Combined endurance and resistance training in women with multiple sclerosis, strength, fatigue and psychological responses: a randomized controlled trial.

Background and Purpose Persons with multiple sclerosis (MS) suffer from strength deficit and muscle mass reduction as expression of central motor areas/pathways demyelization lesions that are implicated in motor function. The loss of function and inactivity lead to a reduction of the work and daily activity, which is frequently associated with depression and other psychological diseases leading to a decline of the quality of life. First aim of this study was to evaluate the effects of a 12-week endurance and strength combined program training on maximal strength, functional capacities and fatigue in women with multiple sclerosis. Therefore, secondary aim was to study the quality of life and psychological outcomes of the participants after the training. Methods Sixteen women with MS (mean age 46±7.2; EDSS 2.25±0.85) were randomized to either a combined training (COM) or waitlist group (WTL). All the participants performed 8 physical tests: body composition with bioelectrical impedance analysis, flexibility with Sit and Reach test (S&R), isometric strength with Handgrip test (HG), maximum dynamic strength with 1 Repetition Max test (1RM) for Legs, Chest and Back, Maximal Voluntary Isometric Contraction (MVIC) with Muscle Lab© force sensor for legs and VO2peak with an incremental test on a cycle-ergometer. Fatigue was measured with MFIS-21 questionnaire, Quality of life (QoL) with MSQOL-54, psychological condition with SCL-90 and depression with BDI-2. The tests were performed at baseline (T0), after 12 weeks (T1), at the end of the combined protocol for WTL and follow-up for COM (T2) and after 12 weeks from the end of intervention for WTL (T3). The COM group performed 2 times a week for 12 weeks a protocol of supervised combined training. The WTL group began the same combined training intervention, after a 12-week period of habitual lifestyle. Every session lasted 60 minutes and was structured by 3 resistance exercises for body portions (lower, high portion and torso) and 20 minutes of High Intensity Interval Training (HIIT) endurance training. Results At the end of the training MVIC improved (+113.4; p=.002; Nm), similarly 1RM increased significantly in Leg Extension and Chest Press (+13.8; p=.001; +6.6; p=.002; Kg). VO2peak increased from 17.5±4.67 to 22±5.93 (p=.02; ml/kg/min). Fatigue decreased significantly in all subscales (Physical -9; p=.003, Cognitive -5; p=.02, Psychosocial -2; p=.005) and depression symptom enhanced from 15.6 to 10.3 points (p<.001) and Quality of life improved significantly in cognitive function (p=.01) and physical health (p=.005). Discussion and Conclusion 12 weeks of combined endurance and resistance training increased strength and oxygen consumption in people with MS. The training was also effective to reduce fatigue and depression and to enhance quality of life. A tailored and supervised training should be recommended to people with MS because is safe and effective way of improving fitness in people with MS. Keywords: Multiple Sclerosis, Combined Training, Strength, Fatigue, Depression.