Is Fatigue Associated With Aerobic Capacity and Muscle Strength in People With Multiple Sclerosis: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine the relationship between self-reported fatigue and aerobic capacity and muscle strength in people with multiple sclerosis (MS). DATA SOURCES: Four databases (Cumulative Index to Nursing and Allied Health, MEDLINE, ProQuest, and Web of Science Core Collections) were searched up to October 2018. STUDY SELECTION: Cross-sectional or longitudinal studies that reported the association between self-reported fatigue and aerobic capacity or objectively measured muscle strength in people with MS were included. DATA EXTRACTION: Study details, participant demographics, outcome measurement protocols, and the correlation coefficient derived from the association between fatigue and aerobic capacity or muscle strength at baseline was extracted, and methodological quality of included studies was assessed using the Joanna Briggs Institute Appraisal Checklist for Analytical Cross-sectional Studies. DATA SYNTHESIS: Ten studies were identified, of which 5 examined the association between fatigue and aerobic capacity and 7 examined the association between fatigue and muscle strength. Meta-analysis of the extracted correlation coefficients was performed using the Hedges-Olkin method, and pooled correlation coefficients demonstrated a moderate negative association between fatigue and aerobic capacity (r=-0.471; 95% CI, -0.644 to -0.251; P<.001) and a weak negative association between fatigue and muscle strength (r=-0.224; 95% CI, -0.399 to -0.032; P=.022). CONCLUSIONS: The results of this meta-analysis suggest that higher levels of aerobic capacity are associated with lower fatigue. Therefore, this finding highlights the potential role of aerobic exercise interventions in managing fatigue. Conversely, the relationship between fatigue and muscle strength was weak and inconsistent, and further studies are required to examine the association between these variables.

Effects of locomotor training after incomplete spinal cord injury: a systematic review.

OBJECTIVE: To provide an overview of, and evaluate the current evidence on, locomotor training approaches for gait rehabilitation in individuals with incomplete spinal cord injury to identify the most effective therapies. DATA SOURCES: The following electronic databases were searched systematically from first date of publication until May 2013: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, MEDLINE, Physiotherapy Evidence Database, and PubMed. References of relevant clinical trials and systematic reviews were also hand searched. STUDY SELECTION: Only randomized controlled trials evaluating locomotor therapies after incomplete spinal cord injury in an adult population were included. Full-text versions of all relevant articles were selected and evaluated by both authors. DATA EXTRACTION: Eligible studies were identified, and methodologic quality was assessed with the Physiotherapy Evidence Database scale. Articles scoring <4 points on the scale were excluded. Sample population, interventions, outcome measures, and findings were evaluated with regard to walking capacity, velocity, duration, and quality of gait. DATA SYNTHESIS: Data were analyzed by systematic comparison of findings. Eight articles were included in this review. Five compared body-weight-supported treadmill training (BWSTT) or robotic-assisted BWSTT with conventional gait training in acute/subacute subjects (≤1y postinjury). The remaining studies each compared 3 or 4 different locomotor interventions in chronic participants (>1y postinjury). Sample sizes were small, and study designs differed considerably impeding comparison. Only minor differences in outcomes measures were found between groups. Gait parameters improved slightly more after BWSTT and robotic gait training for acute participants. For chronic participants, improvements were greater after BWSTT with functional electrical stimulation and overground training with functional electrical stimulation/body-weight support compared with BWSTT with manual assistance, robotic gait training, or conventional physiotherapy. CONCLUSIONS: Evidence on the effectiveness of locomotor therapy is limited. All approaches show some potential for improvement of ambulatory function without superiority of 1 approach over another. More research on this topic is required.

Oxygen Cost of Walking in People With Multiple Sclerosis and Its Association With Fatigue: A Systematic Review and Meta-analysis.

Background: This systematic review and meta-analysis aimed to compare the oxygen cost of walking in individuals with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in individuals with MS. Methods: Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Studies were included if they recruited adults with MS and either compared oxygen cost of walking in those with MS and a control population or determined the relationship between oxygen cost of walking and fatigue. Meta-analysis of the standardized mean difference in oxygen cost of walking between individuals with MS and controls was performed. Results: Nine studies were included in this review, of which 7 compared oxygen cost of walking in individuals with MS (n = 176) and controls (n = 142) and 4 investigated the relationship between oxygen cost of walking and fatigue. Meta-analysis revealed that individuals with MS (with predominantly mild-to-moderate disability) had a significantly higher oxygen cost of walking compared with controls (standardized mean difference = 2.21, 95% CI = 0.88 to 3.54, P = .001). In addition, 3 studies found a significant yet weak positive association between oxygen cost of walking and fatigue. Conclusions: Individuals with MS expend more energy when walking compared with controls. This increase in energy expenditure may contribute to the development of fatigue, as some studies found that higher oxygen costs of walking were associated with greater fatigue. Future studies should investigate whether reducing energy expenditure during movement improves fatigue.

Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique.

Background: Multiple sclerosis (MS) is a chronic, progressive neurological condition. The aim of this study was to explore consensus on the barriers and solutions to exercise for people with MS living in Scotland.Method: Thirty-five people with MS, not regularly exercising, were recruited and took part in five Nominal Group Technique groups throughout Scotland. Background information was collected on participants prior to each group. Participants individually and silently listed their barriers and solutions to participating in exercise. Group discussion then clarified, amended and merged ideas. Participants then ranked ideas by choosing five barriers and solutions to exercise participation. Data were analyzed using descriptive statistics and by carrying out a thematic grouping.Results: Consensus was that fatigue was a barrier to exercise participation . Other identified barriers were a lack of support and advice, the impairments arising from the condition and time. No single item achieved consensus for solutions but exercising with others, receiving support, having a positive attitude, finding time and minimizing environmental barriers were all suggested as solutions to assist in exercise participation.Conclusions: People with MS should be provided with information on how to manage their fatigue alongside any exercise prescription. Information and support should be given on how to personalize exercise to suit individual needs and abilities to overcome some of the barriers suggested within this study.Implications for rehabilitationMore exercise opportunities are required.Exercise should be personalized to address the individual needs of the person with MS.Any identified barriers to exercise should be addressed.

Effectiveness of Fatigue Management Interventions in Reducing Severity and Impact of Fatigue in People with Progressive Multiple Sclerosis: A Systematic Review.

BACKGROUND: Rehabilitation interventions are recommended to manage multiple sclerosis (MS)-related fatigue. However, existing research has largely been generalized to those with relapsing-remitting MS, making it difficult to determine the effectiveness of these interventions in people with progressive MS. Therefore, this study aimed to systematically review the evidence related to the effectiveness of fatigue management interventions in reducing the severity and impact of fatigue in people with progressive MS. METHODS: Six electronic databases (CINAHL, Cochrane Library, MEDLINE, PEDro, ProQuest, and Web of Science Core Collections) were searched for relevant articles up until November 2017. Randomized controlled trials and quasi-experimental studies that examined the effects of exercise, behavioral interventions, and rehabilitation on fatigue in people with progressive MS using self-reported fatigue outcome measures were included in this review. RESULTS: Eight exercise, two rehabilitation, and two behavioral interventions were investigated in the 13 articles included in this review. Heterogeneous effects were reported between studies, with only two exercise, one behavioral, and two rehabilitation interventions recording significant improvements in postintervention fatigue severity or impact. However, most studies were underpowered, only two used fatigue as the primary outcome, and only one specifically recruited participants with predefined levels of fatigue. CONCLUSIONS: Evidence from this review is inconclusive regarding the effectiveness of nonpharmacologic interventions in reducing the severity and impact of fatigue in progressive MS populations. Adequately powered randomized controlled trials are required to evaluate fatigue management interventions in people with progressive MS experiencing high levels of fatigue and using fatigue as the primary outcome.

Prevalence of fatigue and its association with clinical features in progressive and non-progressive forms of Multiple Sclerosis.

BACKGROUND: Fatigue is a complex and disabling symptom of Multiple Sclerosis (MS); however, there is conflicting evidence of the relationship between fatigue and clinical features of MS. Furthermore, few studies have considered these relationships specifically in a progressive MS population. AIMS: (1) estimate the prevalence of self-reported fatigue in people with MS; (2) evaluate the relationship between fatigue severity/impact and clinical features of MS; (3) compare the prevalence of fatigue, and the strength of relationship between fatigue severity/impact and clinical features of MS in progressive and non-progressive forms of MS. METHODS: An online survey was conducted to measure the severity (Fatigue Severity Scale (FSS)) and impact of self-reported fatigue (Modified Fatigue Impact Scale) in people with MS. The survey also contained questionnaires related to disability, quality of life, MS impact, anxiety and depression, cognition, and sleep quality. RESULTS: 412 people responded to the survey, of which 68.7% reported having fatigue (FSS ≥ 5). The prevalence of fatigue was significantly higher in participants with progressive MS (81%) in comparison to those with non-progressive forms of MS (64%, p = 0.01). Fatigue severity and impact were associated with quality of life, MS impact, anxiety, depression, cognition, and sleep quality in both progressive and non-progressive MS populations (p < 0.05). However, fatigue severity (r = 0.335) and impact (r = 0.391) were correlated with disability only in participants with non-progressive MS. CONCLUSION: Fatigue was more prevalent amongst participants with progressive MS. In addition, higher fatigue severity and impact were associated with greater physical, cognitive, and psychological impairment, although the strength of association between these outcomes was generally similar regardless of the type of MS.