The Effect of an Aquatic Training Program on Walking Ability and Quality of Life of Patients with Multiple Sclerosis

IntroductionMultiple sclerosis (MS), is a demyelinating disease that affects the white matter of the Central Nervous System (Kent-Brown, Ng, Castro et al. 1997). MS is one of the most frequent neurological disease (Mostert & Kesserling, 2002) affecting a remarkable number of individuals worldwide (Kantarci & Wingerchuk, 2006) that is more prevalent in women compared to men due to genetic inclination, hereditarily determined immunological factors, hormonal effects and environmental influences (Hawkins & McDonnell, 1999; Kurtzke, 2000). The tendency of the disability to be primary progressive has as a consequence the alteration of patient's needs with MS each year, a change that might be evident even from day to day. Since MS has an onset during early adult life (20-40 years) although it may have a minimal effect on longevity, however, it causes significant delays on the familial, professional, and social life of patients (Kalb, Holland, Giesser, & Lander, 2007; Rao, Leo, Ellington, et al. 1991). In psychometric values, walking ability of patients with MS changes over time to a greater degree compared to the modifications that are relative to the Kurtzke Expanded Disability Status Scale (EDSS) (Schwid, 1997; Schwid, Goodman, McDermott, Bever, & Cook, 2002). In addition, walking deficiency constitutes a decisive factor for the gradual mobility deterioration of MS patients (Schwid, 1997). While walking restriction influences negatively the activities that are connected with the everyday routine of patients with MS (Romberg, 2004), improvement of walking ability resulting from their participation in physical activity programs will probably contribute in the improvement of patients' quality of life.Research concerning quality of life of MS patients has been developed over the last few years. With commencement of illness quality of life deteriorates drastically (Rice, Oger, Duquette, et al. 1999). As for pharmaceutical treatment, interferon b seems to improve quality of patients' life (Rice et al. 1999), however, it can also cause serious neuropsychological syndromes such as depression with suicidal ideation, paranoid psychosis or hallucinations (Schaefer, Schmidt, Neumer, Scholler, & Schwarz, 2002). As for physical exercise and its effect on MS, for many years the prevailed notion was that exercise causes fatigue due to the increase of body temperature, resulting to the avoidance of physical activity participation (Ehrman, Gordon, Visich, & Keteyian, 2009). However, this opinion has been surpassed since safe participation in intervention programs can be achieved with proper adaptations of exercise according to the functionality level and needs of MS patients without deterioration of their clinical feature (Mostert & Kesserling, 2002). The recent recognition of exercise benefits along with the combination of pharmaceutical treatment, ergo-therapy and psychological support have established physical exercise as an integral part of MS patients' treatment (Mathiowetz, Matuska, Finlayson, Luo, & Chen, 2007; Patti, Ciancio, Cacopardo, et al. 2003). The review of literature showed that treadmill training, resistance training and other types of exercise may be beneficial for patients with MS (Broekmans, Roelants, Feys, et al. 2011; Dodd, Taylor, Shields, et al. 2011; Giesser, Beres-Jones, Budovitch, Herlihy, & Harkema, 2007; Newman, Dawes, van den Berg, et al. 2007; Ponichtera-Mulcare, Mathews, Barren, & Gupta, 1997; Sabapathy, Minahan, Turner, & Broadley, 2011; Surakka, Romberg, Ruutiainen, et al. 2004; Svensson, Gerdle, & Elert, 1994). Although aquatic exercise constitutes an increasingly popular therapy method for patients with MS (Becker, 2009), the particular conditions that result from the nature of activity such as appropriate temperature of water and difficulties related to swimming pool access, appear to constitute likely causes for the limited number of studies conducted regarding the application of water exercise programs. …