Abstract
Background
Moderate endurance training leads to a significant improvement of aerobic fitness and fatigue in patients with multiple sclerosis (MS). However, the effects of high-intensity interval training (HIIT) have not systematically investigated.
Aim
To determine the effects of short-term HIIT on aerobic fitness and fatigue in MS patients.
Design
Prospective monocentric, randomized, simple blinded cohort study.
Settings
Participants exercised for 8 weeks on a bicycle ergometer three times weekly for 8 weeks.
Population
Forty patients with relapsing–remitting MS and an extended disability status score (EDSS) of < 3.5 participated.
Methods
For 8 weeks, participants exercised three times weekly for 30 min according to two different protocols (HIIT versus moderate endurance training). Measurements were taken at baseline and after 8 weeks of training. Individual aerobic fitness (VO2peak) was assessed via a stepwise ramp protocol, fatigue by the Fatigue Severity Scale (FSS), and ambulation was measured by the Timed 25-Foot Walk Test (T25-FW). Data were analysed according to the intention-to-treat (ITT) approach.
Results
Aerobic fitness increased significantly in the HIIT group (pre: 26.7 ± 6.1, post: 29.7 ± 6.6 ml/min/kg; p < 0.04). No changes with regard to FSS and T25FW were detected in both groups. However, sub-group analysis revealed a significant decrease of fatigue in patients with elevated baseline fatigue (pre: 5.00 ± 0.7, post: 4.7 ± 1.2; p = 0.03).
Conclusions
HIIT is a promising time-efficient approach in subjects with MS leading to rapid improvement of aerobic fitness.
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Abbreviations
- HIIT:
-
High-intensity interval training
- MS:
-
Multiple sclerosis
- EDSS:
-
Extended disability status score
- FSS:
-
Fatigue Severity Scale
- T25-FW:
-
Timed 25-foot walk Test
- ITT:
-
Intention-to-treat
- VO2max:
-
Maximum aerobic capacity
- MT:
-
Moderate training
References
Klaren RE, Motl RW, Dlugonski D et al (2013) Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil 94(12):2342–2348. https://doi.org/10.1016/j.apmr.2013.07.011
Sandroff BM, Dlugonski D, Weikert M et al (2012) Physical activity and multiple sclerosis: new insights regarding inactivity. Acta Neurol Scand 126(4):256–262. https://doi.org/10.1111/j.1600-0404.2011.01634.x
Béthoux F (2006) Fatigue et sclérose en plaques. Annales de Réadaptation et de Médecine Physique 49(6): 265–271. https://doi.org/10.1016/j.annrmp.2006.04.023
Kayes NM, McPherson KM, Taylor D et al (2011) Facilitators and barriers to engagement in physical activity for people with multiple sclerosis: a qualitative investigation. Disabil Rehabil 33(8):625–642. https://doi.org/10.3109/09638288.2010.505992
Motl RW, Pilutti LA (2012) The benefits of exercise training in multiple sclerosis. Nat Rev Neurol 8(9):487–497. https://doi.org/10.1038/nrneurol.2012.136
Pilutti LA, Greenlee TA, Motl RW et al (2013) Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis. Psychosom Med 75(6):575–580. https://doi.org/10.1097/PSY.0b013e31829b4525
Bjarnadottir OH, Konradsdottir AD, Reynisdottir K et al (2007) Multiple sclerosis and brief moderate exercise. A randomised study. Mult Scler 13(6):776–782. https://doi.org/10.1177/1352458506073780
Petajan JH, Gappmaier E, White AT et al (1996) Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 39(4):432–441. https://doi.org/10.1002/ana.410390405
Ponichtera-Mulcare JA (1993) Exercise and multiple sclerosis. Med Sci Sports Exerc 25(4):451–465
Rampello A, Franceschini M, Piepoli M et al (2007) Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized crossover controlled study. Phys Ther 87(5):545–555. https://doi.org/10.2522/ptj.20060085
Schmidt S, Wonneberger M (2014) Long-term endurance exercise improves aerobic capacity in patients with relapsing-remitting multiple sclerosis: impact of baseline fatigue. J Neurol Sci 336(1–2):29–35. https://doi.org/10.1016/j.jns.2013.09.035
Gormley SE, Swain DP, High R et al (2008) Effect of intensity of aerobic training on VO2max. Med Sci Sports Exerc 40(7):1336–1343. https://doi.org/10.1249/MSS.0b013e31816c4839
Helgerud J, Høydal K, Wang E et al (2007) Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39(4):665–671. https://doi.org/10.1249/mss.0b013e3180304570
Shiraev T, Barclay G (2012) Evidence based exercise—clinical benefits of high intensity interval training. Aust Fam Physician 41(12):960–962
Campbell E, Coulter EH, Paul L (2018) High intensity interval training for people with multiple sclerosis: a systematic review. Mult Scler Relat Disord 24:55–63. https://doi.org/10.1016/j.msard.2018.06.005
Wens I, Dalgas U, Vandenabeele F et al (2015) High intensity exercise in multiple sclerosis: effects on muscle contractile characteristics and exercise capacity, a randomised controlled trial. PLoS One 10(9):e0133697. https://doi.org/10.1371/journal.pone.0133697
Collett J, Dawes H, Meaney A et al (2011) Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities. Mult Scler J 17(5):594–603. https://doi.org/10.1177/1352458510391836
Ross LM, Porter RR, Durstine JL (2016) High-intensity interval training (HIIT) for patients with chronic diseases. J Sport Health Sci 5(2):139–144. https://doi.org/10.1016/j.jshs.2016.04.005
Liou K, Ho S, Fildes J et al (2016) High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart Lung Circ 25(2):166–174. https://doi.org/10.1016/j.hlc.2015.06.828
Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302. https://doi.org/10.1002/ana.22366
Fletcher GF, Balady GJ, Amsterdam EA et al (2001) Exercise standards for testing and training: a statement for healthcare professionals From the American Heart Association. Circulation 104(14):1694–1740. https://doi.org/10.1161/hc3901.095960
Appell H-J (2002) Lehrbuch der Sportmedizin, Unveränd. Nachdr. Dt. Ärzte-Verl., Köln
Wonisch M, Hofmann P, Pokan R et al (2003) Spiroergometrie in der Kardiologie—Grundlagen der Physiologie und Terminologie. Journal für Kardiologie 10(9):383–390
Krupp LB, LaRocca NG, Muir-Nash J et al (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123
Whitehead L (2009) The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 37(1):107–128. https://doi.org/10.1016/j.jpainsymman.2007.08.019
Polman CH, Rudick RA (2010) The multiple sclerosis functional composite: a clinically meaningful measure of disability. Neurology 74 (Suppl 3):S8–S15. https://doi.org/10.1212/WNL.0b013e3181dbb571
Motl RW, Cohen JA, Benedict R et al (2017) Validity of the timed 25-foot walk as an ambulatory performance outcome measure for multiple sclerosis. Mult Scler 23(5):704–710. https://doi.org/10.1177/1352458517690823
Lerdal A, Wahl A, Rustøen T et al (2005) Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health 33(2):123–130. https://doi.org/10.1080/14034940410028406
Rosti-Otajärvi E, Hämäläinen P, Wiksten A et al (2017) Validity and reliability of the fatigue severity scale in finnish multiple sclerosis patients. Brain Behav 7(7):e00743. https://doi.org/10.1002/brb3.743
Bühner M, Ziegler M (2009) Statistik für Psychologen und Sozialwissenschaftler. Pearson Studium, München
Rost R (2005) Sport- und Bewegungstherapie bei Inneren Krankheiten: Lehrbuch für Sportlehrer, Übungsleiter, Physiotherapeuten und Sportmediziner, 3. Aufl. komplett überarb. und erw. von B. Bjarnason-Wehrens (and others). Deutscher Ärzte-Verlag, Köln
Weston KS, Wisloff U, Coombes JS (2014) High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med 48(16):1227–1234. https://doi.org/10.1136/bjsports-2013-092576
Koufaki P, Mercer TH, George KP et al (2014) Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. J Rehabil Med 46(4):348–356. https://doi.org/10.2340/16501977-1278
Langeskov-Christensen M, Heine M, Kwakkel G et al (2015) Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports Med 45(6):905–923. https://doi.org/10.1007/s40279-015-0307-x
Wonneberger M, Schmidt S (2015) Changes of gait parameters following long-term aerobic endurance exercise in mildly disabled multiple sclerosis patients: an exploratory study. Eur J Phys Rehabil Med 51(6):755–762
Kodama S, Saito K, Tanaka S et al (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301(19):2024–2035. https://doi.org/10.1001/jama.2009.681
Marrie R, Horwitz R, Cutter G et al (2009) High frequency of adverse health behaviors in multiple sclerosis. Mult Scler 15(1):105–113. https://doi.org/10.1177/1352458508096680
Marrie R, Horwitz R, Cutter G et al (2008) Comorbidity, socioeconomic status and multiple sclerosis. Mult Scler 14(8):1091–1098. https://doi.org/10.1177/1352458508092263
Heine M, Wens I, Langeskov-Christensen M et al (2016) Cardiopulmonary fitness is related to disease severity in multiple sclerosis. Mult Scler 22(2):231–238. https://doi.org/10.1177/1352458515581437
Andreasen A, Stenager E, Dalgas U (2011) The effect of exercise therapy on fatigue in multiple sclerosis. Mult Scler J 17(9):1041–1054. https://doi.org/10.1177/1352458511401120
Heine M, Verschuren O, Hoogervorst ELJ et al (2017) Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial. Mult Scler 23(11):1517–1526. https://doi.org/10.1177/1352458517696596
Heine M, van de Port I, Rietberg MB et al (2015) Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 9:CD009956. https://doi.org/10.1002/14651858.CD009956.pub2
Langeskov-Christensen M, Bisson EJ, Finlayson ML et al (2017) Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: A scoping review. J Neurol Sci 373:307–320. https://doi.org/10.1016/j.jns.2017.01.002
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This study was supported by a research grant from Bayer Vital (Grant PB05). The sponsor has neither taken influence on the preparation of the article nor on the collection, analysis, and interpretation of data.
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Both authors have received compensations from Bayer Vital for lecturing. S.Schmidt has also served on advisory boards for Bayer Vital.
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All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Deutsche Sporthochschule, Cologne, Germany.
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Wonneberger, M., Schmidt, S. High-intensity interval ergometer training improves aerobic capacity and fatigue in patients with multiple sclerosis. Sport Sci Health 15, 559–567 (2019). https://doi.org/10.1007/s11332-019-00545-1
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DOI: https://doi.org/10.1007/s11332-019-00545-1