Objective: To investigate the effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in subjects with multiple sclerosis (MS).
Design: A randomized controlled trial.
Setting: At Masku Neurological Rehabilitation Centre, Masku, and the Social Insurance Institution, Research Department, Turku, Finland.
Subjects: Ninety-five MS patients with mild to moderate disability were randomized into exercise group (n = 47) and a control group (n = 48).
Intervention: Participants in the exercise group attended in a supervised exercise period of three weeks, which was followed by a home exercise programme lasting for 23 weeks. Patients in the control group continued with their normal living.
Outcome measures: Motor fatigue of knee flexor and extensor muscles was measured during a static 30-s maximal sustained muscle contraction. The decline in force (Nm) during the 30 s was recorded, and a fatigue index (FI) was calculated. Subjective fatigue was measured by using the Fatigue Severity Scale (FSS). The Ambulatory Fatigue Index (AFI) was calculated on the basis of a 500-m walking test. Assessment took place at baseline, at the third week (not for the control group) and at the 26th week. All outcome variables were analysed, men and women together, and some interesting contrasts were analysed by gender.
Results: Associations were observed with changes in extension FI and Expanded Disability Status Scale (EDSS) score and mean extension torque (Nm), but not with changes in FI and aerobic or strength exercise activity, mean AFI, mean FSS or in mean knee flexion torque. AFI was decreased in all subject groups (p = 0.007). Motor fatigue was reduced in knee flexion (p = 0.0014) and extension (ns) among female but not in male exercisers after six months of exercise. The exercise activity of women was 25% higher than that of the men.
Conclusions: Six months of exercise reduced motor fatigue in women, but not in men.
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References
1.
1 Freal JE, Kraft GH, Coryell JK. Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil1984; 65: 135-138.
3 Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ. The impact of fatigue in patients with multiple sclerosis. Can J Neurol Sci1994; 21: 9-14.
4.
4 Vercoulen JHMM, Hommes OR, Swanink CMA et al. The measurement of fatigue in patients with multiple sclerosis: a multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol1996; 53: 642-649.
5.
5 Schwid SR, Covington M, Segal BM, Goodman AD. Fatigue in multiple sclerosis: Current understanding and future directions. J Rehabil Res Dev2002; 39: 211-224.
6.
6 Iriarte J, De Castro P. Correlation between symptom fatigue and muscular fatigue in multiple sclerosis. Eur J Neurol1998; 5: 579-585.
7.
7 Gehlsen GM, Grigsby SA, Winant DM. Effects of aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis. Phys Ther1984; 64: 653-657.
8.
8 Kent-Braun JA, Sharma KR, Miller RG, Weiner MV. Postexercise phoshocreatine resynthesis is slowed in multiple sclerosis. Muscle Nerve1994; 17: 835-841.
9.
9 Petajan JH, Grappmaier E, White AT, Spencer AK, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol1996; 39: 422-423.
10.
10 De Haan A, de Ruiter CJ, van Der Woude LH, Jongen RJ. Contractile properties and fatigue of quadriceps muscles in multiple sclerosis. Muscle Nerve2000; 23: 1523-1541.
11.
11 Sutherland G, Andersen MB. Exercise and multiple sclerosis: physiological, psychological, and quality of life issues. J Sports Med Phys Fitness2001; 41: 421-432.
12.
12 Petajan JH, White A. Recommendations for physical activity in patients with multiple sclerosis. Sports Med1999; 27: 179-191.
13.
13 Djaldetti R, Ziv I, Achiron A, Melamed E. Fatigue in multiple sclerosis compared with chronic fatigue syndrome. A quantitative assessment. Neurology1996; 46: 632-635.
14.
14 Schwid SR, Thornton CA, Pandya S et al. Quantitative assessment of motor fatigue and strength in MS. Neurology1999; 53: 743-750.
15.
15 Poser C, Paty DW, Scheinberg L. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol1983; 13: 227-231.
16.
16 Kurtzke JF. Rating neurologic impairment in multiple sclerosis. An expanded disability status scale (EDSS). Neurology1983; 33: 1444-1452.
17.
17 Feigenbaum MS, Pollock ML. Prescription of resistance training for health and disease. Med Sci Sports Exerc1999; 31: 38-45.
18.
18 Häkkinen K, Alen M, Kallinen M, Newton RU. Neuromuscular adaptation during prolonged strength training, detraining and re-strengthtraining in middle-aged and elderly people. Eur J Appl Physiol2000; 83: 51-62.
19.
19 Surakka J, Romberg A, Ruutiainen J, Virtanen A, Aunola S, Mäentaka K. Assessment of muscle strength and motor fatigue with a knee dynamometer in subjects with multiple sclerosis: a new fatigue index. Clin Rehabil2004; 18: 652-659.
20.
20 Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol1989; 46: 1121-1123.
21.
21 Schwid SR, Goodman AD, Mattson DH et al. The measurement of ambulatory function in multiple sclerosis. Neurology1997; 49: 1419-1424.
22.
22 Morganti CM, Nelson ME, Fiatarone MA et al. Strength improvements with 1 yr of progressive resistance training in older women. Med Sci Sports Exerc1995; 27: 906-912.
23.
23 Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med2000; 343: 938-952.
24.
24 Weinshenker BG, Rice GPA, Noseworthy JH, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. Brain1991; 114: 1045-1056.
25.
25 Runmarker B, Andersen O. Prognostic factors in a multiple sclerosis incidence cohort with twenty years of follow-up. Brain1993; 116: 117-134.
26.
26 Kent-Braun JA, Ng AV, Castro M et al. Strength, skeletal muscle composition, and entzyme activity in multiple sclerosis. J Appl Physiol1997; 83: 1998-2004.
27.
27 Maugham RJ, Harmon M, Leiper JP, Sale D, Delman A. Endurance capacity of untrained males and females in isometric and dynamic muscular contractions. Eur J Appl Physiol1986; 55: 395-400.
28.
28 Behm DG, St-Pierre DMM. The effects of strength training and disuse on the mechanisms of fatigue. Sports Med1998; 25: 173-189.
29.
29 Hicks A, Kent-Braun J, Ditor DS. Sex differences in human skeletal muscle fatigue. Exerc Sport Sci Rev2001; 29: 109-112.
30.
30 Sharma KR, Kent-Braun J, Mynher MA, Weiner MW, Miller RG. Evidence of an abnormal intramuscular component of fatigue in multiple sclerosis. Muscle Nerve1995; 18: 1403-1411.
31.
31 Sheean GL, Murray NMF, Rothwell JC, Miller DH, Thompson AJ. An electrophysiological study of the mechanism of fatigue in multiple sclerosis. Brain1997; 120: 299-315.
32.
32 Scutter S, Fulton I, Trott P, Parnianpour M, Grant R, Brien C. Effects of various isoresistive training programmes on trunk muscle performance. Clin Biomech1995; 7: 379-384.
33.
33 Baldi JC, Snowling N. Resistance training improves glyaemic control in obese type 2 diabetic men. Int J Sports Med2003; 6: 419-424.
