Effects of normobaric hypoxic endurance training on fatigue in patients with multiple sclerosis: a randomized prospective pilot study

Tobias Zrzavy,Paulus Rommer,Anna Pfitzner,Uwe Klaus Zettl,Peter Flachenecker

doi:10.1007/s00415-021-10596-5

Abstract

BackgroundFatigue is one of the most frequent symptoms in patients with multiple sclerosis (MS), causing a major impact on quality-of-life. Non-pharmacological intervention strategies involve physical activity, which has been shown to reduce fatigue. Training under normobaric hypoxic conditions is thought to improve the response to endurance training and may, therefore, have an additional benefit over normoxic training conditions in MS patients.ObjectiveTo compare the effects of endurance training under hypoxic and normoxic conditions on fatigue, mobility and spasticity in patients with MS during inpatient rehabilitation.MethodsThirty-nine patients with MS were assigned within a randomized prospective longitudinal pilot study to (1) a routine clinical rehabilitation program, (2) a routine clinical rehabilitation program + normoxic endurance training and (3) a routine clinical rehabilitation program + hypoxic endurance training for 14 days. Fatigue (WEIMuS and MFIS), spasticity (MSSS-88) and walking endurance (6MinWT) were assessed at days 0, 7 and 14.ResultsFatigue scores improved significantly in all groups, but these improvements were reached faster in the groups which additionally received endurance training (normoxic p = 0.004; hypoxic p = 0.002). Spasticity scores were significantly lower in endurance training groups at the end of the study compared to baseline (normoxic p = 0.048, hypoxic p = 0.012), while only the hypoxic group increased significantly in 6MinWT (p = 0.001).ConclusionsOur findings demonstrate that endurance training provides substantial benefit to neurological rehabilitation programs. Endurance training under hypoxic conditions could positively influence walking endurance within a 2-week training intervention and warrants further investigations.

Highlights

Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease of the central nervous system (CNS) that is clinically heterogeneous and the most common cause of neurological disability in young adults [3, 25, 28]
When performing the ITT analysis, all described changes remained statistically significant. In this single-blind prospective study, we provide evidence of a positive impact of endurance exercises in general on multiple sclerosis (MS)-related fatigue and spasticity; we show improved endurance capacity as measured by walking distance, when training was performed under hypoxic training conditions
Reduced fatigue as measured by the Modified Fatigue Impact Scale (MFIS) was seen in all three groups after participating in the rehabilitation program and those receiving additional endurance training under different conditions

Summary

Introduction

Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease of the central nervous system (CNS) that is clinically heterogeneous and the most common cause of neurological disability in young adults [3, 25, 28]. One of the most efficacious non-pharmacological intervention strategies is physical activity, which has been numerously shown to reduce fatigue in MS patients, and is recommended as important treatment option [8]. Fatigue is one of the most frequent symptoms in patients with multiple sclerosis (MS), causing a major impact on quality-of-life. Non-pharmacological intervention strategies involve physical activity, which has been shown to reduce fatigue. Objective To compare the effects of endurance training under hypoxic and normoxic conditions on fatigue, mobility and spasticity in patients with MS during inpatient rehabilitation. Spasticity scores were significantly lower in endurance training groups at the end of the study compared to baseline (normoxic p = 0.048, hypoxic p = 0.012), while only the hypoxic group increased significantly in 6MinWT (p = 0.001). Endurance training under hypoxic conditions could positively influence walking endurance within a 2-week training intervention and warrants further investigations

Methods

Results

Conclusion