Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study
Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study
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DOI：
10.1186/s12883-020-1611-0
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发表时间：
2020-01-22
期刊：
影响因子：
2.6
通讯作者：
Ploughman, Michelle
中科院分区：
文献类型：
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作者：
Devasahayam, Augustine J.;Chaves, Arthur R.;Ploughman, Michelle
在多发性硬化症（MS）患者中，有氧训练具有恢复功能、刺激大脑修复和减少炎症的潜力。然而，残疾、疲劳和热敏是ms患者运动的主要障碍。我们的目的是确定在冷却至16摄氏度的房间中进行高强度的跑步机训练的可行性（10周；3次/周），并检查使用动态辅助设备的患者对功能标志物、脑修复和炎症的长期影响。方法10名参与者（9名女性），年龄29 ~ 74岁，残疾状态扩展量表6 ~ 7分，以80%自选步行速度开始训练（心率储备40% ~ 65%）。采用检查表评估进行高强度训练的可行性，包括出勤率、错过次数、不参加的原因、不良事件、训练期间的安全隐患、退出的原因、对训练负荷的耐受性、运动期间和运动后症状恶化的主观报告以及对运动的生理反应。在训练前、训练后和训练后3个月评估功能结果。步行能力是通过计时25英尺步行测试和在仪器人行道上以快速和自行选择的速度进行测量的。采用SF-36单项健康调查疲劳/能量/活力子量表、疲劳严重程度量表、修正疲劳影响量表对疲劳进行测量。采用最大分级运动试验（GXT）测定有氧适能（最大耗氧量）。生活质量采用SF-36健康调查进行测量。测定GXT前后血清神经营养因子（脑源性神经营养因子）和细胞因子（白细胞介素-6）水平。结果10名参与者中有8人完成了培训（出勤率>= 80%）。未观察到不良事件。训练后快速步行速度（cm/s）、自选速度步行时的步态质量（双支撑（%））、疲劳（修正疲劳影响量表）、体能（GXT期间达到的最大工作量）和生活质量（SF-36身体功能量表）显著改善，并在3个月后持续改善。适应度的提高（GXT期间最大呼吸交换比和最大耗氧量）与脑源性神经营养因子的增加和白细胞介素-6的降低有关。结论高强度的冷房训练是可行的，可以潜在地改善中度至重度ms相关残疾患者的行走、疲劳、健康和生活质量。
Background Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16 degrees C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids. Methods Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. Results Eight of the ten participants completed training (attendance rates >= 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. Conclusion Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.