Upper-lower limb and breathing exercise program for improving sleep quality and psychological status in multiple sclerosis: a pilot randomized controlled trial

Tanja Grubić Kezele; Zrinka Trope; Valentina Ahel; Natali Ružić; Hrvoje Omrčen; Luka Đudarić; Ariana Fužinac-Smojver

doi:10.1017/BrImp.2021.17

Upper-lower limb and breathing exercise program for improving sleep quality and psychological status in multiple sclerosis: a pilot randomized controlled trial

Brain Impair. 2023 Mar;24(1):86-102. doi: 10.1017/BrImp.2021.17. Epub 2021 Oct 1.

Authors

Tanja Grubić Kezele¹, Zrinka Trope², Valentina Ahel², Natali Ružić², Hrvoje Omrčen³, Luka Đudarić⁴, Ariana Fužinac-Smojver⁵

Affiliations

¹ Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
² University of Rijeka Faculty of Health Studies, Rijeka, Croatia.
³ Department of Anatomy, University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
⁴ Department of Radiology, General Hospital Pula, Pula, Croatia.
⁵ Department of Basic Sciences, University of Rijeka, Faculty of Health Studies, Rijeka, Croatia.

PMID: 38167585
DOI: 10.1017/BrImp.2021.17

Abstract

Purpose: To examine the feasibility and possible effect of an 8-week exercise program on sleep quality, insomnia and psychological distress in individuals with multiple sclerosis (MS).

Methods: Twenty-four individuals with MS were recruited into a controlled pre-post feasibility study and divided into 2 groups: exercise (n = 13; Expanded Disability Status Scale (EDSS): 1.0-7.5) and a related control group with no exercise (n = 11; EDSS: 1.0-7.0). The exercise group performed combined upper limb, lower limb and breathing exercises in a controlled group (2d/week, 60 min/session) for 8 weeks. Participants were administered measures to evaluate sleep quality (Pittsburgh Sleep Quality Index, PSQI), insomnia severity (Insomnia Severity Index, ISI), psychological distress (Clinical Outcomes in Routine Evaluation-Outcome Measure, CORE-OM) and additionally impact of fatigue (Modified Fatigue Impact Scale, MFIS) after 8-weeks.

Results: Insomnia severity measured with ISI (F(1;22)=5.95, p = 0.023, η _p ² = 0.213, 90% CI = 0.02-0.42) and psychological distress measured with the CORE-OM (F(1;22)=4.82, p = 0.039, η _p ² = 0.179, 90% CI = 0.01-0.40) showed statistically significant group-by-time interaction. Sleep quality measured with the PSQI showed statistically significant group-by-time interaction only in an aspect of daytime sleep dysfunction (F(1;22)=5.33, p = 0.031, η _p ² = 0.195, 90% CI = 0.01-0.40). The fatigue impact measured with the MFIS showed statistically significant group-by-time interaction in physical (F(1;22)=6.80, p = 0.016, η _p ² = 0.236, 90% CI = 0.02-0.44) and cognitive aspects (F(1;22)=9.12, p = 0.006, η _p ² = 0.293, 90% CI = 0.05-0.49), and total score (F(1;22)=11.29, p = 0.003, η _p ² = 0.339, 90% CI = 0.08-0.52).

Conclusions: Our 8-week program reduced insomnia severity, psychological distress and some aspects of fatigue (physical; cognitive; total), and improved sleep quality in an aspect of daytime sleep dysfunction in a small group of individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.

Trial registration: ClinicalTrials.gov NCT03768830.

Keywords: fatigue; insomnia; multiple sclerosis; psychological distress; quality of life; sleep quality.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Breathing Exercises / methods
Fatigue / etiology
Humans
Multiple Sclerosis* / complications
Pilot Projects
Sleep Initiation and Maintenance Disorders* / etiology
Sleep Quality

Associated data

ClinicalTrials.gov/NCT03768830