MULTİPL SKLEROZDA EKSENTRİK VE KONSENTRİK EGZERSİZ EĞİTİMİNİN HEMODİNAMİK YANITLAR, FONKSİYONEL KAPASİTE VE YORGUNLUK ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Year 2021, Volume: 32 Issue: 1, 10 - 19, 10.04.2021

Zekiye İpek Katırcı Kırmacı , Tüzün Fırat , Melda Sağlam , Abdurrahman Neyal Ayşe Neyal Nevin Ergun

https://doi.org/10.21653/tjpr.698367

Abstract

Amaç: Çalışmada, Multipl Skleroz (MS) hastalarında eksentrik ve konsentrik egzersiz eğitiminin (EEE ve KEE), hemodinamik yanıtlar, fonksiyonel kapasite ve yorgunluk üzerine etkilerinin karşılaştırılması amaçlandı.
Yöntem: Çalışmaya 22 MS hastası dahil edildi. Hastalar rastgele olarak koşubandında EEE (-% 10 eğimle yokuş aşağı yürüme) ve KEE (+% 10 eğimle yokuş yukarı yürüme) gruplarına ayrıldı. Eğitim, sekiz hafta süre ile 2 gün/hafta ve 30 dakika/gün olarak uygulandı. Her eğitim seansı öncesi ve sonrası oksijen saturasyonu ve hemodinamik yanıtlar ölçüldü ve “double-product” değerleri hesaplandı. Modifiye Borg Skalası (MBS) ile algılanan yorgunluk şiddeti değerlendirildi. Eğitim öncesi ve sonrasında fonksiyonel kapasite altı dakika yürüme testi (6DYT) ile, yorgunluk ise, Yorgunluk Şiddet (YŞÖ) ve Yorgunluk Etki Ölçeği (YEÖ) ile değerlendirildi.
Sonuçlar: EEE grubunda kalp hızı 5., 9., 12., 13. ve 16. seans, sistolik kan basıncı 7. ve 13. seans, diastolik kan basıncı 2., 5., 6., 11., 12. ve 13. seans, “double product” değeri 5., 7., 9., 11., 12., 13., 15., ve 16. seans, oksijen saturasyonu fark değeri 6., ve 8. seanslarda anlamlı olarak daha düşük bulundu (p<0,05). MBS puanı, EEE grubunda 13. seansta anlamlı olarak daha düşüktü (p<0,05). Her iki grupta tedavi sonrasında, 6DYT mesafesinde artış, YŞÖ ve YEÖ’de ise, anlamlı azalma olduğu görüldü (p<0,05). Gruplar arasında eğitim sonrası, 6DYT mesafesi, YŞÖ ve YEÖ değerleri birbirine benzerdi (p>0,05).
Tartışma: MS hastalarında EEE düşük hemodinamik yanıtlar, enerji harcama düzeyleri ve daha az yorgunluk oluşturması açısından avantajlı bir egzersiz türü olabilir. Cinsiyet dağılımının homojen olduğu, ileri çalışmalara ihtiyaç duyulmaktadır.

Keywords

Egzersiz, Hemodinamikler, Multipl Skleroz

Supporting Institution

Yok

A COMPARISON OF THE EFFECTS OF ECCENTRIC AND CONCENTRIC EXERCISE TRAINING ON HEMODYNAMIC RESPONSE, FUNCTIONAL CAPACITY, AND FATIGUE IN PATIENTS WITH MULTIPLE SCLEROSIS

Abstract

Purpose: The aim was to compare the hemodynamic response, functional capacity, and fatigue in
eccentric and concentric exercise training (EET and CET, respectively) in MS.
Methods: Twenty-two patients with MS were included in the study. Individuals were randomly assigned
as EET (downhill walking with -10% slope) and CET (uphill walking with +10% slope) exercise on a
treadmill. The training was applied for eight weeks, 30 min/day, 2 days/week. Hemodynamic responses
were measured, and double-product values were calculated before and after the sessions. Perceived
fatigue was evaluated using the Modified Borg Scale (MBS). Functional capacity was evaluated using
6-minute walk test (6MWT) before and after the training. Fatigue was assessed using Fatigue Severity
Scale (FSS) and Fatigue Impact Scale (FIS).
Results: In the EET group, heart rate at session 5, 9, 12, 13, and 16, systolic blood pressure session 7
and 13, diastolic blood pressure at session 2, 5, 6, 11, 12, and, double product at session 5, 7, 9, 11, 12,
13, 15, and 16, and oxygen saturation session 6 and 8 were found to be significantly lower (p<0.05). In
the EET group, the MBS score was lower at session 13 (p<0.05). In both groups, a significant increase
in 6MWT distance and a significant decrease in FSS and FIS scores were observed (p<0.05). The 6MWT
distance, FSS, and FIS scores were similar between the groups (p>0.05).
Conclusion: The EET may be advantageous since it causes less fatigue due to lower hemodynamic
responses and energy consumption in MS. Further study with homogeneous gender distribution is
needed.

References

• Hayes HA, Gappmaier E, LaStayo PC. Effects of high-intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized controlled trial. Journal of Neurologic Physical Therapy. 2011;35(1):2-10.
• Samaei A, Bakhtiary AH, Hajihasani A, Fatemi E, Motaharinezhad F. Uphill and downhill walking in multiple sclerosis: a randomized controlled trial. International Journal of MS Care. 2016;18(1):34-41.
• Cruickshank TM, Reyes AR, Ziman MR. A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine. 2015;94(4).
• Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe mobility disability: a systematic review and future research directions. Multiple Sclerosis and Related Disorders. 2017;16:31-9.
• Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology. 2017;17(1):185.
• Wens I, Eijnde BO, Hansen D. Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review. Journal of The Neurological Sciences. 2016;367:107-21.
• Andreasen A, Stenager E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Multiple Sclerosis Journal. 2011;17(9):1041-54.
• Ponichtera JA, Rodgers MM, Glaser RM, Mathews TA, Camaione DN. Concentric and eccentric isokinetic lower extremity strength in persons with multiple sclerosis. Journal of Orthopaedic & Sports Physical Therapy. 1992;16(3):114-22.
• Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database of Systematic Reviews. 2015(9).
• Guyton A, Hall J. Heart muscle; the heart as a pump and function of the heart valves. Textbook of Medical Physiology. 2006;11:103-15.
• Froelicher V, Myers J. Exercise and the Heart 5th edition, Philedelphia, PA: Saunders. Elsevier; 2006.
• Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respiratory Soc; 2014.
• Borg GA. Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise. 1982.
• Armutlu K, Korkmaz NC, Keser I, Sumbuloglu V, Akbiyik DI, Guney Z, et al. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. International Journal of Rehabilitation Research. 2007;30(1):81-5.
• Armutlu K, Keser İ, Korkmaz N, Akbıyık Dİ, Sümbüloğlu V, Güney Z, et al. Psychometric study of Turkish version of Fatigue Impact Scale in multiple sclerosis patients. Journal of The Neurological Sciences. 2007;255(1-2):64-8.
• Monteiro Junior RS, Dantas A, de Souza CP, da Silva EB. Acute responses of a physical training session with a Nintendo Wii on hemodynamic variables of an individual with multiple sclerosis. GAMES FOR HEALTH: Research, Development, and Clinical Applications. 2012;1(6):456-9.
• Maciejczyk M, Więcek M, Szymura J, Szyguŀa Z. Comparison of physiological and acid-base balance response during uphill, level and downhill running performed at constant velocity. Acta Physiologica Hungarica. 2013;100(3):347-54.
• Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. The Journal of Physiology. 2001;537(2):333-45.
• Numanoğlu EA. Eksentik Kas Eğitimi ve Kliniğe Uyarlanması. Ed: Karaduman, A., Ülger, Ö., Kılınç, M., Vardar Yağlı, N., Serel, S. Fizyoterapi Seminerleri. Ankara: Pelikan Kitapevi; 2014(1): p. 278-89.
• Simões RP, Mendes RG, Castello V, Machado HG, Almeida LB, Baldissera V, et al. Heart-rate variability and blood-lactate threshold interaction during progressive resistance exercise in healthy older men. The Journal of Strength & Conditioning Research. 2010;24(5):1313-20.
• Huang M, Allen DR, Keller DM, Fadel PJ, Frohman EM, Davis SL. Impaired carotid baroreflex control of arterial blood pressure in multiple sclerosis. Journal of Neurophysiology. 2016;116(1):81-7.
• Huang M, Jay O, Davis SL. Autonomic dysfunction in multiple sclerosis: implications for exercise. Autonomic Neuroscience. 2015;188:82-5.
• Toyomura J, Mori H, Tayashiki K, Yamamoto M, Kanehisa H, Maeo S. Efficacy of downhill running training for improving muscular and aerobic performances. Applied Physiology, Nutrition, and Metabolism. 2018;43(4):403-10.
• Keytsman C, Hansen D, Wens I, O. Eijnde B. Impact of high-intensity concurrent training on cardiovascular risk factors in persons with multiple sclerosis–pilot study. Disability and Rehabilitation. 2019;41(4):430-5.
• Vernillo G, Giandolini M, Edwards WB, Morin J-B, Samozino P, Horvais N, et al. Biomechanics and physiology of uphill and downhill running. Sports Medicine. 2017;47(4):615-29.
• Newman M, Dawes H, Van den Berg M, Wade D, Burridge J, Izadi H. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Multiple Sclerosis Journal. 2007;13(1):113-9.
• Van den Berg M, Dawes H, Wade D, Newman M, Burridge J, Izadi H, et al. Treadmill training for individuals with multiple sclerosis: a pilot randomised trial. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(4):531-3.
• Ayache SS, Chalah MA. Fatigue in multiple sclerosis–insights into evaluation and management. Neurophysiologie Clinique/Clinical Neurophysiology. 2017;47(2):139-71.
• Lollo PC, Moura CS, Morato PN, Amaya-Farfan J. Differential response of heat shock proteins to uphill and downhill exercise in heart, skeletal muscle, lung and kidney tissues. Journal of Sports Science & Medicine. 2013;12(3):461.