Körperliche Aktivität und körperliche Funktionsfähigkeit: Erfassung und Wechselwirkungen bei Personen mit Multipler Sklerose

Persons with Multiple Sclerosis have, until recently, been medically advised to avoid physical exertion. In the last two decades, though, scientific evidence for the benefits of physical activity and exercise has been established. This paper purposively addresses gaps in knowledge concerning physical activity and physical functioning in persons with Multiple Sclerosis. In the introduction, a detailed investigation into medical history reveals the origination of the outdated doctrine concerning physical exertion in Multiple Sclerosis, and, at the same time, disables historically grown preconceptions. The main part of the paper is divided up into three independent empirical analyses. Data are generated from two studies conducted at the Institute of Sport Science and Sport at the University of Erlangen-Nürnberg, the Department of Neurology at the University Hospital Erlangen and the Caritas-Krankenhaus Bad Mergentheim. The first analysis, based on data from a large german sample (cross-sectional analysis of questionnaires, n=632), investigates interrelationships between physical activity and physical and psychological aspects of health-related quality of life in persons with Multiple Sclerosis. The second analysis focuses on the assessment of physical activity using objective and subjective methods. A dataset of 45 persons with Multiple Sclerosis allows the first validation of a german physical activity questionnaire. Ergospirometry and accelerometry are used as objective reference criterion, both of which are also subject to a thorough analysis of content validity. The third analysis introduces cardiorespiratory fitness as an important health indicator for persons with Multiple Sclerosis and investigates the importance of disease-related or behavioral determinants. Analysis and discussion takes place within the taxonomy of the International Classification of Functioning, Disability and Health (ICF). Finally, the results are interpreted to draw conclusions for the ICF-based diagnosis and promotion of functional health in persons with Multiple Sclerosis.Lange wurde Personen mit Multipler Sklerose davon abgeraten, körperlich aktiv zu sein. Heutzutage sind jedoch die vielfältigen positiven Wirkungen von körperlicher und sportlicher Aktivität auch bei Multipler Sklerose belegt. Diese Arbeit greift einige spezifische Wissenslücken zum Thema körperliche Aktivität und körperliche Funktionsfähigkeit bei Multipler Sklerose auf. In der Einleitung zeigt eine ausführliche medizinhistorische Recherche auf, wie die veraltete Lehrmeinung zu körperlicher Anstrengung bei Multipler Sklerose entstehen konnte und entkräftet gleichzeitig und gezielt historisch gewachsene Vorurteile. Der Hauptteil der Arbeit ist in drei eigenständige empirische Untersuchungen gegliedert. Die Datenbasis stellen zwei Studien am Institut für Sportwissenschaft und Sport der Universität Erlangen-Nürnberg, die in Kooperation mit der Neurologischen Klinik des Universitätsklinikums Erlangen und dem Caritas-Krankenhaus Bad Mergentheim durchgeführt wurden. Die erste Untersuchung analysiert auf Basis einer großen deutschen Stichprobe (querschnittliche Fragebogenuntersuchung, n=632) Wechselbeziehungen zwischen körperlicher Aktivität und physischen und psychischen Aspekten der gesundheitsbezogenen Lebensqualität bei Personen mit Multipler Sklerose. Bei der zweiten Untersuchung steht die Erfassung der körperlichen Aktivität im Vordergrund, objektive und subjektive Messmethoden werden vorgestellt und diskutiert. Anhand eines Datensatzes von 45 Personen mit Multipler Sklerose wird schließlich erstmals ein deutschsprachiger Fragebogen zur Messung der körperlichen Aktivität bei Multipler Sklerose validiert. Als objektive Vergleichskriterien werden Spiroergometrie und ein Beschleunigungssensor verwendet, der ebenfalls einer ausführlichen inhaltlichen Validitätsprüfung unterzogen wird. In der dritten Untersuchung wird die kardiovaskuläre Fitness als bedeutsame Gesundheitsvariable für Personen mit Multipler Sklerose vorgestellt und der Frage nachgegangen, inwieweit sie von krankheitsbedingten, neurologischen Einschränkungen der Funktionsfähigkeit oder personenbezogenen, verhaltensabhängigen Faktoren wie körperlicher Aktivität determiniert wird. Analyse und Diskussion erfolgt innerhalb der Taxonomie der International Classification of Functioning, Disability and Health (ICF) und es werden Schlussfolgerungen für eine ICF-bezogene Diagnostik und Förderung der funktionellen Gesundheit vom PmMS abgeleitet

Physical Activity in Multiple Sclerosis: A Comparative Study of Vitamin D, Brain-Derived Neurotrophic Factor and Regulatory T Cell Populations

Background: Previous studies suggest beneficial effects of exercise in multiple sclerosis (MS). However, knowledge on the effects of physical activity on the immune system is limited. Objective: To assess potential relationships between cardiorespiratory fitness, cognitive function, and immune parameters in physically active and inactive MS patients. Methods: We identified 83 patients with relapsing-remitting disease, an unrestricted walking range, and stable interferon- � treatment from our data base. Based on the subjective report of physical activity, the lower/inactive (n = 21) and upper/ active quartiles (n = 21) of patients were selected. We assessed the frequency of T cells, B cells, NK cells, monocytes and regulatory T cell populations by flow cytometry, measured brain-derived neurotrophic factor and vitamin D serum levels by ELISA, and conducted spiroergometry and transcranial sonography. Results: Physical activity and cardiorespiratory fitness were not associated with brain-derived neurotrophic factor, frequency of T regulatory cells or any other immune cell subpopulation. However, we found a positive correlation of vitamin D serum levels with cardiorespiratory fitness. Conclusion: Overall, we found no negative effect of physical activity on the immune system. The association between vitamin D and cardiorespiratory fitness most likely reflects longer hours of sunlight exposure in active patients, suggesting a desirable ‘side- effect’ of physical activity

A randomized study to evaluate the effect of exercise on fatigue in people with relapsing–remitting multiple sclerosis treated with fingolimod

Background Fatigue is a major symptom of multiple sclerosis (MS) in patients, and it has been shown to improve with physical exercise. Although fingolimod might lessen fatigue, it is unclear how patients treated with fingolimod react to physical activity regarding fatigue. Objective This study evaluated the effect of an exercise intervention on fatigue in relapsing–remitting MS patients receiving fingolimod. Methods People with MS (PwMS) were randomized to either a structured internet-based exercise program (e-training) or no e-training intervention. The primary endpoint was the change in the Modified Fatigue Impact Scale (mFIS) after six months. Results The primary analysis showed no statistically significant difference between groups in the mFIS change. Subgroup analyses revealed a beneficial effect of physical exercise for PwMS with low aerobic capacity and with low aerobic capacity plus more severe fatigue. The incidence of adverse events was similar in both groups. No cardiovascular events were reported. The majority of PwMS were relapse free. Conclusion Physical exercise benefits on fatigue may depend on the physical capacity of the patient and requires individualized training. Consistent with previous studies, these results suggest that physical exercise generally does not impose a risk and that this holds true also for patients receiving fingolimod

Calling Out MS Fatigue : Feasibility and Preliminary Effects of a Pilot Randomized Telephone-Delivered Exercise Intervention for Multiple Sclerosis Fatigue

This project was supported by a National Multiple Sclerosis Society Pilot grant to N.F. and A.K. (#PP-1612-26378) and a FRAP internal grant from Wayne State University to N.F. ACKNOWLEDGMENTS The authors gratefully acknowledge all the individuals with MS who participated in this study.Peer reviewedPublisher PD

Testing the feasibility and acceptability of using the Nintendo Wii in the home to increase activity levels, vitality and well-being in people with multiple sclerosis (Mii-vitaliSe): protocol for a pilot randomised controlled study.

The benefits of physical activity for people with multiple sclerosis (pwMS) have been recognised. However, exercise regimens can be difficult to maintain over the longer term and pwMS may face unique barriers to physical activity engagement. Pilot research suggests the Nintendo Wii can be used safely at home by pwMS with minimal mobility/balance issues and may confer benefits. We have developed a home-based physiotherapist supported Wii intervention ('Mii-vitaliSe') for pwMS that uses commercial software. This is a pilot study to explore the feasibility of conducting a full scale clinical and cost-effectiveness trial of Mii-vitaliSe

Physical activity and physical functioning: Assessment and interrelationship in persons with Multiple Sclerosis

Lange wurde Personen mit Multipler Sklerose davon abgeraten, körperlich aktiv zu sein. Heutzutage sind jedoch die vielfältigen positiven Wirkungen von körperlicher und sportlicher Aktivität auch bei Multipler Sklerose belegt. Diese Arbeit greift einige spezifische Wissenslücken zum Thema körperliche Aktivität und körperliche Funktionsfähigkeit bei Multipler Sklerose auf. In der Einleitung zeigt eine ausführliche medizinhistorische Recherche auf, wie die veraltete Lehrmeinung zu körperlicher Anstrengung bei Multipler Sklerose entstehen konnte und entkräftet gleichzeitig und gezielt historisch gewachsene Vorurteile. Der Hauptteil der Arbeit ist in drei eigenständige empirische Untersuchungen gegliedert. Die Datenbasis stellen zwei Studien am Institut für Sportwissenschaft und Sport der Universität Erlangen-Nürnberg, die in Kooperation mit der Neurologischen Klinik des Universitätsklinikums Erlangen und dem Caritas-Krankenhaus Bad Mergentheim durchgeführt wurden. Die erste Untersuchung analysiert auf Basis einer großen deutschen Stichprobe (querschnittliche Fragebogenuntersuchung, n=632) Wechselbeziehungen zwischen körperlicher Aktivität und physischen und psychischen Aspekten der gesundheitsbezogenen Lebensqualität bei Personen mit Multipler Sklerose. Bei der zweiten Untersuchung steht die Erfassung der körperlichen Aktivität im Vordergrund, objektive und subjektive Messmethoden werden vorgestellt und diskutiert. Anhand eines Datensatzes von 45 Personen mit Multipler Sklerose wird schließlich erstmals ein deutschsprachiger Fragebogen zur Messung der körperlichen Aktivität bei Multipler Sklerose validiert. Als objektive Vergleichskriterien werden Spiroergometrie und ein Beschleunigungssensor verwendet, der ebenfalls einer ausführlichen inhaltlichen Validitätsprüfung unterzogen wird. In der dritten Untersuchung wird die kardiovaskuläre Fitness als bedeutsame Gesundheitsvariable für Personen mit Multipler Sklerose vorgestellt und der Frage nachgegangen, inwieweit sie von krankheitsbedingten, neurologischen Einschränkungen der Funktionsfähigkeit oder personenbezogenen, verhaltensabhängigen Faktoren wie körperlicher Aktivität determiniert wird. Analyse und Diskussion erfolgt innerhalb der Taxonomie der International Classification of Functioning, Disability and Health (ICF) und es werden Schlussfolgerungen für eine ICF-bezogene Diagnostik und Förderung der funktionellen Gesundheit vom PmMS abgeleitet.Persons with Multiple Sclerosis have, until recently, been medically advised to avoid physical exertion. In the last two decades, though, scientific evidence for the benefits of physical activity and exercise has been established. This paper purposively addresses gaps in knowledge concerning physical activity and physical functioning in persons with Multiple Sclerosis. In the introduction, a detailed investigation into medical history reveals the origination of the outdated doctrine concerning physical exertion in Multiple Sclerosis, and, at the same time, disables historically grown preconceptions. The main part of the paper is divided up into three independent empirical analyses. Data are generated from two studies conducted at the Institute of Sport Science and Sport at the University of Erlangen-Nürnberg, the Department of Neurology at the University Hospital Erlangen and the Caritas-Krankenhaus Bad Mergentheim. The first analysis, based on data from a large german sample (cross-sectional analysis of questionnaires, n=632), investigates interrelationships between physical activity and physical and psychological aspects of health-related quality of life in persons with Multiple Sclerosis. The second analysis focuses on the assessment of physical activity using objective and subjective methods. A dataset of 45 persons with Multiple Sclerosis allows the first validation of a german physical activity questionnaire. Ergospirometry and accelerometry are used as objective reference criterion, both of which are also subject to a thorough analysis of content validity. The third analysis introduces cardiorespiratory fitness as an important health indicator for persons with Multiple Sclerosis and investigates the importance of disease-related or behavioral determinants. Analysis and discussion takes place within the taxonomy of the International Classification of Functioning, Disability and Health (ICF). Finally, the results are interpreted to draw conclusions for the ICF-based diagnosis and promotion of functional health in persons with Multiple Sclerosis

Web-based interventions in multiple sclerosis: the potential of tele-rehabilitation

The World Wide Web is increasingly used in therapeutic settings. In this regard, internet-based interventions have proven effective in ameliorating several health behaviors, amongst them physical activity behavior. Internet-delivered interventions have shown positive effects on physical activity and physical function in persons with MS (pwMS). In this review we give an overview on several online exercise programs for pwMS and discuss the advantages and drawbacks of web-based interventions. Although participants of online exercise programs reported a high acceptance and satisfaction with the intervention, decreasing compliance was a major issue. A possible remedy might be the implementation of game-design elements to increase compliance and long-term adherence to internet-delivered interventions. In addition we believe that the integration of social networks seems to be a promising strategy

Mental Health in Multiple Sclerosis Patients without Limitation of Physical Function: The Role of Physical Activity

Multiple sclerosis (MS) patients, in general, show reduced physical function, physical activity, and quality of life. Positive associations between physical activity and quality of life have been reported. In particular, we were interested in the relation between physical activity and mental health in MS patients without limitation of physical function, since limitations of physical function may influence both physical activity and quality of life. Assessment comprised the Baecke questionnaire on physical activity, the Short Form 36 Health Survey (SF-36), and Beck Depression Inventory (BDI). We ranked our sample according to physical activity into four groups and performed an ANOVA to analyze the relationship between levels of physical activity and health-related quality of life (HRQoL). Then we performed a subgroup analysis and included patients with unlimited walking distance and a score of less than 18 in the BDI. Most active vs. inactive patients were compared for the mental subscales of the SF-36 and depression scores. From 632 patients, 265 met inclusion criteria and hence quartiles were filled with 67 patients each. Active and inactive patients did not differ considerably in physical function. In contrast, mental subscales of the SF-36 were higher in active patients. Remarkable and significant differences were found regarding vitality, general health perception, social functioning and mental health, all in favor of physically active patients. Our study showed that higher physical activity is still associated with higher mental health scores even if limitations of physical function are accounted for. Therefore, we believe that physical activity and exercise have considerable health benefits for MS patients