Over-the-counter anti-oxidant therapies for use in multiple sclerosis: A systematic review.

BACKGROUND: Anti-oxidant compounds that are found in over-the-counter (OTC) supplements and foods are gaining interest as treatments for multiple sclerosis (MS). They are widely used by patients, sometimes without a clear evidence base. OBJECTIVE: We conducted a systematic review of animal and clinical research to determine the evidence for the benefits of OTC anti-oxidants in MS. METHODS: Using predefined criteria, we searched key databases. Two authors scrutinized all studies against inclusion/exclusion criteria, assessed study risk-of-bias and extracted results. RESULTS: Of the 3507 titles, 145 met criteria and included compounds, α(alpha)-lipoic acid (ALA), anti-oxidant vitamins, Ginkgo biloba, quercetin, resveratrol and epigallocatechin-3-gallate (ECGC). The strongest evidence to support OTC anti-oxidants was for compounds EGCG and ALA in animal models; both consistently showed anti-inflammatory/anti-oxidant effects and reduced neurological impairment. Only vitamin E, Ginkgo biloba and ALA were examined for efficacy in pilot clinical trials with either conflicting evidence or evidence of no benefit. CONCLUSION: OTC anti-oxidants EGCG and ALA show the most consistent benefit, however only in preclinical studies. There is no evidence that they alter MS relapses or progression. Future work should focus on testing more of these therapies for clinical efficacy before recommending them to MS patients.

Corticospinal excitability, assessed through stimulus response curves, is phase-, task-, and muscle-dependent during arm cycling.

The purpose of the present study was to examine corticospinal excitability to the biceps and triceps brachii during arm cycling and an intensity-matched tonic contraction using stimulus response curves (SRCs) elicited via transcranial magnetic stimulation (TMS). Corticospinal excitability was assessed using TMS elicited motor-evoked potentials (MEPs) at eight different stimulation intensities (85-190% of MEP threshold). MEPs were recorded during arm cycling at two different positions, mid-elbow flexion (6 o'clock relative to a clock face) and mid-elbow extension (12 o'clock relative to a clock face), in addition to an intensity-matched (12 o'clock) tonic contraction. At the 12 o'clock position, the slope of the SRC was significantly lower during arm cycling than the tonic contraction for the biceps brachii (Cycling: 0.64 ± 0.47, Tonic: 1.02 ± 0.38, P < 0.05) but was not different for the triceps brachii (Cycling: 1.33 ± 0.49, Tonic: 1.48 ± 0.43, P = 0.42). Within arm cycling, the SRC slope was significantly greater at the 6 o'clock position than 12 o'clock position for the biceps brachii (6 o'clock: 1.37 ± 0.24, 12 o'clock: 0.64 ± 0.47, P < 0.05) but was not different for the triceps brachii (6 o'clock: 1.11 ± 0.28, 12 o'clock: 1.33 ± 0.49, P = 0.34). These findings demonstrate that corticospinal excitability to the biceps brachii is task-dependent during the extension phase of arm cycling. Neither position nor task influenced corticospinal excitability to the triceps brachii, providing further support that the motor control of locomotor outputs is muscle-specific.

Upper and lower body responses to repeated cyclical sprints.

PURPOSE: To compare the physiological and perceptual responses of the upper and lower body to all-out cyclical sprints with short or long rest periods between sprints. METHODS: Ten recreationally trained males completed four 10 × 10 s sprint protocols in a randomized order: upper body with 30 s and 180 s of rest between sprints, and lower body with 30 s and 180 s of rest between sprints. Additionally, maximum voluntary contractions (MVC) were measured at pre-sprint and post-sprints 5 and 10. Normalized (% of first sprint) peak power, MVC, heart rate (HR) and rating of perceived exertion (RPE) were compared between upper and lower body within the same recovery period, and absolute values (Watts, bpm, RPE scores) were compared within the same body part and between recovery periods. RESULTS: Trivial differences were identified in normalized peak power, HR and RPE values between the upper and lower body in both recovery conditions (<2%, d ≤ 0.1), but MVC forces were better maintained with the upper body (∼9.5%, d = 1.0) in both recovery conditions. Absolute peak power was lower (∼147 Watts, d = 1.3), and HR was higher (∼10 bpm, d = 0.73) in the 30 s compared to 180 s condition in both the upper and lower body whereas RPE scores were similar (<0.6 RPE units, d ≤ 0.1). Despite the reductions in peak power, MVC forces were better maintained in the 30 s condition in both upper (2.5 kg, d = 0.4) and lower (7.5 kg, d = 0.7) body. CONCLUSIONS: Completing a commonly used repeated sprint protocol with the upper and lower body results in comparable normalized physiological and perceptual responses.

Women's and Men's Differing Experiences of Health, Lifestyle, and Aging with Multiple Sclerosis.

BACKGROUND: The growing population of older people with multiple sclerosis (MS) has led to more interest in understanding factors associated with healthy aging. We aimed to determine whether older women and men with MS have different health and lifestyle behaviors and whether there are sex differences in contributors to perceived health. METHODS: Data were obtained from a postal survey involving 743 Canadians older than 55 years with MS for at least 20 years. Sex differences in health, lifestyle, mood, and socioeconomics were examined using analysis of variance. Multiple regression was used to build explanatory models of health perception. RESULTS: Despite no differences in age, years with MS, disability, fatigue, or social support, older men (n = 166) experienced lower perceived health and lower resilience and participated less in life roles than older women (n = 577). Men experienced more depressive symptoms, and women reported more anxiety. Depression was the strongest predictor of health perception in both women and men (ß = -2.40 and -5.19, respectively, for each 3-point increase in depressive symptoms). Other contributors included household participation, fatigue, resilience, and disability in women and physical activity, financial flexibility, and alcohol use in men. CONCLUSIONS: Older men exhibit poorer adaptation to aging with MS than older women.

Repeated sprint ability but not neuromuscular fatigue is dependent on short versus long duration recovery time between sprints in healthy males.

OBJECTIVES: During maximal intensity leg cycling sprints, previous research has shown that central and peripheral fatigue development occurs with various (<30s) short-duration recovery periods between sprints. The aim of the current study was to compare the development of neuromuscular fatigue during maximal intensity lower-body sprints interspersed with short and longer duration recovery periods. DESIGN: Crossover study. METHODS: Ten participants completed 10, 10s sprints interspersed with either 30 or 180s of recovery. Peak power outputs were measured for each sprint. Maximal force, voluntary activation (VA) and evoked contractile properties of the knee extensors were measured at pre-sprint 1, post-sprint 5 and post-sprint 10. Perceived pain was also measured immediately following each sprint. RESULTS: Peak power output was significantly lower by 16.1±4.2% (p<0.001) during sprint 10 with 30 compared to 180s of recovery. Irrespective of recovery time, maximal force, VA and potentiated twitch force decreased by 26.7±7.2% (p<0.005), 5.8±1.2% (p=0.025), 38.7±6.1% (p=0.003) respectively, from pre-sprint 1 to post-sprint 10. MVC and PT decreased by 17±4% (p<0.003) and 23±9% (p<0.002) respectively, from pre-sprint 1 to post-sprint 5. CONCLUSIONS: Although decreases in peak power and increases in perceived pain were greater when sprints were interspersed with 30 compared to 180s of recovery, the development of neuromuscular fatigue of the knee extensors was similar. The results illustrate that peripheral fatigue developed early whereas central fatigue developed later in the sprint protocol, however the effect of recovery time on neuromuscular fatigue could be task specific.

Arm-cycling sprints induce neuromuscular fatigue of the elbow flexors and alter corticospinal excitability of the biceps brachii.

We examined the effects of arm-cycling sprints on maximal voluntary elbow flexion and corticospinal excitability of the biceps brachii. Recreationally trained athletes performed ten 10-s arm-cycling sprints interspersed with 150 s of rest in 2 separate experiments. In experiment A (n = 12), maximal voluntary contraction (MVC) force of the elbow flexors was measured at pre-sprint 1, post-sprint 5, and post-sprint 10. Participants received electrical motor point stimulation during and following the elbow flexor MVCs to estimate voluntary activation (VA). In experiment B (n = 7 participants from experiment A), supraspinal and spinal excitability of the biceps brachii were measured via transcranial magnetic and transmastoid electrical stimulation that produced motor evoked potentials (MEPs) and cervicomedullary motor evoked potentials (CMEPs), respectively, during a 5% isometric MVC at pre-sprint 1, post-sprint 1, post-sprint 5, and post-sprint 10. In experiment A, mean power output, MVC force, potentiated twitch force, and VA decreased 13.1% (p < 0.001), 8.7% (p = 0.036), 27.6% (p = 0.003), and 5.6% (p = 0.037), respectively, from pre-sprint 1 to post-sprint 10. In experiment B, (i) MEPs decreased 42.1% (p = 0.002) from pre-sprint 1 to post-sprint 5 and increased 40.1% (p = 0.038) from post-sprint 5 to post-sprint 10 and (ii) CMEPs increased 28.5% (p = 0.045) from post-sprint 1 to post-sprint 10. Overall, arm-cycling sprints caused neuromuscular fatigue of the elbow flexors, which corresponded with decreased supraspinal and increased spinal excitability of the biceps brachii. The different post-sprint effects on supraspinal and spinal excitability may illustrate an inhibitory effect on supraspinal drive that reduces motor output and, therefore, decreases arm-cycling sprint performance.