Learmonth, Yvonne Charlotte
Therapeutic exercise for those moderately affected with Multiple Sclerosis.
PhD thesis, University of Glasgow.
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Multiple Sclerosis (MS) is a chronic progressive disease which presents with a variety of cognitive, motor and sensory deficits. Rehabilitation strategies to help manage some of these deficits include increasing physical activity and undertaking therapeutic exercise. A literature review begins this thesis and where relevant gaps are highlighted. These include; minimal literature on the long-term effects of therapeutic exercise, the views of those with MS taking part in therapeutic exercise and the characteristics of outcome measures used to assess those with MS. To address these areas three studies are presented related to therapeutic exercise for those moderately affected with MS (defined as an Expanded Disability Status Score of 5 to 6.5).
In the first study, a 12-week therapeutic exercise programme was delivered to twenty people with MS, whilst 12 people acted as controls who received usual care. Clinical outcomes were assessed at five time points over the intervention and 12-month follow-up period of the study. No statistically significant results emerged to suggest the intervention was effective, however calculated effect sizes indicated the intervention had a positive effect on areas related to the physiological (strength, mobility, fatigue and body composition), functional (mobility, balance and activity participation) and psychological (mood and quality of life) status of participants.
The second study sought to establish the views and opinions of participants, who had attended the exercise intervention. Three inter-related themes emerged. These were (1) the Exercise Class, which developed as a bridge to allow participants to realise (2) the Benefits of the Class, helping them to overcome (3) Barriers to Exercise. Results suggested the benefits to participating in exercise and the exercise intervention included social support and symptom improvement. Barriers to exercise included perceived psychosocial factors, symptoms and lack of service.
A third study investigated the test re-test reliability of four outcome measures used in the first study, calculations were done to establish the clinically significant change and precision of the outcome measures. The test re-test reliability of the outcome measures was good, with the calculated clinical change and precision of the outcome measures in those moderately affected with MS highlighting the problems of assessing those with MS.
The overall investigation suggests that therapeutic exercise and monitoring its effect in MS is good. Clinical and research recommendations emerged from this work, these include that the heterogeneity of symptoms presented in MS should be considered in future research designs and that group therapeutic exercise may improve physiological, functional and psychological status of those with MS, with the social benefits important to participants.
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