The Effects of Trunk Stabilization and Aerobic Trainings in Multiple Sclerosis
Condition: Physical Therapy
MeSH terms: Multiple Sclerosis
Study type: Interventional

Summary: 
      Balance requires many central nervous system controlled functions, and most or all of these
      functions can be affected by MS, so balance is very often impaired in patients with MS. Core
      stability is also decreased in patients with MS. Core stability is among the most important
      factors that ensure the balance and walking of the participants in different environments and
      conditions during functional activities. In addition to core muscle activity, lower extremity
      muscle strength and endurance decrease due to the influence of central nervous system and
      decrease in physical activity. Functional exercise capacity also decreases due to the
      influence of the central nervous system and the decrease in physical activity in patients
      with MS.

      Despite all these symptoms and the benefits of exercise training, unfortunately, most MS
      patients are physically inactive, which can initiate a cycle of deconditioning and worsening
      of symptoms. In the literature, the combined effects of aerobic training and resistance
      training have been examined, and it has been stated that combining these two trainings will
      increase the effectiveness on symptoms. In recent years, trunk stabilization training has
      started to be included in physiotherapy and rehabilitation programs as an alternative method
      in patients with MS, based on the knowledge that core stability is effective on many
      functions and symptoms, as well as aerobic and resistance training. Considering that combined
      training practices are more effective in reducing symptoms, the investigators think that
      aerobic training and trunk stabilization training may be more effective in reducing symptoms
      in patients with MS when applied in combination. In addition, when all these studies were
      examined, the subtypes of MS patients included in the studies were generally not specified.
      The effects of these trainings on balance, core stability lower extremity muscle strength and
      endurance, and functional exercise capacity have not been demonstrated in patients with
      relapsing remitting MS (RR-MS), the most common type of MS disease. Therefore, the aim of
      this study is to examine the effects of trunk stabilization training combined with aerobic
      training on balance, core stability, lower extremity muscle strength and endurance, and
      functional exercise capacity in patients with RR-MS.
    

Detailed description: 
      This study was carried out with the purpose of examining the effects of trunk stabilization
      training combined with aerobic training on balance, core stability, lower extremity muscle
      strength and endurance, and functional exercise capacity in patients with RR-MS.

      A total of 20 patients, 10 in each group, were included in the study. Both the combined
      exercise group and the control group performed 30 minutes of aerobic training. The combined
      exercise group also received trunk stabilization training after a 10-minute resting period.
      Both groups received treatment 2 times a week for 8 weeks (in total 16 sessions). The static
      and dynamic balance were measured using the posturography (Biodex Balance System SDTM) with
      Postural Stability Test and Limits of Stability Test. Core stability was assessed by core
      endurance tests using the McGill protocol. Core endurance tests used are flexion endurance
      test, extension endurance test, and right and left lateral bridge tests. The lower extremity
      muscle strength and endurance of the patients were determined by evaluating the strength and
      endurance of the knee flexor and extensor muscles at angular velocities of 60º/sec and
      180º/sec. Evaluations were made using the Biodex System 4 (Biodex Corp, Shirley, NY, USA)
      isokinetic dynamometer. Functional exercise capacity was assessed using the 6-Minute Walking
      Test (6-MWT) according to criteria set by the American Thoracic Society.
    

Intervention name(s): Combined exercise training; Aerobic training
Intervention type(s): Other; Other
Intervention description(s): Combined exercise group (CEG) performed 30 minutes of aerobic training and also received trunk stabilization training in about 30 minutes after a 10-minute resting period. CEG received treatment 2 times a week for 8 weeks. During trunk stabilization training, the participants were taught how to contract the transversus abdominis and multifidus muscles. Due to the progression protocol, endurance levels of trunk muscles were increased by holding each posture for longer periods. The training was started with theraband resistance, which could be repeated between 10-12 repetitions, and the repetition time was increased up to 20. Aerobic training (AT) was given using a treadmill. A heart rate monitor (Polar V800™, Finland) was used by each patient to follow heart rates during the AT. During AT, the target heart rate was calculated as 60-80% of maximum heart rates (MHR). Each exercise session consisted of a 5-minutes warm-up, 20 minutes of walking, and 5 minutes cool down on the treadmill.; Control group (CG) performed 30 minutes of aerobic training.CG received treatment 2 times a week for 8 weeks. Aerobic training (AT) was given using a treadmill. A heart rate monitor (Polar V800™, Finland) was used by each patient to follow their heart rates during the AT. During AT, the target heart rate was calculated as 60-80% of maximum heart rates (MHR). Each exercise session consisted of a 5-minutes warm-up, 20 minutes of walking, and 5 minutes cool down on the treadmill.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: balance; strength; endurance; stability; exercise