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Some MS patients resist physical activity boost(04/06/14)

Multiple sclerosis (MS) patients who would benefit the most from an increase in physical activity were, unfortunately, those for whom an intervention designed to boost it was least effective, a researcher said here.

In a secondary analysis of data from an earlier, overall successful trial of an Internet-based exercise intervention, factors associated with the strongest responses included mild versus moderate disability, body weight in the normal range versus obesity, and relapsing-remitting versus progressive MS, according to Robert Motl, PhD, of the University of Illinois in Urbana-Champaign.

There is "value in modifying and refining interventions" to improve their chances of success in difficult populations, he suggested at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Separately, another analysis of the same trial data indicated that, in the overall study sample, the improvements seen in measures of physical activity were accompanied by reductions in time spent sitting.

Rachel Klaren, a graduate student in Motl's laboratory, reported that mean sitting time among all study participants (including dropouts) was lower by 1.6 hours per day compared with a wait-listed control group; and among those completing the study per protocol, the difference was 2.1 hours per day.

The results confirmed that participants did indeed get up out of their chairs to achieve the increased step counts seen in the primary study results, reported at the CMSC-ACTRIMS meeting in 2013.

Motl and colleagues had developed a 6-month intervention geared to increasing physical activity in MS patients. It 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. Participants wore pedometers and had goals for the number of steps, recording their actual step counts in a diary.

At the 2014 meeting, Motl explained that physical activity is known to be beneficial in preserving mobility for MS patients, which typically diminishes over time even in those who remain in the relapsing-remitting phase.

The trial randomized 82 patients either to the intervention or to a wait-listed control. While on the wait-list, participants received no encouragement or coaching; they then entered the program at the trial's conclusion.

Who Responds, Who Doesn't

Overall, mean step counts increased from baseline by nearly 40% in the intervention group. But Motl said that the investigators noted that not every participant showed such an increase. In fact, some had marked decreases.

Relative to the wait-listed controls, only those in the intervention group with mild disability on the basis of Expanded Disability Status Scale scores showed increases in step counts, whereas the intervention had no effect for those classified with moderate disability (P<0.01 for the effect of disability status).

Similarly, the intervention was effective only in those with relapsing-remitting disease, not in those with progressive forms of MS (P<0.01 for the effect of clinical course) -- and it was effective only for those with body mass index values of 25 kg/m2 or less, not for those with higher values (P<0.05 for the effect of obesity status).

As it happens, the subgroups not benefiting from the intervention were those at the greatest risk for continued or accelerated disability progression, and therefore those for whom an increase in physical activity would have the greatest health benefit. Motl concluded that his, or other interventions, may need to be tailored more specifically to these patients to increase the chances of success.

Other factors, including whether patients were taking disease-modifying drugs or medications for specific MS symptoms, did not affect the intervention's impact, Motl indicated.

Effect on Sedentarism

Klaren noted that time spent sitting "has been described as 'the new smoking'" because of its adverse effects on a host of health outcomes.

Although the increase in step counts seen in the trial's primary results might logically entail a commensurate decrease in sitting times, it can't be assumed. Consequently, Klaren analyzed data on sitting time specifically collected in the trial.

As part of the baseline and 6-month follow-up evaluations, participants were asked to estimate their average daily time spent sitting down over the past 7 days. The analysis covered 70 participants who had provided baseline data (intent-to-treat sample), of whom 13 did not complete the intervention.

In the overall group and after adjusting for baseline differences, the mean daily sitting time in the intervention group at follow-up was 7.2 hours (SE 3.3), compared with 8.8 (SE 3.3, P<0.05) for the wait-listed controls.

For the per-protocol group, mean daily sitting time at follow-up was 6.8 hours (SE 3.5) with the intervention versus 8.9 (SE 3.5, P<0.05) for controls, Klaren reported.

She said these were the first data specifically addressing the effect on sitting time of an exercise intervention in MS patients.

Next steps, she added, would be to examine whether reductions in sitting time really do lead to demonstrable health benefits, and to identify factors associated with sedentarism in MS patients.

The study was supported by the National Multiple Sclerosis Society.

Motl reported relationships with Biogen Idec and Acorda. Klaren declared she had no relevant financial interests.

Primary source: Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis
Source reference: Motl R, et al, "Does the effect of a physical activity behavior intervention vary by clinical characteristics of people with multiple sclerosis?" CMSC-ACTRIMS 2014; Abstract RH05.

Additional source: Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis
Source reference:Klaren R, et al "Efficacy of a behavioral intervention for reducing sedentary behavior in people with multiple sclerosis" CMSC-ACTRIMS 2014; Abstract RH04.

Source: MedPage Today © 2014 MedPage Today, LLC (04/06/14)

Gentle yoga an alternative for MS patients(26/02/14)

Some people are content to sit back and relax when they retire, maybe traveling or working in their gardens.

Others want to turn their talents toward helping others. That was true of Jana Gasiorkiewicz.

About seven months ago, Gasiorkiewicz became a certified yoga instructor. Several months ago, she launched her Yoga on a Chair classes.

But her practice targets patients with multiple sclerosis and similar medical conditions. The classes are conducted on chairs “because so many people can’t get down on the mat,” she explains.

“You don’t need the stamina (to stand),” she said. “Without overtaxing those already weakened limbs and your heart, you can bring some movement and build some heat without exhausting yourself.”

Gasiorkiewicz retired in 2011 after working for 20 years for the Kenosha Unified School District. The last 11 years were spent teaching French at Bradford High School. She has been teaching one French class at the University of Wisconsin-Parkside since September.

After retiring, she said she had more time and started going to yoga classes at YogaRoots Racine, 518 College Ave., in Downtown Racine.

Gasiorkiewicz’s daughter, Suzanne Selmo, had become a yoga therapist in California. Gasiorkiewicz, 65, received her instructor certification in July. But then the question became whom would she teach?

She said a friend’s husband has Parkinson’s disease, and he benefited from yoga.

“It gave me the idea to target my practice to a particular audience,” Gasiorkiewicz said. “When I looked into it, I found there were many more MS patients than Parkinson’s patients.”

Multiple sclerosis is an often-disabling central nervous system disorder. Symptoms range from abnormal fatigue to memory, attention and vision problems, according to the National Multiple Sclerosis Society. Some patients may suffer some form of paralysis, or need help from a cane or crutches to work, according to the organization.

Because people with MS may have a limited range of motion, or may not be able to lie on the floor on mats, Gasiorkiewicz teaches her classes on chairs.

A relative with MS died about six years ago. And Gasiorkiewicz said she learned a few years ago that a former coworker with MS had died.

“Those two women — their lives were so changed by MS. Those reasons were in the back of my mind,” she said.

Some patients have mild symptoms. Others, she said, are in wheelchairs. Two participants, a married couple from Kenosha, have said they both benefit from the classes. But only the wife has MS.

“For me, it’s strengthening, flexibility, balance, stress reduction,” she said. “If they would try it consistently, after a few months they would see the benefits would warrant setting aside a little money or time.”

Source: Journal Times © Copyright 2014, Journal Times (26/02/14)

Exercise can alleviate fatigue caused by multiple sclerosis, researchers say(15/01/14)

Study finds short bouts of moderately intense activity can have big impact on tiredness levels of people with MS.

Multiple sclerosis sufferers can reduce the fatigue that accompanies their condition by undertaking short bursts of moderately intense exercise, such as walking or cycling, according to new research.

Participating in such activities even for a few minutes boosted their quality of life and reduced their extreme tiredness, patients reported in a trial of 120 people with MS living in Sheffield.

"It seems illogical to turn to exercise as a way of managing fatigue but the results showed that a pragmatic programme based on short bouts of moderate intensity exercise can really help improve symptoms and quality of life", said Professor John Saxton, who led the research while at Sheffield Hallam University but who is now at the University of East Anglia.

For 12 weeks, 60 of the 120 participants undertook five bursts of three minutes of exercises, either in a gym or at home, with two-minutes rests in between. As the trial progressed, they were encouraged to increase the busts to four minutes or take shorter rest breaks. The other 60 received standard NHS care for their condition, which did not include exercise.

Those who had done the physical activity had "significantly lower" levels of fatigue than those who had not. They also reported "long-term improvements in emotional wellbeing, social function and overall quality of life", which lasted for up to nine months, according to the MS Society, which funded the study. The exercise regime was also more cost-effective than normal NHS care.

The charity believes exercise could help the UK's 100,000 or so MS patients.

"Fatigue in MS is an incredibly common but troubling symptom that can hugely affect an individual's quality of life. For many people with MS this programme could be a cost-effective treatment option", said Ed Holloway, its head of care and services research.

Source: The Guardian © 2014 Guardian News and Media Limited (15/01/14)

Effects of a 4-month ananda yoga program on physical and mental health outcomes in MS(08/11/13)


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 boosts memory in people with multiple sclerosis(04/11/13)

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)

Popular video game helping patients ease the symptoms of multiple sclerosis(23/09/13)

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)