Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals

• Published in: Neurological sciences 2019-04, Vol.40 (4), p.733-743
• Main Authors: Grubić Kezele, Tanja, Babić, Matea, Štimac, Dinko
• Format: Article
• Language: English
• Subjects: Aged; Breathing Exercises - methods; Cognitive ability; Exercise Therapy - methods; Fatigue; Fatigue - etiology; Fatigue - therapy; Feasibility Studies; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - therapy; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Outcome Assessment, Health Care; Pain; Psychiatry; Quality of Life; Registration; Respiration; Statistical analysis; Upper Extremity - physiopathology; Well being
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-019-3707-0

Purpose To evaluate the feasibility of a combined upper limb and breathing exercise for a home-based program and to explore its effect on primary fatigue and quality of life in ambulatory and non-ambulatory individuals with multiple sclerosis (MS) in a short time. Method Nineteen individuals with MS were assigned into semi-controlled pre-post feasibility study based on Expanded Disability Status Scale (EDSS) status and divided into two groups: exercise (five ambulatory, five non-ambulatory; EDSS 1.0–8.0) and related control with no exercise (four ambulatory, five non-ambulatory; EDSS 1.0–7.5). Exercise group performed combined upper limb and breathing exercise in a controlled group (2 days/week, 60 min/session) accompanied by independent home exercise (3 days/week, ≥ 20 min/session). Participants underwent measures of fatigue impact (Modified Fatigue Impact Scale (MFIS) and quality of life (RAND Medical outcomes study 36-item short-form health survey (SF-36)) before and after a 4-week period. Results The MFIS (physical, psychosocial, total) showed statistically significant group-by-time interaction in ambulatory ( p  = 0.033, d  = 1.60; p  = 0.039, d  = 1.59; p  = 0.033, d  = 1.62) and non-ambulatory individuals ( p  = 0.009, d  = 2.42; p  = 0.018, d  = 1.96; p  = 0.0008, d  = 3.92). Physical functioning (SF-36) showed statistically significant group-by-time interaction in ambulatory ( p  = 0.014, d  = 2.14) but no significance in non-ambulatory ( p  = 0.368, d  = 0.68) individuals. Despite the absent statistical significance, there were large intervention effects on MFIS cognitive scores for ambulatory ( d  = 1.28) and non-ambulatory ( d  = 1.47), and on other SF-36 scores for ambulatory (general health: d  = 1.76 and pain: d  = 1.02) and non-ambulatory (physical limitation: d  = 1.03 and emotional well-being: d  = 0.94) individuals. Conclusion Our 4-week program reduced some aspects of fatigue and improved some aspects of quality of life in a small group of ambulatory and non-ambulatory individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work. Trial registration Name of the registry: The Impact of Exercise Training on Living Quality in Multiple Sclerosis. Registration: The study was registered at www.clinicaltrial.gov on July 14, 2017. First participant enrollment: August 28, 2017. URL: 602-01/17-01-147; Trial registration ID: NTC03222596.