Multiple sclerosis (MS) is the most common inflammatory demyelinating chronic disease of the central nervous system and the second leading cause of disability in young adults. Motor deficits also involve respiratory muscles. This involvement is present from early stages of disease and is frequently dismissed by professionals until advanced stages of disease. The effect of a training program of respiratory muscles is not sufficiently studied. The aim of this research is to assess the clinical and functional response of a 12-week respiratory muscles training program (RMTP) for persons with relapsing-remitting multiple sclerosis (RRMS). This study is consisted with two sub research: Firstly, a single-blind randomized clinical trial will be carried out in 40 persons with RRMS. Participants either will be received (n = 20) peripheric resistive muscle training program which will be supplemented by a 12-week Respiratory Muscles Training Program (RMTP) with ORYGEN Dual® device for 50 minutes, twice a week during three months or (n = 20) they will be received peripheric resistive muscle training program and health education program. Main outcomes will be strength of the respiratory muscles assessed by maximal inspiratory and expiratory pressure measurements (MIP and MEP). The secondary outcomes will be assessed the quality of life (MSQOL-54), walking speed (T25-FW, MSWS-12 and Hauser ambulatory index), fatigue (MFIS), endurance of the respiratory muscles (10RM) manoeuvre and peripherical muscle strength (Multiple-Sit-to-Stand Test and handgrip strength). Secondly, the qualitative research where researchers will interview participants about their interest in carrying out the intervention (difficulties and advantages) and identify themes of interest about changes in quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
Every session will be lasted 50 minutes and performed under supervision of a physiotherapist. It will be comprised of 30 minutes of progressive aerobic training program followed by peripheric resistive muscle training program which will be supplemented by a 12-week Respiratory Muscles Training Program (RMTP) with ORYGEN Dual® device for 20 minutes. Patients will be instructed to maintain adequate inspiration and expiration while using the Origen-Dual® valve at a rate of 15-20 breaths/minute. Participants will be performed five sets of 10 repetitions followed by 1-2 minutes of unloaded recovery breathing off the device, once a day, 2 days per week, for 12 weeks. The respiratory muscles training will be begun at 30% of MIP achieved at baseline and increased by 5% each week to reach 60% of the baseline assessment MIP.
Every session will be comprised of 30 minutes of progressive aerobic training program followed by peripheric resistive muscle training program and Health Education Program.
University of Málaga
Málaga, Málaga, Spain
Maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP)
Change in respiratory muscle function strength with transducer measuring maximal inspiratory (MIP) and expiratory pressures (MEP)
Time frame: Baseline and 12 weeks
Pulmonary function test
Pulmonary function test will be performed using spirometer "DATOSPIR 120" according to the Guidelines of American Thoracic Society and the European Respiratory Society.
Time frame: Baseline and 12 weeks
Handgrip strength
Handgrip strength will be determined using hydraulic hand dynamometer "JAMAR"
Time frame: Baseline and 12 weeks
Multiple-Sit-to-Stand Test (MSTS)
Lower limb strength using the Multiple-Sit-to-Stand Test (MSTS)
Time frame: Baseline and 12 weeks
The 12 item MS Walking Scale (MSWS-12)
Walking Capacity using the 12 item MS Walking Scale (MSWS-12)
Time frame: Baseline and 12 weeks
Timed 25 foot walk (T25FW)
Exercise Capacity using the Shorter timed walking tests with Timed 25 foot walk (T25FW)
Time frame: Baseline and 12 weeks
Gait analysis
Gait analysis (the Hauser ambulatory index) with which will be assessed the time and effort used by the patient to walk 25 feet (8 meters)
Time frame: Baseline and 12 weeks
The 54 items Specific Questionnaire Quality of Life Multiple Sclerosis (MSQOL-54)
Change in quality of life using the 54 items Specific Questionnaire Quality of Life Multiple Sclerosis (MSQOL-54)
Time frame: Baseline and 12 week
10 Maximum Resistance (10RM)
Change in endurance of the respiratory muscles with the 10RM manoeuvre
Time frame: Baseline, 4 weeks, 8 weeks, 12 weeks.
Perceptions Measures
Post interview with participants to qualitatively identify themes of interest and quality of life effects After that the respiratory muscles training program, researchers will interview participants about their interest in carrying out the intervention (difficulties and advantages) and changes in quality of life
Time frame: 12 weeks
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