Martin Heine

Multiple sclerosis (MS) is a chronic disease affecting over 1.3 million people globally. MS is characterized by diffuse damage to the central nervous system, leading to a wide range of different physical and cognitive (mental processes) symptoms. One of the most prominent and disabling symptoms of MS is fatigue. Currently, there is no effective medicine to reduce fatigue in people with MS. Treatment with exercise may be a way to reduce fatigue either directly by changing how the body works, for… Meer weergeven

Multiple sclerosis (MS) is a chronic disease affecting over 1.3 million people globally. MS is characterized by diffuse damage to the central nervous system, leading to a wide range of different physical and cognitive (mental processes) symptoms. One of the most prominent and disabling symptoms of MS is fatigue. Currently, there is no effective medicine to reduce fatigue in people with MS. Treatment with exercise may be a way to reduce fatigue either directly by changing how the body works, for example hormonal function, or indirectly through improved physical activity and general health.

We found 45 trials, involving 2250 people with MS, assessing the effect of exercise therapy using self reported fatigue. We used 36 studies, involving 1603 people with MS, in an analysis. Combined, these 36 trials supported the idea that exercise therapy may be a promising treatment to reduce fatigue without side events. This finding seems especially true for endurance training, mixed training (i.e.muscle power training mixed with endurance training), or ’other’ training (e.g. yoga, tai-chi). To assess the safety of exercise therapy we counted the number of reported MS relapses in the people receiving exercise therapy and in people in a non-exercise group and did not find a significant difference. Minder weergeven

BACKGROUND:
In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life.

OBJECTIVE:
To investigate the association between disease severity and cardiopulmonary fitness.

METHODS:
Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease… Meer weergeven

BACKGROUND:
In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life.

OBJECTIVE:
To investigate the association between disease severity and cardiopulmonary fitness.

METHODS:
Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin.

RESULTS:
The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation (r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R2 = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg-1∙min-1); VO2peak = 36.622 - 5.433 (Sex (1=men)) - 0.124 (Age) - 2.082 (EDSS) 2.737 (Belgium) 8.674 (Denmark).

CONCLUSION:
There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS. Minder weergeven

OBJECTIVE:
To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS).

DATA SOURCES:
PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify additional relevant studies.

STUDY SELECTION:
Inclusion of original studies was on the basis of performance of maximal… Meer weergeven

OBJECTIVE:
To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS).

DATA SOURCES:
PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify additional relevant studies.

STUDY SELECTION:
Inclusion of original studies was on the basis of performance of maximal CPET, description of the protocol, and participants with definite MS aged ≥18 years. No language restrictions were applied.

DATA EXTRACTION:
The quality of CPET reporting in included studies was scored according to a structured checklist considering 10 feasibility (eg, test abnormalities) and 12 safety quality criteria (eg, adverse events). Structured data extraction was performed for these feasibility and safety features of CPET.

DATA SYNTHESIS:
Forty-six studies were included, comprising 1483 patients with MS, with a mean age ± SD of 42.0±5.8 years and a median Expanded Disability Status Scale (EDSS) score of 2.8 (first quartile=2.1; third quartile=3.9; range of average EDSS scores, .75-5.8). Quality of reporting on CPET varied from 3 to 13 out of a possible 22 quality points. The percentage of test abnormalities (feasibility) was 10.0%, primarily because of an inability to maintain pedaling at a specific resistance. The percentage of adverse events (safety) was 2.1%. All adverse events were temporary.

CONCLUSIONS:
Based on the available data, we conclude that CPET is feasible provided that the CPET modality is tailored to the physical abilities of the patient. Furthermore, CPET is safe when recommended precautions and safety measures are implemented. However, future optimization of CPET will require protocolized testing and the implementation of standard reporting procedures.
Minder weergeven

BACKGROUND:
Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied.

OBJECTIVE:
(1) to investigate the reliability of cardiopulmonary exercise parameters in PwMS; (2) to determine the responsiveness, in… Meer weergeven

BACKGROUND:
Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied.

OBJECTIVE:
(1) to investigate the reliability of cardiopulmonary exercise parameters in PwMS; (2) to determine the responsiveness, in terms of the smallest detectable change (SDC), for each parameter.

DESIGN:
Two repeated measurements of cardiopulmonary exercise outcomes were obtained, with a median time interval of 16 days.

METHODS:
Thirty-two PwMS suffering from subjective fatigue performed cardiopulmonary exercise tests on a cycle ergometer, to voluntary exhaustion. We calculated the reliability, in terms of the intra-class correlation coefficient (ICC [2,k]; absolute agreement), and the measurement error, in terms of standard error of measurement (SEM) and SDC at individual (SDCindividual) and group level (SDCgroup).

RESULTS:
The ICC for VO2peak was 0.951, with an SEM of 0.131 L∙min(-1) and an SDCindividual of 0.364 L∙min(-1). When corrected for bodyweight, the ICC of VO2peak was 0.933, with an SEM of 1.7 mL∙kg(-1)∙min(-1) and in an SDCindividual of 4.6 mL∙kg(-1)∙min(-1).

LIMITATIONS:
Generalization of our study results is restricted to fatigued PwMS with a low to mild level of disability.

CONCLUSIONS:
At individual level, cardiopulmonary exercise testing can be used reliably to assess physical fitness in terms of VO2peak, but less so to determine significant changes. At group level, VO2peak can be reliably used to determine physical fitness status and establish change over time.
Minder weergeven

Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS.

Objective: To examine the Oxygen Uptake Efficiency Slope (OUES) as an outcome for physical fitness in patients with multiple sclerosis. Design: Cross-sectional study. Patients: A maximal cycling ergometry test was performed by 56 patients with multiple sclerosis. Methods: The OUES was compared with healthy reference values. Correlation analysis was used to assess the concurrent validity of the OUES and the following commonly used parameters of maximal exercise testing: maximal power output… Meer weergeven

Objective: To examine the Oxygen Uptake Efficiency Slope (OUES) as an outcome for physical fitness in patients with multiple sclerosis. Design: Cross-sectional study. Patients: A maximal cycling ergometry test was performed by 56 patients with multiple sclerosis. Methods: The OUES was compared with healthy reference values. Correlation analysis was used to assess the concurrent validity of the OUES and the following commonly used parameters of maximal exercise testing: maximal power output (Wmax) and peak oxygen consumption (VO2peak). The predictive validity of a submaximal OUES, derived using only 50% of the exercise duration (OUES50), and an OUES derived using the full exercise duration (OUES) were determined. Results: The OUES (mean 24.2 (standard deviation; SD 7.2)) was markedly lower than previously reported healthy reference values (mean 46.0 (SD 9.0)). Pearson correlation coefficients ranged from 0.514 (p < 0.01) between the OUES and Wmax and 0.857 for VO2peak (p < 0.01). The predictive validity of OUES50 for OUES was 0.918 (p < 0.01). Conclusion: The moderate to high concurrent validity of the OUES with Wmax and VO2peak and high predictive validity of OUES50 for OUES suggest that maximal exercise testing in patients with low to moderate multiple sclerosis is not necessary. Minder weergeven

BACKGROUND: Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability.OBJECTIVE: The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures… Meer weergeven

BACKGROUND: Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability.OBJECTIVE: The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures related to the participant, disease, and function. DESIGN: This was a cross-sectional study. METHODS: Cardiopulmonary exercise testing was conducted with a sample of 56 participants with MS. Analysis of variance was used to assess the criteria in participants with MS and low, mild, and moderate levels of disability. RESULTS: Mean peak oxygen consumption (V̇o2peak) was 21.4 (SD=7.1) mL·kg(-1)·min(-1). An oxygen consumption (V̇o2) plateau was seen in 37.5% of participants. A respiratory exchange ratio of 1.10 or greater was achieved by 69.6% of the participants, a maximal heart rate within 90% of their age-predicted maximal heart rate was achieved by 48.2% of the participants, and 23.2% of the participants perceived their exertion to be 18 or greater on the Borg Scale of Perceived Exertion (scores of 6-20). The values for achieved heart rate and incidence of a V̇o2 plateau were significantly lower in participants with moderate levels of disability than in those with mild levels of disability. CONCLUSION: The findings suggest that the outcome of cardiopulmonary exercise testing in people with MS and low to mild levels of disability (Expanded Disability Status Scale scores of ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in people with moderate levels of disability (Expanded Disability Status Scale scores of >4.0) is most likely symptom limited. Minder weergeven

Conference proceeding

TREFAMS is an acronym for TReating FAtigue in Multiple Sclerosis, while ACE refers to the rehabilitation treatment methods under study, that is,Aerobic training, Cognitive behavioural therapy, and Energy conservation management. The TREFAMS-ACE research programme consists of four studies and has two main objectives: (1) to assess the effectiveness of three different rehabilitation treatment strategies in reducing fatigue and improving societal participation in patients with MS; and (2) to study… Meer weergeven

TREFAMS is an acronym for TReating FAtigue in Multiple Sclerosis, while ACE refers to the rehabilitation treatment methods under study, that is,Aerobic training, Cognitive behavioural therapy, and Energy conservation management. The TREFAMS-ACE research programme consists of four studies and has two main objectives: (1) to assess the effectiveness of three different rehabilitation treatment strategies in reducing fatigue and improving societal participation in patients with MS; and (2) to study the neurobiological mechanisms of action that underlie treatment effects and MS-related fatigue in general. The TREFAMS-ACE programme is unique in its aim to assess the effectiveness of three rehabilitation treatments. The programme will provide important insights regarding the most effective treatment for MS-related fatigue and the mechanisms that underlie treatment response. A major strength of the programme is that the design involves three almost identical RCTs, enabling a close comparison of the treatment strategies and a strong overall meta-analysis. The results will also support clinical practice guidelines for the treatment of MS-related fatigue. Minder weergeven