|Abstract: ||Multiple Sclerosis (MS) is a complex neurodegenerative and auto-immune disease
that can affect several parts of the central nervous system (CNS). Fatigue, motor
disorders, muscle weakness and balance problems are very common consequences in MS
patients. There are many suggestions that indicate impairments, resulting not only from
disease’s progression per se, but also from sedentary lifestyle secondary to the MS
(Dalgas et al. 2008). Moreover it has been demonstrated that patients show impaired
autonomic functions and cardiovascular regulation during exercise.
The aim of the present investigation was to assess the effectiveness of a six months
combined training (CT) - in terms of aerobic capacity, walk and speed ability, balance,
fatigue and cardiovascular regulation in response to the muscle metaboreflex recruitment
- on subjects with relapsing - remitting MS (RR-MS).
Eleven subjects (5 females; age 47.09±10.8; BMI 23.94±4.8) with RR-MS (EDSS
2.5-6.0) participated to a 6 months supervised CT, 1 h/session, 3 days/week of adapted
physical activity (APA). Ten subjects (4 females; age 47.7±10.9; BMI 24.3±4.3) with
RR-MS (EDSS 2.5-6.0) were enrolled as sedentary control group (CTL). CT program
consisted of endurance training, resistance training, and exercises for balance,
coordination, joint mobility and stretching. Cardiopulmonary testing on a
electromagnetically braked cycle-ergometer was used to assess maximum workload
(Wmax), oxygen uptake (VO2max), carbon dioxide output (VCO2max), pulmonary
ventilation (Vemax) and heart rate (HRmax). These parameters were measured by means of
a metabolic measurement cart (MedGraphics Ultima CPX, St. Paul, USA). Patients were
also evaluated with the Modified Fatigue Impact Scale (MFIS), the Berg Balance Scale
(BBS), the Timed Up and Go (TUG), and the 6 Minute Walking Test (6MWT).
Hemodynamic parameters: stroke volume (SV), cardiac output (CO), the pre-ejection
period/left ejection time ratio (PEP/VET), systemic vascular resistance (SVR) during
post-exercise muscle ischemia (PEMI) and control exercise recovery (CER) tests were
measured by means of impedance cardiography (NCCOM 3, BoMed Inc., Irvine, CA).
Also the difference between the PEMI and the CER tests was calculated to allow for
metaboreflex response to be assessed. Evaluations were performed before training (T0),
at the third (T3) and at the sixth month (T6).
The study described so far showed that the 6 months training could effectively
improve physical capacity of MS patients. There was a remarkable increase in strength
and speed of lower limbs, moreover perception of fatigue drastically decreased and
balance enhanced. On the contrary, no difference for hemodynamic parameters between
groups was highlighted. It can be speculated that MS patients need more time (1 or 2
years training) to obtain necessary metabolic and structural changes to modify
cardiovascular regulation during exercise.|