早期多发性硬化症的运动疗法可改善身体机能但不能改善认知：一项随机对照试验的二次分析。
Exercise Therapy in Early Multiple Sclerosis Improves Physical Function But Not Cognition: Secondary Analyses From a Randomized Controlled Trial.
机构信息
Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark.
The Danish MS Hospitals, Ry and Haslev, Denmark.
出版信息
Neurorehabil Neural Repair. 2023 May;37(5):288-297. doi: 10.1177/15459683231159659. Epub 2023 Mar 10.
BACKGROUND
Exercise positively affects multiple sclerosis (MS) symptoms, physiological systems, and potentially cognition. However, an uninvestigated "window of opportunity" exists for exercise therapy early in the disease.
OBJECTIVE
This study presents secondary analyses from the Early Multiple Sclerosis Exercise Study, and aims to investigate the efficacy of exercise on physical function, cognition, and patient-reported measures of disease and fatigue impact early in the disease course of MS.
METHODS
This randomized controlled trial (n = 84, time since diagnosis <2 years) included 48 weeks of aerobic exercise or an active control condition (health education) and between-group changes are based on repeated measurement mixed regression models. Physical function tests included measures of aerobic fitness, walking (6-minute walk, Timed 25-foot walk, Six-spot step test), and upper-limb dexterity. Tests of processing speed and memory evaluated cognition. The questionnaires Multiple Sclerosis Impact Scale and Modified Fatigue Impact Scale assessed perception of disease and fatigue impact.
RESULTS
Following early exercise aerobic fitness showed superior between-group physiological adaptations (4.0 [1.7; 6.3] ml O/min/kg; large effect size [ES = 0.90]). No other outcomes showed significant between-group differences, yet all measures of walking and upper-limb function showed small-to-medium effect sizes in favor of exercise (ES = 0.19-0.58). Overall disability status as well as cognition were unaffected by exercise, whereas perception of disease and fatigue impact were reduced in both groups.
CONCLUSION
In early MS, 48 weeks of supervised aerobic exercise seem to positively modify physical function, but not cognitive function. Perception of disease and fatigue impact may be modifiable by exercise in early MS.
TRIAL REGISTRATION
Clinicaltrials.gov (identifier: NCT03322761).
背景
运动对多发性硬化症（MS）的症状、生理系统，甚至认知能力都有积极影响。然而，在疾病早期，运动疗法存在一个未被研究的“机会之窗”。
目的
本研究对早期多发性硬化症运动研究进行了二次分析，旨在研究运动对 MS 疾病早期患者身体功能、认知能力以及患者报告的疾病和疲劳影响的评估措施的疗效。
方法
这是一项随机对照试验（n=84，诊断后时间<2 年），包括 48 周的有氧运动或积极对照条件（健康教育），并基于重复测量混合回归模型进行组间变化。身体功能测试包括有氧运动能力、行走（6 分钟步行、定时 25 英尺步行、六步台阶测试）和上肢灵巧性的测量。认知测试包括处理速度和记忆测试。多发性硬化影响量表和改良疲劳影响量表评估了对疾病和疲劳影响的感知。
结果
早期运动后的有氧健身表现出优越的组间生理适应（4.0[1.7;6.3]ml O/min/kg；大效应量[ES=0.90]）。其他结果均未显示出显著的组间差异，但所有行走和上肢功能的测量均显示出有利于运动的小到中等效应量（ES=0.19-0.58）。整体残疾状况以及认知能力不受运动影响，而疾病和疲劳影响的感知在两组中均有所减轻。
结论
在早期多发性硬化症中，48 周的监督有氧运动似乎可以积极改善身体功能，但不能改善认知功能。疾病和疲劳影响的感知可能可以通过早期多发性硬化症的运动来改变。
试验注册
Clinicaltrials.gov（标识符：NCT03322761）。
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