# Exercise as it relates to Disease/The effectiveness of yoga on the quality of life of multiple sclerosis patients

The effectiveness of yoga on the quality of life of multiple sclerosis patients

## What is the background to this research?
### Multiple Sclerosis

Multiple sclerosis (MS) is a chronic disorder which affects the central nervous system (CNS). The myelin sheath surrounding the axons within the brain, brain stem and spinal cord is attacked and degraded by the body's own immune system, leaving scars or lesions. This means that MS is a demyelinating and autoimmune disorder. Demyelination along with axonal degredation leads to a blockage of conduction along the neurons. MS occurs mostly in people aged 20 to 40, predominantly women.

#### Prevalence

      * Approximately 2 million diagnosed worldwide
      * Approximately 23,000 diagnosed in Australia
      * If your parent is diagnosed with MS, the risk of being diagnosed is 18 times greater.

#### Symptoms

      * Loss of function and feeling in limbs
      * Fatigue
      * Loss of balance and coordination
      * Pain
      * Cognitive Dysfunction
      * Depression
      * Muscle Weakness

### Hatha Yoga

The word hatha means willful and forceful, which means that hatha yoga is the type of yoga that focuses on physical fitness. It contains 3 of the 8 limbs of yoga which include pranayamas (breath-control exercises), asanas (yoga postures), and chanda (meditation); predominantly focussing on the asanas.

### Testing
#### Kurtzke Expanded Disability Status Scale

The Kurtzke EDSS is a scale used in determining the severity of disability in MS patients. It is a scale ranging from 1 to 10 as outlined in the table below.
| EDSS score | Description | EDSS score | Description |
| 1 | Without impaired function | 6 | Need assistance to walk 100m |
| 2 | Minimal objective abnormality | 7 | Wheelchair restricted, inability to walk 5 metres |
| 3 | Mild disorder, continue normal activities in most situations | 8 | Bed patients that may be in a chair for majority of the day |
| 4 | Mild disorder, continue normal activities, can walk up to 500m without aid or rest | 9 | Helpless bed patients |
| 5 | Can walk about 200m without aid or rest | 10 | Death from MS |

#### Multiple Sclerosis Quality of Life–54 Questionnaire

MSQOL-54 is a 54 part questionnaire used to determine the overall quality of life of the subjects. It is split up into 11 multiple item scales and 2 single item scales. A higher score in each scale equates to a greater quality of life.
    Multiple item scales
      * Physical function
      * Role limitations physical
      * Role limitations emotional
      * Pain
      * Emotional wellbeing
      * Energy
      * Health perception
      * Social function
      * Cognitive function
      * Health Distress
      * Sexual function
    Single item scales
      * Change in health
      * Satisfaction with sexual function

## Where is the research from?

This study was conducted by researchers from:
   * School of Physical Education & Sports Science, Shahid Chamran University, Ahwaz, Iran.
   * School of Rehabilitation, Jundishapour University of Medical Sciences, Ahwaz, Iran.
It was published in the peer reviewed Journal of Human Kinetics, section II - Exercise Physiology & Sports Medicine. It is an open access article, so it is available to read or download online, free of charge.

## What kind of research was this?

This study is a randomised control study, which is seen as the gold standard for determining the effectiveness of a particular treatment. Subjects are randomly allocated to one of two groups, which may be a treatment group and a control group or two different treatment groups. Results are then compared between the groups.

## What did the research involve?

This research involved 21 women aged 19 to 54 volunteering to participate in the study. They were all diagnosed with MS and received a self assessed Kurtzke EDSS score between 1 and 4. Individuals were excluded from the study if they were pregnant, addicts or had any major health problems. The subjects were randomly allocated to one of two groups, a yoga intervention group (n=11) and a control group (n=10).
This study looked at the effects of yoga on the balance, speed, endurance of walking, fatigue and quality of life of the subjects involved. These variables were tested both pre and post intervention via a bergs balance score, 10 metre time, 2 minute distance walking, fatigue severity scale and MSQOL-54 respectively.
The intervention involved three 60 - 70 minute sessions of Hatha yoga per week, over the course of 8 weeks.

## What were the basic results?

The results of this study showed significant improvements for balance, endurance of walking, fatigue and quality of life for those taking part in the yoga training. There was no significant improvements for speed after the yoga training.
| Variable | Pre (intervention) | Post (intervention) | Pre (control) | Post (control) |
| Balance Score | 46.19 ± 8.1 | 53.81 ± 3.4 | 44.5 ± 9.43 | 41.7 ± 8.48 |
| Walk time (s) | 8.96 ± 1.8 | 8.13 ± 1.87 | 9.16 ± 1.88 | 9.47 ± 1.92 |
| Walk Distance (m) | 115 ± 23.15 | 120.36 ± 20.6 | 121.5 ± 27.73 | 119.05 ± 27.12 |
| FFS | 4.07 ± 1.11 | 2.44 ± 1.5 | 4.17 ± 1.28 | 4.23 ± 1.04 |
Pre and post intervention values for 21 subjects with MS.

## How did the researchers interpret the results?

The researchers concluded that hatha yoga exercises are beneficial for those diagnosed with MS, as they resulted in positive effects on the balance, endurance of walking, fatigue and quality of life. Although there was not a significant improvement in the 10m walk, there was a significant difference between the two groups. For this reason and due to the knowledge from previous studies, the researchers could not rule out that yoga training would benefit the speed of MS patients.

## What conclusions should be taken away from this research?

This study showed that yoga training is beneficial for MS sufferers, and is able to improve endurance, balance, quality of life and reduce fatigue. It is suggested that yoga should be participated in by those with MS, even if it is only for short periods.

## What are the implications of this research?

Implications of this study are that they did not take into consideration those with a more severe case of MS. Some sufferers would not be able to participate in a lot of the yoga exercises used in this study and therefore it would be worthwhile to look into the possible exercises that would be beneficial for the more severe cases of MS. The study comprises of a small sample size with only 11 subjects taking part in the intervention. A similar trial with a much larger sample size would provide more reliable results.

## Further reading

For further information on MS, the symptoms and the possible treatment stategies, visit the following websites:
      * MS Australia msaustralia.org.au
      * Better Health VIC betterhealth.vic.gov.au

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 , Ahmadi A, Nikbakh M, Arastoo A, Habibi A. The Effects of a Yoga Intervention on Balance, Speed and Endurance of Walking, Fatigue and Quality of Life in People with Multiple Sclerosis. Journal of Human Kinetics. 2010;23(-1).
* 1 2 3 4 5 6 7 8 , Motl R, McAuley E, Snook E. Physical activity and multiple sclerosis: a meta-analysis. Multiple Sclerosis. 2005;11(4):459-463..
* 1 2 3 4 5 6 , Velikonja O, Čurić K, Ožura A, Jazbec S. Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis. Clinical Neurology and Neurosurgery. 2010;112(7):597-601.
* 1 2 3 4 5 , Msaustralia.org.au. What is MS? | MS Australia [Internet]. 2015 [cited 30 September 2015]. Available from: http://www.msaustralia.org.au/what-is-ms.
* 1 2 3 4 5 6 7 , White L, Dressendorfer R. Exercise and Multiple Sclerosis. Sports Med. 2004;34(15):1077-1100.
* 1 2 3 , Lee C. 10 Beginner Yoga FAQs Answered | Yoga Frequently Asked Questions [Internet]. Yoga Journal. 2014 [cited 29 September 2015]. Available from: http://www.yogajournal.com/article/beginners/yoga-questions-answered/
* 1 2 , Tran M, Holly R, Lashbrook J, Amsterdam E. Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness. Preventive Cardiology. 2001;4(4):165-170.
* ↑ , Kurtzke J. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-1444.
* 1 2 , Nhs.uk. News glossary - Behind the Headlines - NHS Choices [Internet]. 2009 [cited 27 September 2015]. Available from: http://www.nhs.uk/news/Pages/Newsglossary.aspx#Openaccess
* ↑ , Stolberg H, Norman G, Trop I. Randomized Controlled Trials. American Journal of Roentgenology [Internet]. 2004 [cited 27 September 2015];183(6):1539-1544. Available from: http://www.ajronline.org/doi/full/10.2214/ajr.183.6.01831539
* ↑ Ahmadi, Azra et al. 'The Effects Of A Yoga Intervention On Balance, Speed And Endurance Of Walking, Fatigue And Quality Of Life In People With Multiple Sclerosis'. Journal of Human Kinetics 23.-1 (2010): n. pag. Web. Table 2, Pre intervention and post intervention values for balance, 10-m timed walk, 2-minute walk tests and Fatigue Scale Score in the 21 subjects with multiple sclerosis (yoga and control groups).