Discussion: Exercise and Neurons in Multiple Sclerosis paper

Discussion: Exercise and Neurons in Multiple Sclerosis paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Exercise and Neurons in Multiple Sclerosis paper I want you to write a paper about Exercise and Neurons in Multiple Sclerosis. The paper must be 6-7 double-spaced pages of text), highly focused term paper with at least 10-12 original research articles cited. The paper must include an abstract, a title, brief introduction, a purpose statement, lengthy discussion, and a conclusion also tables. I have already submitted 4 original articles and I want you to find 8 more original articles. Discussion: Exercise and Neurons in Multiple Sclerosis paper this paper would be more like thr qualitative/narrative review The topic is Exercise and Neurons in Multiple Sclerosis effects_of_an_individual_12_week_community_located____start_to_run____program_on_physical_capacity__walking__fatigue__cognitive_function__brain_volumes__and_structures_in_persons__1_.pdf exploring_the_feasibility_of_a_mild_and_short_4_week_combined_upperlimb_and_breathing_exercise_program_as_a_possible_home_base_programto_decrease_fatigue_and_improve_quality___1_.pdf multiple_sclerosis_patients_need_and_want_information_on_exercise_promotion_from_healthcare_providers__a_qualitative_study__1_.pdf walking_training_enhances_corticospinal__1_.pdf 740211 research-article2017 MSJ0010.1177/1352458517740211Multiple Sclerosis JournalP Feys, L Moumdjian MULTIPLE SCLEROSIS JOURNAL MSJ Original Research Paper Effects of an individual 12-week communitylocated “start-to-run” program on physical capacity, walking, fatigue, cognitive function, brain volumes, and structures in persons with multiple sclerosis Multiple Sclerosis Journal Peter Feys, Lousin Moumdjian, Florian Van Halewyck, Inez Wens, Bert O Eijnde, Bart Van Wijmeersch, Veronica Popescu and Paul Van Asch Correspondence to: P Feys Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Life Sciences, Hasselt University, REVAL/ BIOMED, Agoralaan gebouw A, Diepenbeek 3590, Belgium. [email protected] Abstract Background: Exercise therapy studies in persons with multiple sclerosis (pwMS) primarily focused on motor outcomes in mid disease stage, while cognitive function and neural correlates were only limitedly addressed. Objectives: This pragmatic randomized controlled study investigated the effects of a remotely supervised community-located “start-to-run” program on physical and cognitive function, fatigue, quality of life, brain volume, and connectivity. Method: In all, 42 pwMS were randomized to either experimental (EXP) or waiting list control (WLC) group. The EXP group received individualized training instructions during 12 weeks (3×/week), to be performed in their community aiming to participate in a running event. Measures were physical (VO2max, sit-to-stand test, Six-Minute Walk Test (6MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12)) and cognitive function (Rao’s Brief Repeatable Battery (BRB), Paced Auditory Serial Attention Test (PASAT)), fatigue (Fatigue Scale for Motor and Cognitive Function (FSMC)), quality of life (Multiple Sclerosis Impact Scale-29 (MSIS-29)), and imaging. Brain volumes and diffusion tensor imaging (DTI) were quantified using FSL-SIENA/FIRST and FSL-TBSS. Results: In all, 35 pwMS completed the trial. Interaction effects in favor of the EXP group were found for VO2max, sit-to-stand test, MSWS-12, Spatial Recall Test, FSMC, MSIS-29, and pallidum volume. VO2max improved by 1.5 mL/kg/min, MSWS-12 by 4, FSMC by 11, and MSIS-29 by 14 points. The Spatial Recall Test improved by more than 10%. Conclusion: Community-located run training improved aerobic capacity, functional mobility, visuospatial memory, fatigue, and quality of life and pallidum volume in pwMS. Keywords: Multiple sclerosis, running, community, walking, cognitive function, exercise, neuroplasticity Date received: 10 March 2017; revised: 23 September 2017; accepted: 25 September 2017 Introduction Persons with multiple sclerosis (pwMS) have an overall sedentary lifestyle that increases morbidity and cardiovascular risk.1,2 As such, physical training shifted over years for being regarded with caution toward an important part of MS treatment. Exercise therapy and enhanced physical activity were shown not to increase relapse risk rate.3 In fact, exercise therapy, with mainly 92 resistance and endurance training under investigation, leads to important benefits in motor function as muscle strength and walking.4–6 Currently, the impact of exercise on preservation or even restoring neural capacity is under investigation.7–10 2019, Vol. 25(1) 92­–103 DOI: 10.1177/ https://doi.org/10.1177/1352458517740211 1352458517740211 https://doi.org/10.1177/1352458517740211 © The Author(s), 2017. Discussion: Exercise and Neurons in Multiple Sclerosis paper Article reuse guidelines: sagepub.com/journalspermissions Peter Feys Florian Van Halewyck Inez Wens Bert O Eijnde REVAL Rehabilitation Research Center, Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium Lousin Moumdjian REVAL Rehabilitation Research Center, Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium/IPEM Institute for Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium Bart Van Wijmeersch Rehabilitation & MS Centre Overpelt, Overpelt, Belgium/FBI, BIOMED, Faculty of Life Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium Veronica Popescu REVAL Rehabilitation Research Center, Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium/Rehabilitation & MS Centre Overpelt, Overpelt, Belgium Paul Van Asch Fit Up, Physiotherapy Centre, Kontich, Belgium So far, exercise therapy studies in MS predominantly focused on pwMS in the Expanded Disability Status journals.sagepub.com/home/msj P Feys, L Moumdjian et al. Figure 1. Illustration of the experimental design and methods of training supervision. Scale (EDSS) range between 3 and 5.5. However, also pwMS in the early disease phase show reduced aerobic capacity, walking, and jogging functions requiring adapted exercise therapy programs.11–14 Also, nonmotor symptoms such as abnormal fatigue and cognitive impairments occur at an early stage.15,16 An interaction of above-mentioned dysfunctions clearly impacts on quality of life. In this framework, there is emerging interest in investigating whether exercise has impact on fatigue, cognitive function, and quality of life.17–20 12-week running training program with the aim to run 5 km on a public event were compared with a waitlist control group. The primary outcome measures were physical fitness, walking capacity and perceived ability, functional mobility, and quality of life. Secondary outcome measures were fatigue, cognitive function, brain volumes, and structural connectivity. In particular, aerobic capacity is a key feature of health and performance given its associations with muscle strength, walking, fatigue, information processing speed, as well as overall and regional brain volumes such as the thalamus, basal ganglia, and hippocampus.14,21,22 Endurance training was shown to improve aerobic capacity in pwMS,18,23,24 as well as walking, functional mobility, fatigue, and quality of life.4,17,25 The effect of exercise (modality) on type of cognitive symptoms is not yet well understood.18,26 In addition, few studies in MS have investigated exercise effects on neural correlates,9,10,22 despite promising results in the healthy population.27,28 Most studies applied (treadmill) walking or bicycle training.29–31 So far, physical benefits of exercise were mainly demonstrated in studies applying directly supervised interventions.4,6 Unsupervised studies in a home or community setting seemed less effective,6 likely because the prescribed exercise volume and intensity were not fully reached. This advocates for alternative supervision strategies and motivational methods to increase adherence. Participants Adults with MS were recruited through announcements at REVAL rehabilitation research institute (UHasselt), Flemish MS rehabilitation centers and MS Society, and Move-to-Sport. Adults diagnosed with MS were included based on the ability to walk 5 km without rest or use of assistive device. Interested pwMS attended an information session and jointly walked 5 km for verification of their ability. Discussion: Exercise and Neurons in Multiple Sclerosis paper Exclusion criteria were reports to have run 5 km in the preceding 6 months or a relapse occurring in the preceding 3 months. The Medical Ethics Committees of the Jessa Hospital and Hasselt University approved the study. Participants signed an informed consent. This pragmatic randomized controlled trial investigated the multi-dimensional effects of remotely supervised community-located running training in pwMS with mild disability. pwMS who performed a journals.sagepub.com/home/msj Methods Experimental design and intervention Figure 1 illustrates the trial design and training supervision. pwMS were assigned to the experimental (EXP) or the “waiting list control” (WLC) group prior to baseline testing. Both groups shared the goal to run 5 km during a public event. The EXP group ran on 26 April 2015 (Antwerp 10 Miles) and the WLC group on 11 October 2015 (Dwars door Hasselt). Patients were tested at two time points (0 and 12 weeks). The EXP group completed a 12-week gradual “start-torun” program in between time points. The WLC group 93 Multiple Sclerosis Journal 25(1) was offered a comparable training program after the final measurements. (HADS) and the Exercise Self-Efficacy Scale (ESES), respectively.32 pwMS received training instructions by email. They were asked to train three times weekly according to a personalized training intensity schedule that was based on their baseline aerobic capacity. An illustration of a training protocol is provided in supplementary material S1. During the first weeks, training consisted of longer walking bouts, interspersed with short 1? running bouts. The relative amount of running gradually increased until participants were able to run 5 km without interruption at 12 weeks. pwMS wore an activity tracker (Withings Pulse Ox) at the waist that registered the intensity of steps per minute. Participants were asked to weekly upload data to allow remote supervision of the training adherence by the research assistant. If a participant had been inactive, a phone call was made for enquiry. Besides, two group training sessions were organized (weeks 4 and 8) at a 400-m outdoor running track at KULeuven. Participants performed their individual training session simultaneously, while being observed by the project dedicated researcher (MSc exercise physiology and PhD) and master students (rehabilitation sciences and physiotherapy). This allowed to monitor individual progress and discuss potential risk for injuries. In addition, the sessions included elements of education, individual knowledge acquisition also related to observing others, and communication within the context of shared experiences and social interactions. Primary outcomes. Aerobic capacity was assessed on an electronically braked cycle ergometer (eBike Basic®; General Electric GmbH, Bitz, Germany) with continuous pulmonary gas exchange analysis (Oxycon, Erich Jaeger GmbH, Germany), and heart rate (HR) monitoring (Polar®). Oxygen uptake (VO2), expiratory volume, and respiratory exchange ratio were collected breath-by-breath and averaged every minute. Outcome measures and test procedures First, descriptive characteristics and outcomes were registered. After 30? rest, physical tests were performed. Discussion: Exercise and Neurons in Multiple Sclerosis paper Following another 1.5-hour rest, cognitive function tests were performed. Evaluation was performed at REVAL by a study nurse, a PhD student in Rehabilitation Sciences and Physiotherapy, and the project dedicated researcher (MSc in exercise physiology, PhD). Evaluation was standardized by an instruction booklet, composed under supervision of senior researchers and a neuropsychologist, and practiced during tester training sessions preceding the trial. Neural imaging was recorded at UZA (University Hospital Antwerp, in Wilrijk) on another day mostly within 1-week time period. Descriptive outcomes. The MS Functional Composite (MSFC) score consisted of the Nine Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW), and Paced Auditory Serial Attention Test (PASAT). Self-report measures documented mood and self-efficacy applying the Hospital Anxiety and Depression Scale 94 After 10? warming up, participants performed a maximal graded exercise test (75 r/min; female: 20 W + 10 W/min; male: 30 W + 15 W/min) to volitional fatigue. Maximal exercise intensity was expressed in workload (Wmax), HR (HRmax), and aerobic capacity (VO2max; mL/kg/min) at the level of voluntary exhaustion. Walking was determined using the Six-Minute Walk Test (6MWT; m), performed at maximal speed according to instructions of Goldman et al.,33 and the Multiple Sclerosis Walking Scale-12 (MSWS-12; range 0–100).34 The 5-repetition Sit-toStand (5-STS) test evaluated functional strength of the lower limbs and dynamic balance.35 Quality of life was measured by the Multiple Sclerosis Impact Scale29 (MSIS-29).36 Secondary outcomes. The Fatigue Scale for Motor and Cognitive Function (FSMC) documented perceived fatigue.37 For cognitive function, the PASAT and Rao’s Brief Repeatable Battery (BRB) were applied, including the Digit Symbol Substitution Test (DSST), Word List Generation (WLG), Selective Reminding Test (SRT), and the Spatial Recall Test (SPART).38–40 The DSST measured sustained attention and information processing speed by presenting a random sequence of numbers to be complemented with the respective symbol during 120?. The phonemic WLG examined verbal fluency during 15? starting with letters “N,” “A,” or “K.” The SRT assessed longterm memory distinguishing long-term storage (LTS) and consistent long-term retrieval (CLTR). The examiner verbally presented 12 words which the patient had to recall. This was repeated until one could repeat all 12. The SPART is a visuospatial learning and delayed recall test. A checkerboard with seven checkers in specified places was presented during 10?. Immediately after, and after another 30?, the patient was requested to place them back on a blank checkerboard. The total score is a sum of the correct checkers. Brain volume and structural connectivity were analyzed based on three-dimensional (3D)-T1 and journals.sagepub.com/home/msj P Feys, L Moumdjian et al. diffusion tensor imaging (DTI) sequences recorded on a 3-T scanner at UZA (Magnetom Trio Tim; Siemens AG, Erlangen, Germany) using a 32-channel head coil. The percentage brain volume change was calculated on the 3D-T1 images using the FSL software library using SIENA, SIENAX, FIRST, and TBSS all part of FSL.41 Structural connectivity was analyzed with voxelwise statistical analysis of the fractional anisotropy (FA), carried out using TractBased Spatial Statistics.42 Detailed analyses are described in supplementary material S2. Statistical analyses SAS JMP pro11.2 was used for analyses. Baseline descriptive outcomes were compared between groups using an unpaired t-test. Normality was evaluated through visual inspection of a residual quantile plot. Groups were compared by means of a linear mixed model analysis which accounts for fixed and random effects (participants).Discussion: Exercise and Neurons in Multiple Sclerosis paper These models adjust for confounding variables and dropout. Intention-to-treat analysis was performed. The group (EXP–WLC), time (0–12 weeks), and the group × time interaction effects were investigated. Tukey’s post hoc test was applied where appropriate to correct for multiple comparisons. Significance level was set at p <0.05. Results Participants Figure 2 illustrates the participant’s flow. A total of 50 candidates attended an information session, after which eight pwMS were not included: two were not able to walk 5 km without rest or aid, four declined due to the demanding training program, and two pwMS indicated lacking sufficient social support. The 42 remaining participants were randomized prior to baseline testing. During the 12 weeks, seven patients dropped out of the EXP (n = 3) and WLC (n = 4). Reasons were experiencing the combination with work too exhausting, moving to another country in between tests, and encountering subjective discomfort during tests. Baseline characteristics are shown in Table 1. No significant differences between the EXP and WLC group were found except for age and body mass index with the EXP group being younger and having lower weight. Four pwMS (two in each group) were not imaged due to contraindications for magnetic resonance (MR) scanning and logistical reasons. One scan from a participant in each group had to be excluded due to errors in the automated segmentation. Brain images of 15 journals.sagepub.com/home/msj and 14 pwMS in the EXP and WLC groups, respectively, were included. Training adherence and adverse events Participants who completed the training program showed high adherence. The EXP group completed 607 of 648 prescribed sessions (94%). In all, 25 of 41 missed training sessions were related to trainingrelated complaints, such as repetitive strain injury of the ankle (n = 2; 9 sessions), training-related fatigue (n = 2; 7 sessions), hip and groin pain (n = 1; 6 sessions), and calf muscle strain (n = 1; 3 sessions). The remaining missed sessions were caused by external factors such as work, holiday, and flu. One participant missed the first 18 training sessions due to relapserelated hospitalization, while another participant missed first 12 training sessions due to psychosocial problems. Both participants continued training until they completed a full 12 weeks and were then tested. Effects of the training program The results of 12 weeks’ running training versus no training are shown in Table 2 (clinical measures) and Table 3 (MR imaging (MRI) measures). The primary outcomes did not differ between groups at baseline. Significant group × time interactions and post hoc tests showed higher workload (WattageMAX), aerobic capacity (VO2max), and the 5-STS(s) in the EXP group, while no changes occurred in the WLC group. Walking capacity (6MWT) did not change significantly in contrast to a significant group × time interaction effect for the MSWS-12. There was a trend in the EXP group for less impact of MS on walking ability after 12 weeks, while the opposite occurred in the WLC group. A significant group × time interaction effect was found in the physical subscale of the MSIS-29. Post hoc tests revealed a borderline significant reduced impact of MS in the EXP group and no change in the WLC group. A borderline interaction effect was found in the psychological subscale in favor of the EXP group. For the secondary measures, baseline fatigue and cognitive function were not different between groups except for the DSST, with worse performance for the WLC group. The SPART revealed a significant group × time interaction effect with post hoc tests revealing a significant improvement in the EXP group while there was no change in the WLC group. There were no significant effects in any other cognitive test although generally improvements were found in the EXP group.Discussion: Exercise and Neurons in Multiple Sclerosis paper There were significant group × time 95 Multiple Sclerosis Journal 25(1) Figure 2. Participant flowchart according to CONSORT. interaction effects for both the physical and motor domains of the FSMC. Post hoc tests revealed that fatigue was reduced in the EXP group while the WLC group remained unchanged. Brain volumes did not differ between groups at baseline. The whole as well as gray and white matter volumes of the brain did not change significantly. After 12 weeks, a significant group × time interaction effect was found in the left pallidum with post hoc tests revealing an increased volume in the EXP group which was not present in the WLC 96 group. There was no significant change in any groups in structural connectivity. Discussion This pragmatic randomized controlled trial investigated the multi-dimensional effect of 12-week community-located running training in pwMS with mild disability. Participants in the training group adhered well to the remotely supervised program while showing low adverse event rates. Compared to the control group, primary measures such as aerobic capacity, journals.sagepub.com/home/msj P Feys, L Moumdjian et al. Table 1. Descriptive characteristics for the experimental (EXP) and waiting list control (WLC) groups, expressed in mean ± SD (Q1–Q3) except for sex (number). Demographics Age (years) Sex (M/F) Body mass index MS Disease duration (years) MS Functional Composite score T25FW (s) 9HPT Dominant hand (s) 9HPT Non-dominant hand (s) PASAT ESES 0–40 Mood HADS anxiety HADS depression EXP WLC p-Value 36.6 ± 8.5 (19.5–51.3) 1/20 24.0 ± 5.8 (16.6–40.0) 44.4 ± 8.5 (29.2–62.4) 3/18 27.0 ± 3.7 (20.1–32.6) p < 0.01 ns p < 0.05 8.1 ± 6.1 (0.7–19.1) 9.2 ± 5.3 (0.6–21.9) ns 4.1 ± 0.5 (3.4–5.3) 16.0 ± 1.9 (15.1–22.0) 19.2 ± 2.3 (16.1–23.8) 47.8 ± 7.7 (44.2–51.4) 4.0 ± 0.6 (3.1–5.2) 19.3 ± 3.3 (14.3–23.8) 19.9 ± 3.4 (16.0–27.7) 48 ± 11.0 (42.4–53.6) ns ns ns ns … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

RECOMMENDED: Discussion: Exercise and Neurons in Multiple Sclerosis paper