Quality of the tools used to assess aerobic capacity in people with multiple sclerosis.

INTRODUCTION: Assessments of physical fitness, including exercise tolerance functions, are valuable in persons with multiple sclerosis (MS). Many tools with widely varying advantages and disadvantages have been used to assess physical fitness in research and clinical practice. To date, there are no recommendations regarding the best tools to use for this purpose in persons with MS. This study aims to systematically review the psychometric properties of the tools used to assess exercise tolerance functions in persons with MS, and to propose recommendations regarding the best test to use. EVIDENCE ACQUISITION: The literature was searched (PubMed, SPORTdiscus, PEDro, MEDLINE, Embase via Scopus, CINAHL, and PsycInfo) to identify the tools most frequently used to assess exercise tolerance functions. These tools were systematically analyzed. EVIDENCE SYNTHESIS: Forty-eight articles were selected. Six tools or categories of tools concerning exercise tolerance functions were identified. Whole-body exercise tests combined with gas exchange analysis had the best psychometric properties (e.g., validity, reliability) for assessing aerobic capacity in pwMS with mild to moderate disability (Expanded Disability Status Scale [EDSS] ≤6.5). Although sometimes used for this purpose, walk tests seemed to assess walking performance rather than exercise tolerance functions. The psychometric properties of other tests had scarcely been studied. CONCLUSIONS: The tools vary widely in quality. Whole-body exercise testing combined with gas exchange analysis has the best psychometric properties of the reviewed tools. If gas exchange analysis is feasible, whole-body exercise tests combined with gas exchange analysis, with maximal exercise effort for pwMS with EDSS ≤4 and submaximal exercise effort for pwMS with EDSS ≥4.5, should be recommended to assess exercise tolerance, both in research and in clinical practice. A selection algorithm is proposed.

Fatigue and physical fitness of mildly disabled persons with multiple sclerosis: a cross-sectional study.

Fatigue is frequent and disabling in persons with multiple sclerosis (pwMS) with mild neurological disability. These patients also have impaired physical fitness. Whether mildly disabled pwMS are deconditioned, and this deconditioning is linked to fatigue, remains unknown. Our aim is to determine the physical fitness of mildly disabled patients with multiple sclerosis and study its relationship with perceived fatigue and to link perceived fatigue with other parameters. Twenty patients (14 women; mean age: 45.5 years) with mild disability (Expanded Disability Status Scale 0-4) underwent a 2-min walking test, Timed Up-and-Go test, aerobic capacity testing, and isometric knee extension testing to assess strength and neuromuscular fatigability. They completed questionnaires assessing perceived fatigue, psychological status, and physical activity. Correlation coefficients and multivariate regression were used to analyze the relationships among variables. Seventeen (85%) patients reported a high level of fatigue. Thirteen (65%) patients had subnormal aerobic capacity. Fatigue was weakly to moderately associated with aerobic capacity, mobility, walking capacity, depression, and neuromuscular fatigability. An association of disease duration, aerobic capacity, and the neuromuscular fatigability index explained 65.1% of fatigue. A high proportion of pwMS with mild neurological disability are fatigued and deconditioned. Perceived fatigue is linked to aerobic capacity, neuromuscular fatigability, depression, mobility, and walking capacity. Focusing on these parameters could help in the management of fatigue.