Development of a Combined Exercise and Cognitive Stimulation Intervention for People with Mild Cognitive Impairment-Designing the MEMO_MOVE PROGRAM.

Dementia patients are at high risk for the decline of both physical and cognitive capacities, resulting in an increased risk of the loss of autonomy. Exercise is regarded as a non-pharmacological therapy for dementia, considering the potential benefits of preventing cognitive decline and improving physical fitness. In this paper, we aim to describe the different design stages for an exercise program combined with cognitive stimulation for a population with mild cognitive impairment, i.e., the MEMO_MOVE program. METHODS: The intervention design followed the Medical Research Council's guidelines for complex interventions and was structured according to the six steps in quality intervention development (6SQuID). The intervention was described considering the Template for Intervention Description and Replication (TIDieR). In order to establish the intervention characteristics, a literature review was conducted to collate and analyze previous work, which provided a summary the type of exercise that should be implemented among this population. RESULTS: The MEMO_MOVE program was structured and described, regarding (i) inclusion of a cognitive stimulation component; (ii) the kind of cognitive stimulation; and (iii) the type of exercise, duration, frequency, intensity, and program length. CONCLUSIONS: A systematic step-by-step process design was followed to create a specific intervention to promote physical fitness and cognitive stimulation in individuals with mild dementia.

The effect of aerobic vs. resistance training on plasma homocysteine in individuals with type 2 diabetes.

Elevated plasma homocysteine concentration is a risk factor for cardiovascular disease, which seems to be the main cause of increased mortality in patients with type 2 diabetes. Previous studies have demonstrated the effect of exercise on homocysteine levels and the magnitude of these benefits seems to depend on the type, mode and frequency of training. The present study aimed to compare the effects of aerobic and resistance training on plasma homocysteine in individuals with type 2 diabetes. The study included 15 individuals undergoing aerobic training, 14 subjects undergoing resistance training, and 18 individuals in the control group. Homocysteine, total cholesterol and fractions, glucose, and anthropometric measurements were conducted. The training program lasted 16 weeks. Aerobic training was performed twice a week and lasted 75 min, and resistance training was performed twice a week and lasted 75 min. Homocysteine levels were not significantly different between before and after training. High-density lipoprotein levels increased in both training groups and decreased in the control group. Glucose levels decreased after aerobic and resistance training. Body fat mass (percentage and total) decreased in both training group, but with more expression in the aerobic group. We conclude that 16-week aerobic and resistance training programs did not significantly affect plasma homocysteine levels in patients with type 2 diabetes. Nevertheless, these training programs yielded positive results in HDL control, plasma glucose, and body composition.

Exercise with Music: An Innovative Approach to Increase Cognition and Reduce Depression in Institutionalized Elderly / Ejercicio con música: Un enfoque innovador para aumentar la cognición y reducir la depresión en ancianos institucionalizados / Exercício com música: uma proposta inovadora para otimização da cognição e da redução da depressão em idosos institucionalizados

Concerning dementia and depression prevention, non-pharmacological interventions such as cognitive-training are currently recommended as an alternative for the elderly, for the reason that they produce less side effects. Based on this perspective, the aim of this study was to identify the effects of movement with music upon cognition and depression in institutionalized elderly. A longitudinal study was conducted from November 2013 to February 2014 in Vila Real, Portugal. The sample included thirty-nine institutionalized healthy seniors over 60 years of age who were divided into two groups: music plus movement (MMG, n=20, 80.65±6.59 years) and cognitive training group without music (CTG, n=19, 83.68±6.54 years); both groups were submitted to an intervention period (4 months, 3x/week, 90min/session). Before and after the intervention period the following instruments were applied in both groups: Mini Mental State Examination (MMSE), Raven's Coloured Progressive Matrices (MPCR), and Geriatric Depression Scale (GDS-27). Both interventions proved to improve cognitive function, mental ability and depression. The interaction effect between programs' intervention and time was observed in language, mental ability, and depression indicators. Considering these variables, the magnitude of variation between moments was higher in the MMG in language and depression with a high effect value for depression (η2ρ =.342). In conclusion, this study emphasises the role of music and movement as a broad intervention in mental health, acting simultaneously as cognitive training and an anti-depressive

Actualmente las intervenciones no farmacológicas se recomiendan como alternativas en la prevención de la demencia y la depresión en los ancianos, porque tienen menos efectos secundarios. En esta perspectiva, este estudio tiene como objetivo identificar los efectos de una intervención que combina música y ejercicio en la cognición y la depresión en ancianos institucionalizados. Se realizó un estudio longitudinal de noviembre de 2013 a febrero de 2014 en dos instituciones de ancianos, en la ciudad de Vila Real, Portugal. La muestra incluyó a 39 individuos ancianos sanos institucionalizados mayores de 60 años que se dividieron en dos grupos: "grupo de música y ejercicios" (MMG, n = 20, 80.65 ± 6.59 años) y "grupo de entrenamiento cognitivo" (CTG, n = 19; 83.68 ± 6.54 años). Ambos fueron sometidos a un período de intervención (4 meses, 3 veces por semana, 90 minutos por sesión). Antes y después de la intervención, se utilizaron los siguientes instrumentos en ambos grupos: Mini Mental State Examination (MMSE), Test de Matrices Coloridas de Raven (MPCR) y Escala de Depresión Geriátrica (GDS-27). Ambas intervenciones mostraron mejoras en la función cognitiva, la capacidad mental y la depresión. El efecto de interacción entre los programas de intervención y el tiempo se observó en el lenguaje, la capacidad mental y la depresión. Teniendo en cuenta estas variables, la amplitud de la variación entre los momentos fue mayor en el lenguaje y la depresión en el grupo MMG, y se encontró un alto valor de efecto para la depresión (η2ρ = 0.342). En conclusión, este estudio enfatiza el papel de la música y del movimiento como una intervención más completa en la salud mental, actuando simultáneamente en el entrenamiento cognitivo y en la depresión

Hoje em dia, as intervenções não farmacológicas são recomendadas como alternativas na prevenção da demência e depressão em idosos, porque apresentam menos efeitos secundários. No âmbito desta perspetiva, o presente estudo tem como objetivo identificar os efeitos de uma intervenção combinando a música e o exercício na cognição e depressão em idosos institucionalizados. Foi realizado um estudo longitudinal de Novembro de 2013 a Fevereiro de 2014 em duas instituições de idosos, na cidade de Vila Real, Portugal. A amostra incluiu 39 idosos saudáveis institucionalizados, com idade superior a 60 anos, que foram divididos em dois grupos: "grupo música e exercício" (MMG, n= 20; 80.65±6.59 anos) e "grupo de treino cognitivo" (CTG, n=19; 83.68±6.54 anos). Ambos foram sujeitos a um período de intervenção (4 meses, 3x/semana, 90min/sessão). Antes e depois da intervenção foram utilizados os seguintes instrumentos em ambos os grupos: Mini Mental State Examination (MMSE), Matrizes Coloridas de Raven (MPCR), e a Escala de Depressão Geriátrica (GDS-27). Ambas as intervenções evidenciaram melhorias na função cognitiva, capacidade mental e na depressão. O efeito de interação entre os programas de intervenção e o tempo foi observado na linguagem, capacidade mental e depressão. Considerando estas variáveis, a amplitude da variação entre os momentos foi maior na linguagem e na depressão no grupo MMG, sendo o tamanho do efeito grande na depressão (η2ρ = 0,342). Em conclusão, este estudo enfatiza o papel da música e do movimento como uma intervenção mais completa na saúde mental, atuando simultaneamente no treino cognitivo e na depressão

Effect of Strength Training on Plasma Levels of Homocysteine in Patients with Type 2 Diabetes.

BACKGROUND: The objective of this study was to analyze the effects of strength training on plasma homocysteine levels and cardiovascular risk factors in patients with type 2 diabetes. METHODS: The sample consisted of 14 diabetic women with a mean age of 68 ± 6 years. Biochemical evaluations and anthropometric measurements were taken before and after training. Training sessions lasted 50 min and comprised three sets of 8-12 repetitions each. The established load was 60% of 1 repetition maximum. RESULTS: After the training program, it was observed that the levels of homocysteine (average before 13.4 ± 2.9 and after 12.8 ± 3.3, P = 0.40), very low-density lipoprotein (LDL) (average before 41.9 ± 17.0 and after 36.2 ± 11.8, P = 0.47), total cholesterol (average before 214.4 ± 60.6 and after 190.2 ± 62.3, P = 0.09), triglycerides (average before 209.3 ± 85.4 and after 181.5 ± 59.2, P = 0.47), and blood glucose (average before 123.5 ± 30.4 and after 110.1 ± 24.7, P = 0.26) showed no significant changes, but the LDL (average before 129.1 ± 63.4 and after 95.7 ± 53.3, P = 0.04), high-density lipoprotein (average before 43.2 ± 12.0 and after 58.2 ± 15.6, P = 0.01), lean mass (average before 41.1 ± 5.7 and after 42.8 ± 5.4, P = 0.008), fat mass (average before 31.4 ± 8.8 and after 29.7 ± 8.5, P = 0.001), and percentage fat (average before 42.6 ± 4.0 and after 40.3 ± 4.6, P = 0.000) showed significant changes. CONCLUSIONS: This study concluded that strength training does not improve homocysteine levels, but help to improve the lipoprotein profile in type 2 diabetic patients.

Influence of acupuncture on the pain perception threshold of muscles submitted to repetitive strain / Influência da acupuntura no limiar de percepção dolorosa de musculatura submetida a esforço repetitivo

ABSTRACT BACKGROUND AND OBJECTIVES: Muscle pain is one of the causes of the leave of absence in physical activities, as well as limiting factor in sports performance. The objective of this study was to evaluate the early and late response to the pain perception threshold after acupuncture in a single application, in subjects submitted to repetitive strain. METHODS: Clinical-experimental quantitative trial, with control group and blind, with 47 healthy women, aged between 18 and 55 years (36.3±10.6), divided deterministically by sequential alternation to the groups: acupuncture (GACP n=16), Sham (Gsham n=16) and control (CGRT n=15). The repetitive strain was performed in the Reformer equipment of the Pilates method, before and after the intervention, with 0,25x40mm needles. The GACP received the needling at point ST36 (Zusanli). The Gsham received superficial needling out of the acupuncture point, and the CGRT only performed the exercise. All patients had the needles for 20 minutes, except for the CGRT who remained only at rest. A digital pressure algometer was used at point BL57 (Chengshan). The algometry was conducted before the intervention and the exercise, immediately after, and after 24 hours. RESULTS: The GACP showed a significant increase in the pain perception threshold when compared to Gsham (p =0.021) and to CGRT (p<0.001) and after 24 hours, with CGRT (p=0.006). The results were coherent with the acupuncture theoretical foundations, suggesting the release of opioid analgesics and applicability in the recovery of post-exercise sore muscles. CONCLUSION: A single acupuncture intervention was able to increase the Pain Perception Threshold immediately and after 24 hours.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor muscular é uma das causas de afastamento de práticas de atividades físicas e fator limitante no desempenho desportivo. O objetivo deste estudo foi avaliar a resposta imediata e tardia do limiar de percepção dolorosa após estímulo de acupuntura em uma única aplicação, em sujeitos submetidos a esforço repetitivo. MÉTODOS: Ensaio clínico-experimental, quantitativo, com grupo controle e encoberto, 47 mulheres sadias, com idades entre 18 e 55 anos (36,3±10,6), separadas por alocação determinista por alternância sequencial em grupos: acupuntura (GACP n=16), Sham (Gsham n=16) e controle (GCRT n=15). Realizou-se o esforço repetitivo no equipamento Reformer do método Pilates, antes e após a intervenção com agulhas 0,25x40mm. O GACP recebeu agulhamento no ponto E36 (Zusanli). O Gsham agulhamento superficial, fora do ponto de estímulo de acupuntura e o GCRT só realizou o exercício. Todos permaneceram 20 min com agulhas e o GCRT só em repouso. Utilizou-se um algômetro de pressão digital no ponto B57 (Chengshan). A algometria foi realizada antes da intervenção e do exercício, imediatamente após, e após 24 horas. RESULTADOS: O GACP teve aumento significativo do limiar de percepção dolorosa no momento imediato, quando comparado ao Gsham (p=0,021) e ao GCRT (p<0,001), e após 24 horas com o GCRT (p=0,006). Houve coerência dos resultados com as bases teóricas do estímulo da acupuntura, sugerindo liberação de opioides analgésicos e aplicabilidade em recuperação de dores musculares pós-exercícios. CONCLUSÃO: Uma única intervenção de acupuntura foi capaz de aumentar o limiar de percepção dolorosa de imediato e após 24 horas.

Efeito do treinamento aeróbio nos níveis de homocisteína em indivíduos diabéticos do tipo 2 / Effect of aerobic training on plasma levels of homocysteine in patients with type 2 diabetes / Efecto del entrenamiento aeróbico en los niveles de homocisteína en individuos diabéticos del tipo 2

INTRODUÇÃO: Os programas de treinamento aeróbio têm demonstrado bons resultados no controle das variáveis de risco cardiovascular em indivíduos diabéticos; no entanto, os efeitos nos níveis de homocisteína não estão claros. Objetivo: Analisar os efeitos do treinamento aeróbio nos níveis plasmáticos de homocisteína e fatores de risco cardiovascular em indivíduos diabéticos do tipo 2.MÉTODOS: Participaram do estudo 15 mulheres com diabetes do tipo 2 e média de idade 68,86 ± 11,2 anos. Todos os indivíduos da amostra foram submetidos a um teste de avaliação do consumo máximo de oxigénio (VO2máx) seguindo o protocolo de Bruce, avaliação da pressão arterial e avaliação antropométrica. Foi também efetuada uma coleta de 10 ml de sangue (veia antecubital) em jejum de no mínimo 12 horas. O plasma foi separado e processado para posterior análise da concentração de homocisteína (mmol/l), colesterol total (mg/dl), lipoproteína de muito baixa densidade (VLDL) (mg/dl), lipoproteína de baixa densidade (LDL) (mg/dl), lipoproteína de alta densidade (HDL) (mg/dl), triglicérides (mg/dl) e glicemia (mg/dl). Os testes foram feitos antes e após 16 semanas de treinamento aeróbio. O programa foi realizado com 2 sessões de treinamento não consecutivas por semana, com intensidade compreendida entre 60% e 70% da frequência cardíaca máxima e duração de 75 minutos por sessão.RESULTADOS: Os resultados observados revelam que o programa de exercício físico induziu uma diminuição não significativa da concentração plasmática de homocisteína. Foram ainda identificadas melhorias do perfil lipídico e do Consumo Máximo de Oxigênio (VO2máx), diminuição da glicemia, da pressão arterial diastólica, do percentual de gordura e massa gorda.CONCLUSÃO: Conclui-se que o programa de treinamento aeróbio reduziu o risco cardiovascular em indivíduos diabéticos do tipo 2, embora a alteração da homocisteína não tenha sido significativa.

INTRODUCTION: Aerobic training programs have shown good control of cardiovascular risk variables in diabetic subjects, but the effects on homocysteine levels remains unclear. Objective: To analyze the effects of aerobic training on plasma homocysteine levels and cardiovascular risk factors in patients with type 2 diabetes.METHODS: The study included 15 women with type 2 diabetes, mean age 68.86 ± 11.2 years. All individuals in the sample underwent an evaluation test of maximal oxygen uptake (VO2max) according to Bruce protocol, evaluation of blood pressure and anthropometric measurements. Additionally, a sample of venous blood (10ml from cubital vein) was drawn from subjects fasted for at least 12 hours. The plasma was separated and processed for further analysis of homocysteine concentration (mmol/l), total cholesterol (mg/dl), very low density lipoprotein (VLDL) (mg/dl), low density lipoprotein (LDL) (mg/dl), high density lipoprotein (HDL) (mg/dl), triglycerides (mg/dl) and blood glucose (mg/dl). The tests were done before the aerobic training and repeated 16 weeks later. The program consisted of 2 non-consecutive training sessions of 75 minutes a week, between 60% and 70% of maximum heart rate.RESULTS: The observed results show that physical exercise program induced a non-significant decrease in plasma concentration of homocysteine. Were also identified improvements in lipid profile and maximal oxygen uptake (VO2max), decreased blood glucose, diastolic blood pressure, body fat percentage and body fat.CONCLUSION: The aerobic training program reduced cardiovascular risk factor in individuals with type 2 diabetes, although homocysteine decline was not significant.

INTRODUCCIÓN: Los programas de entrenamiento aeróbico han demostrado buenos resultados en el control de las variables de riesgo cardiovascular en individuos diabéticos, sin embargo, los efectos en los niveles de homocisteína no están claros. Objetivo: Analizar los efectos del entrenamiento aeróbico en los niveles plasmáticos de homocisteína y factores de riesgo cardiovascular en individuos diabéticos del tipo 2.MÉTODOS: Participaron en el estudio 15 mujeres con diabetes del tipo 2 y promedio de edad de 68,86 ± 11,2 años. Todos los individuos de la muestra fueron sometidos a un test de evaluación del consumo máximo de oxígeno (VO2máx) siguiendo el protocolo de Bruce, evaluación de la presión arterial y evaluación antropométrica. Fue también efectuada una colecta de 10 ml de sangre (vena antecubital) en ayunas de como mínimo 12 horas. El plasma fue separado y procesado para posterior análisis de la concentración de homocisteína (mmol/l), colesterol total (mg/dl), Lipoproteína de Muy Baja Densidad (VLDL) (mg/dl), Lipoproteína de Baja Densidad (LDL) (mg/dl), Lipoproteína de Alta Densidad (HDL) (mg/dl), triglicéridos (mg/dl) y glucemia (mg/dl). Los tests fueron realizados antes y después de 16 semanas de entrenamiento aeróbico. El programa fue realizado con 2 sesiones de entrenamiento no consecutivas por semana, con una intensidad comprendida entre 60-70% de la frecuencia cardíaca máxima y una duración de 75 minutos por sesión.RESULTADOS: Los resultados observados revelan que el programa de ejercicio físico indujo a una disminución no significativa de la concentración plasmática de homocisteína. Fueron además identificadas mejoras del perfil lipídico y del Consumo Máximo de Oxígeno (VO2máx), disminución de la glucemia, de la presión arterial diastólica, del porcentual de grasa y masa gorda.CONCLUSIÓN: Se concluye que el programa de entrenamiento aeróbico redujo el riesgo cardiovascular en individuos diabéticos del tipo 2, aunque la alteración de la homocisteína no haya sido significativa.

Effects of physical activity and training programs on plasma homocysteine levels: a systematic review.

Homocysteine is an amino acid produced in the liver that, when present in high concentrations, is thought to contribute to plaque formation and, consequently, increased risk of cardiovascular disease. However, daily physical activity and training programs may contribute to controlling atherosclerosis. Given that physical exercise induces changes in protein and amino acid metabolism, it is important to understand whether homocysteine levels are also affected by exercise and to determine possible underlying mechanisms. Moreover, regarding the possible characteristics of different training programs (intensity, duration, repetition, volume), it becomes prudent to determine which types of exercise reduce homocysteine levels. To these ends, a systematic review was conducted to examine the effects of daily physical activity and different training programs on homocysteine levels. EndNote(®) was used to locate articles on the PubMed database from 2002 to 2013 with the keyword combinations "physical activity and homocysteine", "training and homocysteine", and/or "exercise and homocysteine". After 34 studies were identified, correlative and comparative studies of homocysteine levels revealed lower levels in patients engaged in greater quantities of daily physical activity. Regarding the acute effects of exercise, all studies reported increased homocysteine levels. Concerning intervention studies with training programs, aerobic training programs used different methods and analyses that complicate making any conclusion, though resistance training programs induced decreased homocysteine levels. In conclusion, this review suggests that greater daily physical activity is associated with lower homocysteine levels and that exercise programs could positively affect homocysteine control.

Treinamento aeróbio não altera pressão arterial de mulheres menopausadas e com síndrome metabólica / Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome

FUNDAMENTO: A Hipertensão arterial (HA) é uma condição tanto agravante quanto agravada pela Síndrome Metabólica (SM). A menopausa pode tornar o tratamento da hipertensão mais difícil porque é uma condição que favorece a piora nos componentes da SM. Embora existam evidências de que o treinamento com exercícios físicos reduza a pressão arterial, se as condições da menopausa e da SM afetam os benefícios induzidos pelo exercício é algo ainda não evidenciado. OBJETIVO: Comparar os efeitos do treinamento aeróbio na pressão arterial entre mulheres com SM não menopausadas e menopausadas. MÉTODOS: Foram recrutadas 44 mulheres divididas em quatro grupos experimentais: controle não menopausada (CNM: 39,5 ± 1,1 anos, n = 11); controle menopausada (CM: 54,9 ± 1,7 anos, n = 12); aeróbio não menopausada (ANM: 43,1 ± 2,1 anos, n = 11) e aeróbio menopausada (AM: 52,1 ± 1,6 anos, n = 10). Os grupos de exercício realizaram treinamento aeróbio durante três meses, cinco vezes por semana, com intensidade entre 60% e 70% da frequência cardíaca de reserva. A pressão arterial de repouso e a resposta pressórica clínica após 60 minutos de exercício foram medidas antes e após o período treinamento. O teste de ANOVA de dois fatores foi usado, considerando p < 0,05. RESULTADOS: O programa de treinamento resultou em redução da gordura abdominal, glicemia e melhora do VO2 máx. Em comparação aos valores pré-intervenção, Pressão Arterial Sistólica (PAS) e Pressão Arterial Diastólica (PAD) não se alteraram após o treinamento nos grupos CNM, CM, ANM e AM (p > 0,05). CONCLUSÃO: Três meses de treinamento aeróbio melhora componentes da SM, mas não altera a pressão arterial de repouso, nem a resposta pressórica aguda após uma sessão de exercício aeróbio em mulheres com SM.

BACKGROUND: Arterial Hypertension (AH) is an aggravating condition for Metabolic Syndrome (MS), as well as being aggravated by it. Menopause can make hypertension treatment more difficult, as it favors the worsening of MS components. Although there is evidence that exercise training reduces blood pressure, whether menopause and SM affect the exercise-induced benefits is yet to be elucidated. OBJECTIVE: To compare the effects of aerobic training on blood pressure in non-menopausal and menopausal women with MS METHODS: A total of 44 women were recruited and divided into four groups: non-menopausal control (NMC: 39.5 ± 3.6 years, n = 11); menopausal control (MC: 54.9 ± 5.9 years, n = 12), non-menopausal aerobics (NMA: 43.1 ± 6.8 years, n = 11) and menopausal aerobics (MA: 52.1 ± 5 years, n = 10). The exercise groups performed aerobic training for three months, five times a week, at an intensity between 60% and 70% of heart rate reserve. The resting blood pressure and blood pressure response after 60 minutes of exercise were measured before and after the training period. The two-way ANOVA test was used, considering a p value < 0.05. RESULTS: The training program resulted in a decrease in abdominal fat, blood glucose and improved VO2 max. Compared to pre-intervention values, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) did not change after training in NMC, MC, MA and NMA groups (p > 0.05). CONCLUSION: Three months of aerobic training improved MS components, but did not alter resting blood pressure or the BP response after an acute exercise session in women with MS.

Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome.

BACKGROUND: Arterial Hypertension (AH) is an aggravating condition for Metabolic Syndrome (MS), as well as being aggravated by it. Menopause can make hypertension treatment more difficult, as it favors the worsening of MS components. Although there is evidence that exercise training reduces blood pressure, whether menopause and SM affect the exercise-induced benefits is yet to be elucidated. OBJECTIVE: To compare the effects of aerobic training on blood pressure in non-menopausal and menopausal women with MS METHODS: A total of 44 women were recruited and divided into four groups: non-menopausal control (NMC: 39.5 ± 3.6 years, n = 11); menopausal control (MC: 54.9 ± 5.9 years, n = 12), non-menopausal aerobics (NMA: 43.1 ± 6.8 years, n = 11) and menopausal aerobics (MA: 52.1 ± 5 years, n = 10). The exercise groups performed aerobic training for three months, five times a week, at an intensity between 60% and 70% of heart rate reserve. The resting blood pressure and blood pressure response after 60 minutes of exercise were measured before and after the training period. The two-way ANOVA test was used, considering a p value < 0.05. RESULTS: The training program resulted in a decrease in abdominal fat, blood glucose and improved VO2 max. Compared to pre-intervention values, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) did not change after training in NMC, MC, MA and NMA groups (p > 0.05). CONCLUSION: Three months of aerobic training improved MS components, but did not alter resting blood pressure or the BP response after an acute exercise session in women with MS.