@2024 Afarand., IRAN

---

ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(4):286-293

Background
Multiple sclerosis (MS) is an autoimmune, inflammatory, chronic, and progressive disease, in which the immune system attacks neurons in the brain and spinal cord and causes damage to the myelin sheath and the exon of these cells [1].
Previous Studies
... [2-16]. Regular endurance exercise leads to improved intestinal and bladder function, decreased fatigue and depression, increased intake of oxygen and positive attitudes in MS patients [17-19]. Also, progressive resistance training is considered as a very useful sport-based intervention for patients [14]. Coenzyme Q10 or ubiquinone is a vitamin-like compounds and fat-soluble, which can be found in eukaryotic cells, especially in mitochondria. This coenzyme is a part of the electron transport chain and energy production in the aerobic metabolism pathway [20-22]. 200-500 mg/day daily intake of coenzyme Q10 can be beneficial for MS patients [23-26]. ... [27].
Aim(s)
The purpose of this research was to investigate the effect of 8 weeks of combined exercise training (more aerobic and resistance) and supplementation of coenzyme Q10 on muscle function (sitting, rising and walking speed) in patients with MS.
Research type
The present study is a semi-experimental (single-blinded) research with pre-test and post-test design.
Research society, place and time
The present study was done on men and women aged 25-45 years old (mean age: 37.60±7.14, weight: 64.57±9.42 and BMI: 24.30±1.66) who were the members of MS Association of Mahhad with the disability scale of 3-5 in 2016.
Sampling method and number
In this study, 28 male and female members of the MS Association of Mashhad were selected using convenience sampling method.
Used devices&materials
The present study was semi-experimental (single-blinded) research with pre-test-posttest design with three experimental groups (combined exercise+Q10 supplement, combined exercise+placebo and Q10 supplement) and a control (placebo). According to the inclusion criteria (a history of MS for at least 2 years, no regular exercise, no smoking and no consumption of immunosuppressive drugs), the volunteers were enrolled in the study. Exclusion criteria included MS recurrence, musculoskeletal injuries, inability to exercise, and no regular participation in the exercise protocol. All subjects completed the consent of collaboration in the research. The research method was confirmed and registered by the Ethics Committee of Sabzevar University of Medical Sciences (ethics code IR.MEDSAB.REC.1395.20). The combined exercise+ Q10 supplement and exercise+placebo experienced a combined exercise program (two sessions of endurance training and one session of resistance training per week) for eight 3-session weeks weekly. The aerobic exercise included a 3-min jogging on bike ergometer with 1-2 min intervals between each set. It increased from 5 replicates in the first session to 12 repetitions in the final session. To observe overload, the intensity began with 50% of maximum heart rate and at the end of the course reached to 60%. Strength training included bench press, lat, leg extension, and hamstring exercises. The exercises were carried out in three sets with 10 to 8 replications and a 2-4-min interval between each set and also a 3-4-min interval between each move according to the overload. Each session of the exercise included warming up (5-10 min), the main training with variable length and cool down exercises (5-10 min). Coenzyme Q10 (Nutri Century; Canada) was used as a supplement to the experimental exercise group as well as the third experimental group as capsule (200 mg) daily supervise by a neurologist and also starch was also used as a placebo [28]. Functional tests included chair stand, up & go [29], 25-foot walk and 6-min walk [30] tests were measured to evaluate muscle performance before and after the exercise protocol. The chair stand test assesses muscle strength, which its time is measured 5 or 10 times or the number of tests performed in 30 s is considered. Up & go test measures the time it takes the patient to rise from a standard chair, walk to a line on the floor 3 meters away, turn, return, and sit down again. This test evaluates movement, balance and agility skills. 25-foot walk test measures the time it takes to walk 25-foot distance, in which the subject is asked to walk straight for 7.5 meters without assistance and in the least possible time. 6-min walk test measures the total covered distance in 6 min, in which is subjected to walk with the maximum speed without rest and encouragement. This test evaluates endurance and ability to walk for long distances. In general, these tests mostly measure balance, coordination, and muscular endurance of the lower limbs in patients. Each test was performed twice and the best (at least) time to carry out the tests was recorded for each individual. Data was analyzed using analysis of covariance and paired t-test.
Findings by Text
After eight weeks, the average chair stands increased from 10.28 to 15.71 (Table 1). LSD Post-hoc test showed that the supplement+exercise and exercise groups had a significant difference compared with the supplement group as well as the placebo group, whereas there was no significant difference between the supplement group and the placebo group. The mean time 25-foot walk test test decreased from 7.36 to 6.22 s (Table 2). Post-hoc test showed that there was a significant difference between the supplement+exercise and exercise groups in comparison with the supplement and placebo groups and the supplement group did not show any significant difference compared with the placebo group. The average time of up & go tests also reached from 7.94 to 6.63 s (Table 3). ) Post-hoc test showed that there was a significant difference between the supplement+exercise and exercise groups in comparison with the supplement and placebo groups and the supplement group did not show any significant difference compared with the placebo group. Moreover, the 6-min walk distance reached from 270.50 to 283.25 m (Table 4). Based on the results of post-hoc test, there was a significant difference between the supplement+exercise and exercise groups compared with the supplement and placebo groups, and the supplement group did not significantly differ from the placebo group.
Main comparison to the similar studies
The results of this study indicated that eight weeks of combined exercise with and without supplementation of coenzyme Q10 resulted in a significant reduction in the duration of functional tests, including chair stands, chair stands and walking, 25-foot walking (walking speed). On the other hand, it increased 6-min walk distance (endurance) in supplement and exercise groups compared with supplement and placebo groups, which resulted in improved sitting, rising, walking and ability to change direction. In this regard, Romberg et al. [31] reported that combined training (three sessions per week for six months) resulted in improved walking speed for MS patients. Also, according to another study, the researcher stated that the combined exercise led to improved functional capacity in the training group compared with the control group [32]. ... [33-39].
Suggestions
It is suggested to study the effect of combined exercises with different periods of time and using other dietary supplements.
Limitations
None declared.
Conclusions
The combined exercise and supplementation with Q10, and even alone, also improves muscle function, including sitting, rising and walking in patients with MS.
Acknowledgments
The authors are thankful to all the officials and staff of the MS Association of Khorasan Razavi in particular the patients who have contributed to this study for their cooperation.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
This research was extracted from the Ph.D. thesis in Physical Education and Sport Sciences, supported by Hakim Sabzevari University.

TABLES and CHARTS

Show attach file