The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial

Abstract

Background Fatigue is considered one of the most common symptoms of multiple sclerosis (MS) and lacks a current standardized treatment. Therefore, the aim of this study was to examine the feasibility and effectiveness of a cognition-targeted exercise versus symptom-targeted exercise for MS fatigue. Methods In this Pilot, parallel-group, randomized controlled trial, sixty participants with multiple sclerosis, were randomly assigned to either a Cognition-Targeted Exercise (CTE) (N = 30, mean age 41) or a Symptom-Targeted Exercise (STE) (N = 30, mean age 42). The participants in the experimental group received eight, 50-minute sessions of weekly Cognitive Behavior Therapy (CBT) in addition to a CTE Program; whereas, participants in the control group received eight, 50-minute sessions of weekly CBT in addition to the standardized physiotherapy program (STE Program). Feasibility was assessed through recruitment rate, participant retention, adherence and safety, in addition to clinical outcome measures, including: (1) Modified Fatigue Impact Scale (MFIS), (2) Work and Social Adjustment Scale (WSAS), (3) Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). All outcome measures were assessed at baseline (pretreatment), following completion of the eight visit intervention protocol, and at 3-months follow-up. Results The recruitment rate was 60% and 93% of participants completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded. A Generalized Estimation Equation Model revealed a significant difference over time as an interaction term during the post and follow up visit for all clinical outcome measures (p < .001). Conclusion The addition of CTE to CBT exhibited positive and more lasting influence on MS fatigue outcomes compared to Symptom-Targeted Exercise (STE). Feasibility and efficacy data from this pilot study provide support for a full-scale RCT of CTE as an integral component of Multiple Sclerosis fatigue management.

The Effect of Eight Weeks of Training Aerobic and Resistance on Selected Functional Capacities Among Women With Depression and Multiple Sclerosis

“…In contrast, participants in the experimental group underwent eight weekly 50-minute CBT sessions in addition to the CTE program. The hospital anxiety and depression scale (HADS) and the PSS were utilized and there was a significant difference between the groups during follow-up and post-test visits regarding all clinical outcomes [40]. In an- other study with inconsistent results with the current study on 47 women with relapsing-remitting multiple sclerosis (RRMS), physical activity prevented the occurrence of relapse or inactivity could lead to relapse.…”

RECURSOS FISIOTERAPÊUTICOS: UMA ABORDAGEM PLURALISTA - Uma coletânea de artigos

“…O número total de pontos poderá variar de 9 a 63, sendo estabelecido que valores iguais ou maiores do que 28 são indicativos da presença de fadiga; Já Scorcine et al (2022) aplicou o Impact of Fatigue and Severity of Fatigue questionnaire, a versão traduzida para o português do Brasil das versões finais das MFIS e FSS (GOMES, 2011).O tempo de intervenção dos quatro estudos foi pouco detalhado, assim como os protocolos utilizados foram mal explanados. Abonie e Hettinga (2021) aplicou um protocolo de 30 minutos de atividade ritmada, enquantoAlketbi, et al (2021) além do protocolo de tratamento fisioterapêutico utilizaram a Terapia Cognitivo Comportamental (TCC). Segundo os últimos autores, a associação da TCC ao protocolo de tratamento promoveu efeitos reabilitadores mais positivos.…”

“…No Brasil a prevalência é de 8.690/100.000 habitantes, em média. Com a perda da mielina os impulsos nervosos ficam mais lentos e o portador da doença pode sentir dificuldade em realizar determinadas ações podendo apresentar sintomas mentais e físicos significativos, que podem ser transitórios ou irreversíveis como: déficits neurológicos, fraqueza muscular, ataxia, tremor, espasticidade, paralisia, distúrbio do equilíbrio, comprometimento cognitivo, perda de visão, visão dupla, vertigem, deficiência na deglutição e fala, déficits sensoriais, disfunção intestinal e urinaria, dor, fadiga e depressão(ALKETBI et al, 2021;JORGE et al, 2021;TAVEIRA et al, 2019; HALABASHI et al,2017).Esclerose múltipla progressiva secundária (EMSP); apresenta o tipo EMRR por alguns anos e progride com mais episódios de surtos e períodos mais curtos de remissão. Configura-se pelo declínio exponencial das funções e capacidades neurológicas e depois de anos enfrentando surtos e períodos de recidivas, inicia a fase de progressão gradual da doença, caracterizada por maiores dificuldades na reversão das sequelas, sendo que alguns ainda apresentam momentos curtos de avanços dos surtos.…”