, provides the first evidence for beneficial effects of aerobic exercise on brain and memory in individuals with MS.
Hippocampal atrophy seen in MS is linked to the memory deficits that affect approximately 50 per cent of individuals with MS, researchers said.
Despite the prevalence of this disabling symptom, there are no effective pharmacological or behavioural treatments.
"Aerobic exercise may be the first effective treatment for MS patients with memory problems," said Leavitt, research scientist in Neuropsychology & Neuroscience Research at Kessler Foundation.
"Moreover, aerobic exercise has the advantages of being readily available, low cost, self-administered, and lacking in side effects," Leavitt said.
Researchers said no beneficial effects were seen with non-aerobic exercise.
Leavitt noted that the positive effects of aerobic exercise were specific to memory; other cognitive functions such as executive functioning and processing speed were unaffected.
The study's participants were two MS patients with memory deficits who were randomised to non-aerobic (stretching) and aerobic (stationary cycling) conditions. Baseline and follow-up measurements were recorded before and after the treatment protocol of 30-minute exercise sessions 3 times per week for 3 months.
Data were collected by high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment.
Aerobic exercise resulted in a 16.5 per cent increase in hippocampal volume, a 53.7 per cent increase in memory, and increased hippocampal resting-state functional connectivity.
Non-aerobic exercise resulted in minimal change in hippocampal volume and no changes in memory or functional connectivity.
"These findings clearly warrant large-scale clinical trials of aerobic exercise for the treatment of memory deficits in the MS population," said Sumowski, research scientist in Neuropsychology & Neuroscience Research at Kessler Foundation.
Source: The India Express Copyright © 2013 The Indian Express ltd (04/11/13)
Playing video games never used to be a workout. But with new technology making the player a part of the action, they’re helping some multiple sclerosis patients get fit and decrease the symptoms of their disease.
“Individuals with MS have a lot of balance issues and vertigo problems,” said Ruchika Prakash, an assistant professor of psychology at The Ohio State University College of Medicine. “There's numbness in the extremities…And then there's spasticity, or the stiffness of the muscles, as a result of which the movement of the joints becomes challenging, becomes restricted.”
In an unconventional study at The Ohio State University Wexner Medical Center, Prakash and her colleagues have been looking at how the game “Dance Dance Revolution” can keep MS patients on their feet.
“We thought this game might motivate them, because it's fun, and entertaining and because the game gives a lot of feedback,” said Anne Kloos, assistant professor of clinical health and rehabilitation sciences at The Ohio State University College of Medicine.
Tracy Blackwell, 51, was diagnosed with MS in 2001 at age 39. The mother of three was forced to retire from her job as a supervisor at the United States Postal System because of extreme fatigue and failing physical ability.
“I couldn't do anything,” said Blackwell. “My left leg dragged, my left arm was almost useless, so it stopped me from living day to day.
Blackwell took various medications, including daily injections, but didn’t see much improvement. With her disease slowly chipping away at her quality of life, her doctor suggested she enroll in the “Dance Dance Revolution” study at OSU.
“Now, I'm on the infusion therapy where I just go once a month,” said Blackwell. “Before I participated in the study, I'd say I walked maybe to the mailbox – and that's not very far – and now I walk a half a mile every day, and I do (“Dance Dance Revolution”) every day.”
Physical limitations aren’t the only issues patients like Blackwell deal with. Many have extreme fatigue and memory problems, so the study also aims to find out if exercise helps with cognitive function in MS patients.
“We believe this may work because of animal studies that have shown that exercise helps create new neurons in the area of the brain where memories are formed,” said Debbie Kegelmeyer, assistant professor of clinical health and rehabilitation sciences at The Ohio State University College of Medicine.
To qualify for the study, participants must have relapsing-remitting MS, the most common form of the disease that is characterized by periods of worsening neurologic function. Participants play the game for an hour, three times a week over the course of eight weeks.
Source: Fox News ©2013 FOX News Network, LLC (23/09/13)
The effects of pilates on balance, mobility and strength in patients with multiple sclerosis(27/08/13)
BACKGROUND: Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient.
OBJECTIVES: The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis.
METHODS: Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale.
RESULTS: Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05).
DISCUSSION AND SUMMARY/CONCLUSION: Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.
Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B, Batur-Caglayan HZ.
Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Gazi University, Ankara, Turkey.
Sources: NeuroRehabilitation. 2013 Jul 12. & Pubmed PMID: 23949064 (27/08/13)
Pilates for people with MS who use a wheelchair: feasibility, efficacy and participant experiences(27/08/13)
Purpose: This mixed methods study aimed to explore the feasibility, efficacy and the participants' experiences of a Pilates programme for people with Multiple Sclerosis (pwMS) who use a wheelchair.
Method: Fifteen pwMS took part in the 12-week Pilates programme. At baseline and after 6 and 12 weeks of the programme, sitting stability, measured as maximum progression of the Centre of Pressure when leaning sideways (COPmax), posture, pain on a Visual Analogue Scale, function, fatigue and the impact of MS (MSIS29) were assessed. Ten participants took part in two focus groups within six weeks of the completion of the programme.
Results: Significant improvements at the 12-week assessment were found in COPmax (p = 0.046), sitting posture (p = 0.004), pain in the shoulders (p = 0.005) and back (p = 0.005) and MSIS29 (p = 0.006). The majority of participants described various physical, functional, psychological and social benefits from participation that reflected increased confidence in activities of daily living. Enjoyment of the classes was expressed by all, and most wished to continue participation.
Conclusions: Pilates appears to be efficacious in improving sitting stability and posture and decreasing pain and was also well tolerated by wheelchair users with MS. Further mixed methods studies are warranted. Implications for Rehabilitation Group-based core stability exercise or Pilates for people with MS who use wheelchair is a feasible and safe way of exercising for this patient group. Pilates exercises for people moderately to severely affected by MS resulted in a decrease in back and shoulder pain and improvement in sitting balance. Future appropriately powered randomised controlled studies into Pilates for people with MS reliant on wheelchair are warranted.
van der Linden ML, Bulley C, Geneen LJ, Hooper JE, Cowan P, Mercer TH.
Rehabilitation Sciences, School of Health Sciences, Queen Margaret University, Edinburgh, UK
Sources: Disabil Rehabil. 2013 Aug 19. & Pubmed PMID: 23957639 (27/08/13)
A simple behavioral intervention delivered over the Internet helped multiple sclerosis (MS) patients increase their daily walking, according to a randomized trial presented here.
Pedometer recordings indicated that patients receiving the 6-month intervention boosted average daily step counts from about 4,000 at baseline to some 5,500 at its close, said Lara Pilutti, PhD, of the University of Illinois at Urbana-Champaign (UIUC).
Significant improvements were also seen in patients' scores on measures of depression, anxiety, fatigue, and physical ability, Pilutti reported at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.
Also, a separate trial in the same laboratory presented here showed that a somewhat different home-based exercise program reduced the presumed risk for falls by improving patients' balance and other factors.
As UIUC's Jacob Sosnoff, PhD, suggested in a platform presentation on the latter study, the physical symptoms of MS often put patients on a downward spiral in their functional abilities. Falls and difficulties in perform activities of daily living may make patients reluctant even to try them, in turn leading to sedentarism, deconditioning, and further reductions in physical ability.
Both studies involved randomizing patients to either an intervention or a wait-list during which they received no treatment initially, but were allowed to receive the intervention following the trial's completion.
Primary Goal: Increases in Walking
Pilutti's study of the Internet-based program recruited 82 patients who were assigned in equal numbers to the intervention and control groups.
The intervention included a website providing information on how MS patients can become more physically active using social cognitive therapy techniques, as well as one-on-one live video coaching conducted over the Internet. Patients in this group wore pedometers and had goals for the number of steps, recording their actual step counts in a diary.
Increases in walking were the program's primary goal, Pilutti told MedPage Today.
Participants were about 49-years-old on average, with median Expanded Disability Status Score (EDSS) values at baseline of 3.5. Most did not use assistive devices for mobility, but about 12% used canes and another 13% had walkers or "rollator" devices.
All but four of the intervention group and two in the control group completed 6 months in the study. Scores on major outcome measures were very similar between groups at baseline.
Significant differences after 6 months were seen in several measures of functioning after adjusting for baseline differences (data are means; all P<o.05):
- Godin Leisure Time Exercise Questionnaire: 27.2 intervention, 13.0 control
- Fatigue Severity Scale: 4.6 intervention, 5.4 control
- Modified Fatigue Impact Scale, physical domain: 16.0 intervention, 19.3 control
- Hospital Anxiety-Depression Scale, depression domain: 5.0 intervention, 6.6 control
- Hospital Anxiety-Depression Scale, anxiety domain: 4.1 intervention, 5.6 control
- Pedometer-recorded daily times for moderate to vigorous physical activity increased in the intervention group by a mean of 2.5 minutes, compared with a decrease of 2.4 minutes in controls, but the difference did not reach statistical significance.
Pilutti told MedPage Today that the program was relatively inexpensive compared with others designed to promote exercise in MS patients, largely because it required little staff time. She noted that the coaching did not require involvement by highly trained professionals; in some cases, it was provided by undergraduate students, she said.
Reducing Fall Risk
The intervention in Pilutti's study was one of several developed in the UIUC lab of Robert Motl, PhD. Another was the subject of Sosnoff's presentation.
He reported on a 12-week trial of a program for MS patients with a history of falls to pursue at home without supervision, although they came into the clinic four times for instruction and, later, reinforcement of the exercise regimen.
Whereas the intervention in Pilutti's study was intended to promote mobility, the one in Sosnoff's trial was to reduce fall risk. Consequently, it stressed balance and strength training.
The program included 10 such exercises, with progressive intensity customized to individual participants. In-clinic training was provided at weeks 1, 2, 4, and 8.
Sosnoff and colleagues recruited 27 patients who had fallen in the past year for the trial, randomized to the intervention or wait-list control. Three patients subsequently quit the study because of the time commitment. One patient in the control group suffered a serious fall that required her to stop the exercises, and one in the intervention group withdrew because of an MS exacerbation. Sosnoff reported results for the 22 patients (12 control, 10 intervention) who completed 12 weeks in the study.
Patients in Sosnoff's study were considerably more disabled than those in Pilutti's. Median EDSS scores at baseline were 5.0 in the intervention group and 5.5 among controls, with most using some type of assistive device for walking. Mean patient age was about 60.
The primary outcome measure was fall risk, calculated from tests of vision, knee flexion and strength, and hip sway, as well as a computer-based evaluation, which together make up the Physiological Profile Assessment.
Baseline fall risk scores averaged 1.1 in the intervention group and 1.9 in controls, both within the moderate range.
Participants in the 12-week intervention showed a decline to a mean of 0.5, whereas scores in the control group rose to a mean of 2.2. Those changes took the means in the intervention group into the low-risk range, whereas the average for controls was in the high-risk category.
Most of the difference in outcomes stemmed from improvement in balance, Sosnoff said. Strength and spasticity showed little change with the intervention, which he said was common in previous studies of exercise programs.
But he noted an important limitation to the study, namely that effects on actual falls were not evaluated. He said that would be the focus of the next phase in the research program, for which his group was now seeking funding.
Pilutti acknowledged that the open-label study design was a limitation as well. Patients assigned to interventions may show more improvement than untreated controls simply because of the trial engagement, rather than from the intervention's specific content.
Pilutti's study was funded by the National Multiple Sclerosis Society. Sosnoff's was funded by the CMSC and internal university sources.
Both researchers reported no relevant financial interests.
Primary source: CMSC-ACTRIMS Joint Meeting
Source reference: Pilutti L, et al. "RCT of a behavioral intervention targeting physical activity and symptoms in MS" CMSC-ACTRIMS 2013; Abstract SX23.
Additional source: CMSC-ACTRIMS Joint Meeting
Source reference: Sosnoff J, et al. "Home based exercise program and fall risk reduction in older adults with MS" CMSC-ACTRIMS 2013; Abstract RH05.
Source: MedPage Today © 2013 MedPage Today, LLC. (03/06/13)
Studies have shown that the popular video game, Dance Dance Revolution (DDR), which requires players to coordinate their movements to the beat of music, may help improve balance and mobility in certain patient populations. Now, researchers at The Ohio State University Wexner Medical Center are the first to test the game's ability to help decrease the cognitive and physical effects of multiple sclerosis (MS).
An estimated 2.1 million people have multiple sclerosis (MS), an incurable inflammatory disease which progressively impairs nerve function in the brain and spinal cord. While studies with the elderly and Parkinson's patients have shown exercise can slow cognitive decline and improve coordination, similar information is lacking for patients with MS, leaving clinicians without data to help guide prescription of exercise programs.
"The video dancing game provides a good platform for our research because it addresses multiple issues that MS clinicians and patients face. We think our data will not only help doctors and therapists make good clinical recommendations, but provide an evidence based, in-home tool for patients that helps overcome access and cost issues associated with long term physical therapy," says Anne Kloos, PhD, PT, NCS, associate clinical professor of health and rehabilitation sciences in the Ohio State College of Medicine.
Kloos became interested in DDR as a potential therapy by conducting an earlier study of individuals with Huntington's disease. In that study, Kloos and her colleagues found that the interactive video game was a fun way to boost motivation and provide a mental and physical workout, in addition to being a convenient way to deliver physical therapy.
In early 2012, Kloos received a grant from the Ohio State Center for Clinical and Translational Science (CCTS) to examine the effects of DDR on mobility, brain plasticity and cognition in individuals with MS. In the ongoing trial, participants exercise using DDR three times a week for eight weeks. The patients' cognitive functions are tested at the beginning and end of the trial, and functional and structural magnetic resonance imaging is used to detect brain circuitry changes.
"DDR requires a lot of cognitive processing. Players must look at a screen and time their movements to the arrows on the screen," said research team member, Nora Fritz, DPT. "Incorporating DDR into standard MS treatments has the potential to improve balance, walking, cognition and motivation."
Fritz recently received a supplementary grant from the CCTS to expand the work started by Kloos, and is being mentored by both Dr. Kloos and Deborah Larsen, PhD, PT, Director of the Ohio State School of Health and Rehabilitation Sciences. With the additional funding, Fritz will investigate the differences in dual tasking abilities between individuals with MS and healthy controls and whether playing DDR will improve dual tasking abilities.
Many people diagnosed with MS feel as though they have been given a life sentence of incapacitation. Kloos and Fritz are looking to restore hope and improve the quality of life for patients suffering from this disease, something that study participants feel they are achieving.
"Participating in the study and doing the dance program has helped me feel healthier and more independent. And that is really exciting," says Tracy Blackwell, a study participant.
The trial is still enrolling patients.
Source: Science Daily Copyright © 1995-2012 ScienceDaily LLC (28/02/13)