High intensity interval training for people with Multiple Sclerosis: a systematic review

Background: Aerobic High Intensity Interval Training (HIIT) is safe in the general population and more efficient in improving fitness than continuous moderate intensity training. The body of literature examining HIIT in Multiple Sclerosis (MS) is expanding but to date a systematic review has not been conducted. The aim of this review was to investigate the efficacy and safety of HIIT in people with MS. Methods: A systematic search was carried out in September 2017 in EMBASE, MEDline, PEDro, CENTRAL and Web of Science Core collections using appropriate keywords and MeSH descriptors. Reference lists of relevant articles were also searched. Articles were eligible for inclusion if they were published in English, used HIIT, and included participants with MS. Quality was assessed using the PEDro scale. The following data were extracted using a standardised form: study design and characteristics, outcome measures, significant results, drop-outs, and adverse events. Results: Seven studies (described by 11 articles) were identified: four randomised controlled trials, one randomised cross-over trial and two cohort studies. PEDro scores ranged from 3-8. Included participants (n=249) were predominantly mildly disabled; one study included only people with progressive MS. Six studies used cycle ergometry and one used arm ergometry to deliver HIIT. One study reported six adverse events, four which could be attributed to the intervention. The other six reported that there were no adverse events. Six studies reported improvements in at least one outcome measure, however there were 60 different outcome measures in the seven studies. The most commonly measured domain was fitness, which improved in five of the six studies measuring aspects of fitness. The only trial not to report positive results included people with progressive and a more severe level of disability (Extended Disability Status Scale 6.0-8.0). Conclusion: HIIT appears to be safe and effective in increasing fitness in people with MS and low levels of disability. Further research is required to explore the effectiveness of HIIT in people with progressive MS and in those with higher levels of disability

Access, delivery and perceived efficacy of physiotherapy and use of complementary and alternative therapies by people with progressive multiple sclerosis in the United Kingdom: an online survey

Introduction: All people with progressive MS in the United Kingdom should have access to physiotherapy through the National Health Service (NHS). However levels of access and delivery are unknown. Furthermore there is no research on perceived efficacy of physiotherapy or the use of complementary and alternative medicine in people with progressive MS in the United Kingdom. Methods: An online survey was carried out via the UK MS Register. Inclusion criteria were diagnosis of progressive MS, a member of UK MS Register and 18 years or older. The survey asked participants regarding access and delivery of physiotherapy; perceived efficacy of physiotherapy and interventions received; barriers to accessing physiotherapy and use of complementary and alternative medicine. The following additional data were supplied from the UK MS Register: demographics, EQ5D, MSIS-29 physical and psychological sub-scales and geographical data. Results: Total number of respondents was 1,298 from an identified 2,538 potential registrants: 87% could access physiotherapy services, 77% received physiotherapy from the NHS and 32% were currently receiving physiotherapy. The most common interventions received were home exercise programme (86%), exercises with a physiotherapist (74%) and advice/education (67%). 40% had recently used complementary and alternative medicine. Perceived efficacy of physiotherapy was high with 70% reporting it to be either ‘beneficial’ or ‘very beneficial’. Main barriers to accessing physiotherapy were mobility, fatigue, continence, transport issues, requiring someone to go with them and pain. Discussion: Access to physiotherapy was high with most people reporting it as beneficial. However 13% reported not having access indicating a gap in accessibility. Considering some of the barriers reported may allow physiotherapy services to address this gap in accessibility

2014 Dahlberg Award Winner: The effects of dietary toughness on occlusopalatal variation in savanna baboons

This study investigates the relationship between dietary toughness and craniofacial variation in two groups of savanna baboons. Standard craniofacial and malocclusion data were collected from a captive, soft-diet experiment group (n=24) and a sample of wild-captured baboons, raised on tougher, natural foods (n=19). We tested the hypothesis that in the absence of normal masticatory stress experienced during the consumption of wild foods, the captive baboons would exhibit higher levels of facial and dental structural irregularities. Principal component analysis indicates separation of the two samples. The soft-diet sample exhibits significantly shorter palates, greater variability in palate position, and higher frequencies of occlusal irregularities that correlate with the shorter palates. Results offer further support that long-term dietary chewing stresses have a measurable effect on adult craniofacial variation

Transcript for Episode 24: For Future Generations: Preamble & Environmental Provisions of 1972 Montana Constitution

https://digitalcommons.mtech.edu/crucible_transcriptions/1023/thumbnail.jp

Physiotherapy for people with progressive multiple sclerosis

Progressive Multiple Sclerosis (MS) is a degenerative neurological disease with no known cure. The overall aim of the research within this thesis was to investigate physiotherapy, an important part of the care, for people with progressive MS. This was done in three studies. A systematic review of the current literature for the effectiveness of physiotherapy for the rehabilitation of people with progressive MS; an online survey of people with progressive MS assessing levels of access to, and use of, clinical services across the United Kingdom; and a feasibility study of High Intensity Interval Training (HIIT) for people with progressive MS. The systematic search returned 15 studies, 482 participants in total, which investigated eight different interventions: exercise therapy, multi-disciplinary rehabilitation, functional electrical stimulation, botulinum toxin type A injections and manual stretches, inspiratory muscle training, therapeutic standing, acupuncture and body weight supported treadmill training. All studies, apart from one, produced a positive result, however, only one study was adequately powered. In conclusion, the review found that the evidence was positive for using physiotherapy for rehabilitation in people with progressive MS, but further adequately powered research, is required to strengthen this. In total 1298 people with progressive MS from across the United Kingdom completed the online survey in August to October 2015. Participants were asked regarding access and use of clinical services, delivery and opinion of physiotherapy, and use of complementary and alternative therapies. Access to MS Specialists was high (95%), as was access to a physiotherapist (87%). Seventy seven percent of physiotherapy was delivered by the National Health Service and 32% were currently receiving physiotherapy for their MS. Physiotherapy was very well perceived by people with progressive MS and the most common interventions received were independent (83%) and supervised exercise (71%). Five percent of respondents were currently using disease modifying therapies and 23% had previously taken them. Almost three quarters (74%) received a regular review but 37% received this review less than annually. It was recommended that service providers make steps to address this gap in service provision. Finally, eight weeks of twice weekly HIIT sessions were compared to twice weekly sessions of continuous moderate intensity training. Ten out of twelve participants completed the trial. The HIIT intervention was well tolerated with 93% adherence, 100% compliance with protocol and no adverse events. There were three adverse events in the continuous training group and compliance was 79%. In addition, those who received HIIT improved their maximal heart rate and mental processing speed while no changes were found in the continuous training group. A larger, fully powered trial is required to confirm these results. Overall the studies within this thesis demonstrate that physiotherapy has the potential to be beneficial in the rehabilitation of people with progressive MS, that people with progressive MS are engaging with physiotherapy, and that interventions such as HIIT may provide new avenues for eliciting health benefits from this patient group. However, despite these positive findings, more work is required to strengthen the evidence base and gaps in service provision should be addressed

D- VS L-methionine utilization by growing steers

Increasing the amino acid supply to the small intestine of growing cattle can increase performance, if specific amino acids are limiting. Although this can be accomplished by feeding rumen undegradable protein, a more economical approach may be supplementing only those amino acids that actually limit performance, but in a form that will bypass the rumen. Methionine (MET) is thought to be a limiting amino acid for growing cattle. DL-MET, a 50 :50 mixture of natural methionine (L-MET) and the unnatural optical isomer (D-MET) is used widely in monogastric rations. Ruminally protected DL-methionine is also available for cattle; however, little information is available about its utilization by growing steers. We studied the efficiency of utilization of D- vs L-MET by growing steers by measuring nitrogen retention of steers postruminally supplemented with graded levels of D- or LMET. Nitrogen retention increased linearly in response to infusion of both L-MET and D-MET, with similar responses for the two isomers. The efficiency of utilization of DMET relative to L-MET was estimated to be 95.5%. In conclusion, D-MET was similar to L-MET in increasing nitrogen retention of growing steers