HIGH-VOLUME AND HIGH-INTENSITY FUNCTIONAL TRAINING IN PATIENTS WITH MULTIPLE SCLEROSIS: A PILOT STUDY ON FEASIBILITY AND FUNCTIONAL CAPACITY.

Objective: To evaluate the feasibility of a high-volume and high-intensity functional training programme in patients with multiple sclerosis (MS), and to explore whether functional capacity improves. A further objective was to explore changes in muscle strength and aerobic capacity. Methods: This pilot study comprised a 12-week intervention, with an 8-week follow-up period. The intervention consisted of 3 weekly 3-h training sessions, comprising functional resistance-, endurance-, and skills training. Feasibility (questionnaire), functional capacity (Timed Up and Go Test, 10-Meter Walk Test, and 6-Minute Walk Test), aerobic capacity (cardiopulmonary exercise test) and muscle strength (1 repetition maximum (RM) leg press) were evaluated. Results: Seven patients completed the study. Patients attended a mean of 93% of the training sessions. One adverse event was reported, which was not related to the training programme. Patients scored positive or very positive on 86% of the feasibility aspects and scored an overall grade of 8.9 on a scale of 1-10 regarding satisfaction with the training programme. Functional capacity, aerobic capacity, and muscle strength seemed to be improved after the training programme, but the improvements were not always sustained. Conclusion: This new high-volume and high-intensity functional training programme appeared to be feasible in patients with MS, and may improve their functional capacity, aerobic capacity and muscle strength. A large-scale controlled trial over a longer period of time is required to evaluate the added value of the training programme.

Fatigue in relation to long-term participation outcome in aneurysmal subarachnoid haemorrhage survivors.

OBJECTIVE: To examine the association of fatigue with long-term participation in aneurysmal subarachnoid haemorrhage survivors. DESIGN: Cohort study, 4 years post-onset. SUBJECTS: A total of 59 patients with aneurysmal subarachnoid haemorrhage. METHODS: Participation performance was assessed with the Sickness Impact Profile-68, participation autonomy and problem experience with the Impact on Participation and Autonomy questionnaire, and community integration with the Community Integration Questionnaire. Fatigue was assessed with the Fatigue Severity Scale and depression with the Center for Epidemiologic Studies-Depression scale. Multivariable linear regression analyses were performed. RESULTS: Fifty-nine survivors (mean age 53.0 years, standard deviation (SD) 10.8 years) were included, of which 59.3% was fatigued. Fatigued patients had significantly worse participation scores than non-fatigued patients regarding performance (p < 0.001), autonomy indoors (p = 0.001), autonomy outdoors (p = 0.002) and problem experience (p = 0.001), but not regarding community integration. More severe fatigue was related to worse participation in terms of performance (B = 2.79, p < 0.001) and problem experience (B = 0.08, p = 0.003), adjusted for depression and inpatient rehabilitation. CONCLUSION: Four years after onset, many survivors of aneurysmal subarachnoid haemorrhage have persistent fatigue, which is independently associated with reduced participation in activities of daily living. Therefore, future studies should investigate whether rehabilitation programs that focus on fatigue are effective in improving long-term participation outcome after aneurysmal subarachnoid haemorrhage.

Determinants of physical activity in young wheelchair-user with spina bifida.

OBJECTIVE: To explore associations between physical activity and peak oxygen uptake (VO2peak), age, sex, and Hoffer classification in young wheelchair-users with spina bifida. DESIGN: Exploratory study. SUBJECTS: Fifty-three dutch children (age 5-19 years) with spina bifida who use a manual wheelchair. METHODS: For the dependent variable physical activity, data from 2 physical activity monitors were analysed: VitaMove data for 34 participants and Actiheart data for 36 participants. Time sedentary, time physically active, and time in moderate to vigorous physical activity were analysed. The Wheelchair Shuttle Test was used to measure VO2peak. Univariate and multivariate regression analyses were performed. Independent variables were VO2peak, age, sex, and Hoffer classification. RESULTS: Time sedentary and time physically active during a school day were influenced by age (ß=0.326/ß=-0.320) and Hoffer classification (ß=0.409/ß=-0.534) and during a weekend day by Hoffer classification (ß=0.617/ß=-0.428). Time in moderate to vigorous physical activity was influenced by Hoffer classification (ß=-0.527) during a school day and by age (ß=-0.600) during a weekend day. CONCLUSION: Older age and the inability to walk negatively influence physical activity. Sex and VO2peak were not associated with physical activity. These results imply that increasing cardiorespiratory fitness alone will not improve physical activity in young wheelchair-users with spina bifida.