Valutazione degli effetti dell'esercizio fisico adattato sulla capacità fisica e sulla regolazione cardiocircolatoria in pazienti con sclerosi multipla

Multiple Sclerosis (MS) is a complex neurodegenerative and auto-immune disease that can affect several parts of the central nervous system (CNS). Fatigue, motor disorders, muscle weakness and balance problems are very common consequences in MS patients. There are many suggestions that indicate impairments, resulting not only from disease’s progression per se, but also from sedentary lifestyle secondary to the MS (Dalgas et al. 2008). Moreover it has been demonstrated that patients show impaired autonomic functions and cardiovascular regulation during exercise. The aim of the present investigation was to assess the effectiveness of a six months combined training (CT) - in terms of aerobic capacity, walk and speed ability, balance, fatigue and cardiovascular regulation in response to the muscle metaboreflex recruitment - on subjects with relapsing - remitting MS (RR-MS). Eleven subjects (5 females; age 47.09±10.8; BMI 23.94±4.8) with RR-MS (EDSS 2.5-6.0) participated to a 6 months supervised CT, 1 h/session, 3 days/week of adapted physical activity (APA). Ten subjects (4 females; age 47.7±10.9; BMI 24.3±4.3) with RR-MS (EDSS 2.5-6.0) were enrolled as sedentary control group (CTL). CT program consisted of endurance training, resistance training, and exercises for balance, coordination, joint mobility and stretching. Cardiopulmonary testing on a electromagnetically braked cycle-ergometer was used to assess maximum workload (Wmax), oxygen uptake (VO2max), carbon dioxide output (VCO2max), pulmonary ventilation (Vemax) and heart rate (HRmax). These parameters were measured by means of a metabolic measurement cart (MedGraphics Ultima CPX, St. Paul, USA). Patients were also evaluated with the Modified Fatigue Impact Scale (MFIS), the Berg Balance Scale (BBS), the Timed Up and Go (TUG), and the 6 Minute Walking Test (6MWT). Hemodynamic parameters: stroke volume (SV), cardiac output (CO), the pre-ejection period/left ejection time ratio (PEP/VET), systemic vascular resistance (SVR) during post-exercise muscle ischemia (PEMI) and control exercise recovery (CER) tests were measured by means of impedance cardiography (NCCOM 3, BoMed Inc., Irvine, CA). Also the difference between the PEMI and the CER tests was calculated to allow for metaboreflex response to be assessed. Evaluations were performed before training (T0), at the third (T3) and at the sixth month (T6). The study described so far showed that the 6 months training could effectively improve physical capacity of MS patients. There was a remarkable increase in strength and speed of lower limbs, moreover perception of fatigue drastically decreased and balance enhanced. On the contrary, no difference for hemodynamic parameters between groups was highlighted. It can be speculated that MS patients need more time (1 or 2 years training) to obtain necessary metabolic and structural changes to modify cardiovascular regulation during exercise.