A multicenter randomized controlled trial of two group education programs for fatigue in multiple sclerosis: Short- and medium-term benefits.

BACKGROUND: Fatigue occurs in 75%-95% of people with multiple sclerosis (MS) and is frequently reported as the most disabling symptom. A multicomponent group program of six weekly 2-hour sessions, Fatigue: Take Control (FTC), was developed from an international MS fatigue management guideline. OBJECTIVE: To determine whether FTC is associated with greater improvements in fatigue than MS: Take Control (MSTC), a similarly structured general MS education program. METHODS: This four-site, parallel, single-blind, randomized controlled trial compared FTC and MSTC in 204 ambulatory participants with MS. The primary outcome, the Modified Fatigue Impact Scale (MFIS), and secondary outcomes of self-efficacy, physical activity, sleep, and medications were assessed at baseline, program completion, and 3 and 6 months later. RESULTS: Mean MFIS scores improved in both groups between baseline and program completion (FTC -4.4, p < 0.001; MSTC -3.8, p < 0.001), between baseline and 3 months after program completion (FTC -3.2, p = 0.01; MSTC -3.3, p = 0.01), and between baseline and 6 months after program completion (FTC -5.2, p < 0.001; MSTC -4.8, p < 0.001). These improvements were not statistically different between groups ( p = 0.64, 0.92, and 0.82, respectively). CONCLUSION: Participation in FTC modestly improved self-reported fatigue for up to 6 months. This improvement did not differ significantly from that occurring with the control program.

Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study.

BACKGROUND: More than three fourths of patients with heart failure (HF) are 65 years and older, and older age is associated with worse symptoms and prognoses than is younger age. Reduced exercise capacity is a chief HF complaint and indicates poorer prognosis, especially among elderly persons, but the mechanisms underlying functional decline in older patients with HF are largely unknown. METHODS: Baseline cardiopulmonary exercise testing data from the HF-ACTION trial were assessed to clarify age effects on peak oxygen consumption (VO(2)) and ventilation-carbon dioxide production (VE/VCO(2)) slope. RESULTS: Among 2,331 New York Heart Association class II-IV patients with HF, increased age corresponded to decreased peak VO(2) (-0.14 mL kg(-1) min(-1) per year >40 years; P < .0001) and increased VE/VCO(2) slope (0.30 U/y >70 years; P < .0001). In a multivariable model with 34 other potential determinants, age was the strongest independent predictor of peak VO(2) (partial R(2) 0.130, total R(2) 0.392; P < .001) and a significant but relatively weaker predictor of VE/VCO(2) slope (partial R(2) 0.037, total R(2) 0.199; P < .001). Blunted peak heart rate was also a strong predictor of peak VO(2). Although peak heart rate and age were strongly correlated, both were significant independent predictors of peak VO(2) when analyzed simultaneously in a model. Aggregate comorbidity increased significantly with age but did not account for age effects on peak VO(2). CONCLUSIONS: Age is the strongest predictor of peak VO(2) and a significant predictor of VE/VCO(2) slope in the HF-ACTION population. Age-dependent comorbidities do not explain changes in peak VO(2). Age-related changes in cardiovascular physiology, potentially magnified by the HF disease state, should be considered a contributor to the pathophysiology and a target for more effective therapy in older patients with HF.

Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks.

The use of expiratory muscle strength trainers improves parameters related to pulmonary function, speech, and cough in both healthy and patient populations. Recently, it has been speculated that expiratory strength training may alter the force generation of muscles used during the swallow process. Specifically, the use of the trainer may result in increased activation of the submental muscle complex. Support for this hypothesis was tested by examining the timing and amplitude of submental muscle activity obtained using surface EMG. These muscles are known to be important for normal swallow function. Twenty participants (10 males, 10 females; mean age = 29 years) were recruited to participate in a one-session study. Participants were asked to perform two swallows (saliva swallow and water swallow) and develop an expiratory pressure set at 25% and 75% of their maximum expiratory pressure (MEP) using an expiratory muscle strength trainer. These tasks allowed comparison of muscle activity during both the swallow and expiratory tasks completed with the trainer. Results indicated that the patterns of activation in the submental muscle group while training on the expiratory device had longer duration of activation with higher amplitude of EMG activity when compared with the swallowing condition. These findings indicate that expiratory muscle strength training (EMST) increases motor unit recruitment of the submental muscle complex. Discussion centers on the potential benefit of EMST as a treatment modality for dysphagia characterized by decreased amplitude of hyoid movement during swallowing.

Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough.

OBJECTIVE: To determine the effect of expiratory muscle strength training (EMST) on maximal expiratory strength, pulmonary function, and maximal voluntary cough in persons with multiple sclerosis (MS) having mild to moderate disability. DESIGN: Before-after trial. SETTING: Assessments were completed in the privacy of the subject's home or exercise physiology laboratory. PARTICIPANTS: Seventeen persons with MS were age- and sex-matched to 14 healthy controls. INTERVENTION: Eight weeks of EMST and 4 weeks of detraining. MAIN OUTCOME MEASURES: Maximal respiratory pressures, pulmonary function, and maximal voluntary cough were assessed 3 times (pretraining, posttraining, detraining). Maximal expiratory pressure (MEP) was assessed weekly and training intensity adjusted based on the new measurement. RESULTS: Subjects with MS had lower MEP, decreased pulmonary function, and weaker maximal voluntary cough at each assessment. EMST increased MEP and peak expiratory flow. However, improvement in maximal voluntary cough only occurred in subjects with a moderate level of disability when the MS group was subdivided into mild and moderate disability levels based on the Expanded Disability Status Scale. CONCLUSIONS: EMST is a viable tool to enhance the strength of the respiratory muscles. However, further work is needed to determine the best parameters to assess change in cough following EMST.