@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(1):43-50

Background
… [1-13] The main goal of exercises in patients with Multiple Sclerosis and other local diseases which are without any treatment are to enhance the quality of life [14]. The patients can reach to a variety of ways to control their diseases and to reach better functions through regular and true exercises [15]. … [16-18]
Previous Studies
The effects of PNF exercises on spasms, muscular strength, and better functions in the patients with Multiple Sclerosis have been studied [19]. It has been shown that resistance exercises and muscular strengthening can prevent muscular atrophy [20, 21]. Nevertheless, there are contradicting results about enhancing the patients’ strengths.
Aim(s)
The aim of this study was to investigate the effects of 8-week combined exercises, including resistance and proprioceptive neuromuscular facilitation, on fatigue and quality of life in patients with Multiple Sclerosis (MS).
Research type
This is an intervening semi-experimental study.
Research society, place and time
Male and female patients with MS who were members of Specific Diseases Committee of Sabzevar University of Medical Sciences (Iran) and aged between 20 and 50years were studied in 2014.
Sampling method and number
15 male and 22 female patients were voluntarily selected. Based on EDSS, The patients’ inability criterion was a domain between 1 and 5.
Used devices&materials
All the subjects were visited by a neurologist to determine their inability degree and EDSS. The questionnaire assesses different states and functions of the central nervous system. Based on the scale, every patient received scores between zero and 10 according to the severity of damage in the central nervous system. The higher the damage severity, the more the received score is. Any reduction in EDSS means an improvement in the diseases of the patients with MS [15]. The patients were randomly and purposefully divided into “exercise” (n=18) and “control” (n=19) groups based on their inability level and age. The specialized questionnaire of the quality of life in patients with MS (MSQOL-54) was used to investigate the quality of life. Its validity and reliability have been confirmed in Iran. From 54 questions of the questionnaire, 18 and 36 questions assess 14 domains of the MS patients and general quality of life, respectively. Based on Likert’ scale, the scores are between 2 and 7. Two combined domains are “physical health” and “psychological health”. The scores of 14 domains and two combined domains are between zero and 100, and higher scores show better situation [22]. Fatigue Severity Scale (FSS) was used to assess fatigue severity in the MS patients. The scale contains 9 questions, each receiving scores between one and 7 [23]. An exercise session contained warming up stage, resistance exercises, PNF exercises, and cooling down stage. During the first week of the resistance exercises, the subjects performed 50% of 1RM one time with 6-10 repetitions. And during the second week, they performed 60% of 1RM one time with 10-15 repetitions. And from the third to the eighth weeks, they performed 70% of 1RM one time with 10-15 repetitions [21]. Rhythmical Stabilization Technique was used in PNF exercises. During the first week, the subjects performed one set with a 10-second repetition. And during the second week, they performed one set with two 10-second repetitions. And from the third to the eighth weeks, they performed one set with three 10-second repetitions [24]. PNF exercises were performed by a physiotherapist [25]. Mean and Standard Deviation indices were used to describe data. Shapiro-Wilk test was used to investigate normal groups in age and inability level. Data distribution was normal. Independent T test was used to investigate intergroup changes. Correlated T test was used to investigate intragroup changes in fatigue severity. In quality of life, Shapiro-Wilk test was used to investigate normal variables. And, MANOVA and Box test were used to investigate intergroup differences and covariance homogeneity with Post-hoc LSD, respectively. Data was analyzed, using SPSS 18 software.
Findings by Text
Table 1 shows mean and standard deviation of anthropometric characteristics and the subjects’ inability degree in exercise and control groups. Table 2 shows mean, standard deviation, and P values of fatigue severity. The combined exercises led to a significant improvement in fatigue severity of patients with MS. Based on the results of Box test, the homogeneity condition of the variance/covariance matrices was confirmed. Based on Levene’s test showing insignificant variables, intergroup variances were equal. Based on Wilks’s Lambda test, the effects of group on the sub-scales of physical domain were significant. There was a significant difference between the groups at least in one variable. There was a significant difference between exercise and control groups in the mean scores of physical combined, psychological combined, physical health, pain, limited physical functioning, energy, general health comprehension, social functioning, limited psychological functioning, vitality, general quality of life, and mental functioning domains (Table 2). There were significant increases in the variables in exercise group compared to control group. There was no significant difference between exercise and control groups in the mean scores of health changes, sexual satisfaction, health risk, and sexual functioning (Table 3).
Main comparison to the similar studies
8-week combined exercises led to a significant improvement in fatigue severity and quality of life in patients with MS. The present results are consistent with other studies [16, 21, 26]. … [27-29] There is a lower life quality level in patients with MS than the normal persons [30]. There was an improvement in physical and psychological states of quality of life due to the combined exercises. The present results are consistent with some studies [31], while inconsistent with some others [17]. There were significant increases in physical health, physical limited functioning, psychological limited functioning, pain, vitality, energy, general health comprehension, social functioning, mental functioning, and general quality of life. There have been improvements in five levels of quality of life in patients with MS after an exercise program with moderate severity. However, only in the life domain there has been a significant improvement [32]. The results in the life domain are consistent with the present results. There has been an improvement (11%) in the quality of life of patients with MS after an endurance exercise program (16 sessions) [15]. The results are consistent with the present results. There have been improvements in physical and emotional problems, as well as social functioning, due to strengthen exercises. The results and some other results about physical limited functioning [15, 33] are consistent with the present results. … [34] Interferon 1 medication results in an improvement in the quality of life in the physical health and physical limited functioning [35]. The results are consistent with the present results. The results of studies about energy [35, 36], social functioning [33, 35, 37], health risk [36], pain [33, 36], sexual functioning [36], and health changes and sexual satisfaction [38] are consistent with the present results. Aerobic exercises do not affect the quality of life of patients with MS in the physical functioning [36, 39]. The results are inconsistent with the present results. The results of some studies about physical limited functioning [35, 36] are inconsistent with the present results. Endurance exercises significantly increases total quality of life, psychological health domains, and mental health, only [40]. The result is inconsistent with the present results.
Suggestions
Since there was no negative effect due to the exercises, patients with MS should perform them.
Limitations
Type and amount of the medications consumed by the patients, sleep and nutrition amounts, and the subjects’ motivations to participate were of the limitations for the study.
Conclusions
Combined exercises can reduce fatigue and improve most of the aspects of quality of life in patients with MS.
Acknowledgments
All the participants are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
All ethical rules were considered.
Funding Sources
No organization funded the study.

TABLES and CHARTS

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