The objectives of this study were (1) to investigate the cardiovascular risks of people with relapse-onset progressive MS participating in the EXERCISE-PRO-MS trial, (2) to examine the 16-week natural fluctuations of cardiovascular risk factors, and (3) to examine the effect of 16-week progressive resistance exercise training on cardiovascular risk factors in these participants.The objectives of this study were (1) to investigate the cardiovascular risks of people with relapse-onset progressive MS participating in the EXERCISE-PRO-MS trial, (2) to examine the 16-week natural fluctuations of cardiovascular risk factors, and (3) to examine the effect of 16-week progressive resistance exercise training on cardiovascular risk factors in these participants.
The Exercise PRO-MS study was a single-group phase II clinical trial with an extended baseline period. The intervention consisted of 16-week progressive resistance exercise therapy in 3-4 sets of 10-12 repetitions for large muscle groups to improve muscle strength. The Lausanne protocol, consisting of the Lausanne questionnaire, physical examination, and resting electrocardiogram (ECG), was used to assess the risk on heart-, vascular- or pulmonary diseases. The Lausanne questionnaire contains questions about smoking (history), hypertension, cardiac arrhythmias, (family) history of heart-, vascular- or pulmonary diseases. Systematic COronary Risk Estimation (SCORE), Framingham risk score, and individual cardiovascular risk factors (i.e. anthropometrics, systolic and diastolic blood pressure, lipids and lipoproteins, and hemoglobin A1c) were measured at week 0 (baseline), week 16 (extended baseline), and week 32 (post training). Baseline cardiovascular risk factors were compared to Dutch reference values. Natural fluctuations were examined with Bland and Altman plots, intra-class correlations (ICC), standard error of measurement, and smallest detectable change. The effect of progressive resistance training was examined with multivariate analysis of variance (significance level: p0.05).
People with progressive MS (n=30, age 54 years [IQ: 49-60 yrs], 67% females) with no known cardiovascular disease showed a similar cardiovascular risk profile compared to Dutch reference populations. Natural fluctuations in cardiovascular risk factors were small during the extended baseline period (n=26), indicated by ICCs ranging from 0.717 to 0.983, except for systolic blood pressure (ICC: 0.471). Progressive resistance training was successful in strengthening the muscles but did not result in statistically significant or clinically relevant improvement of the cardiovascular risks in people with progressive MS (n=25).
It was concluded that baseline cardiovascular risk profile of middle-aged people with progressive MS was comparable to age- and sex-matched Dutch reference populations. Cardiovascular risk factors showed small natural fluctuations. No improvements in cardiovascular risk profile were observed after a 16-week exercise therapy program.
These results indicate that there is no need for increased awareness among physiotherapists about increased cardiovascular risks in middle-aged people with progressive MS attending progressive resistance exercise training.
Exercise Therapy
Cardiovascular risks
