Is aerobic or resistance training the most effective exercise modality for improving lower extremity physical function and perceived fatigue in people with multiple sclerosis? A systematic review and meta-analysis.,

Background. Fatigue is one of the most frequent symptoms in persons with multiple sclerosis (MS). Distinction is made between subjective perceptions of fatigue and objective measures of fatigability. Fatigability can be measured by different protocols. Yet no studies have compared isometric and concentric contraction protocols of the lower extremities head-to-head. Therefore, the purpose of the present study was to (1) compare 2 such protocols head-to-head and (2) to investigate the association between fatigability evoked by the 2 protocols and measures of fatigue and walking. Methods. A total of 45 patients with MS had their walking capacity measured objectively by the 6-minute walk test (6MWT) and subjectively by the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Fatigue was measured by the Modified Fatigue Impact Scale (MFIS) and fatigability by 2 knee extension protocols: sustained isometric and concentric. Results. The sustained isometric protocol induced a higher degree of fatigability than the concentric protocol ( P < .01). Regression analyses revealed that sustained isometric fatigability was not associated with either measures of fatigue or walking (all r2 = 0.00; P = .85-.99), whereas the concentric protocol was significantly associated with fatigue ( r2 = 0.20; P < .01), 6MWT ( r2 = 0.09; P < .05), and MSWS-12 ( r2 = 0.16; P < .01). Furthermore, after adjusting for maximal strength and sex, concentric fatigability remained a strong and significant predictor of fatigue (β = 0.49) and walking (6MWT: β = −0.26; MSWS: β = 0.37). Conclusion. This study provides the first evidence that a lower-extremity concentric fatigability protocol provides superior reflection of both fatigue and walking when compared with a sustained isometric protocol. We suggest that concentric protocols should be the focus of future studies investigating fatigability.

Exercise booster sessions as a mean to maintain the effect of an exerciseintervention -A Systematic ReviewBackground: Exercise is known to have many beneficial effects. Nevertheless, long-term adherence remains a challenge. A concept suggested to attend this problem is Exercise Booster Sessions (EBS). However, the current knowledge on EBS is limited.Objectives: This systematic review aimed to summarize and synthesize 1) the reported effects of EBS on physical function, pain, quality-of-life and societal costs and 2) delineate the basic components of EBS (frequency, intensity, type and time) following an exercise intervention in all clinical populations. MethodsSeven databases (MEDLINE, EMBASE, CINAHL, SportDISCUS, Physiotherapy Evidence Database PEDro, Web of Science, and Cochrane Central Register of Controlled Trials) were electronically searched in August 2021. Included studies were randomized controlled trials (RCTs) of exercise interventions in all clinical populations followed by a period of EBS or a control group not receiving EBS.Results: Five studies on respectively knee osteoarthritis (n=4) and low back pain (n=1), reporting four different RCTs, were included. Four studies had a potential high risk of bias, whereas one was rated to have some concerns. One study found a positive effect of EBS on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, -46.0 (-80.0, -12.0), whereas the others did not find any differences. The frequency of EBS ranged from 0.09 -1 session/week, and one study found EBS to be cost-effective.Conclusions: Current evidence suggests no or at best moderate effects of EBS on physical 2 function and pain. However, the low number of trials, the potential risk of bias, plus the diversity in trial interventions prevent a firm conclusion.

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