Original clinical research
Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance

https://doi.org/10.1016/j.jbmt.2014.04.004Get rights and content

Summary

Background and Objective

Gait impairment, falls due to balance problems and fatigue are among the most important complaints in patients with multiple sclerosis (MS) and cause significant functional limitation. Use of complementary and alternative medicine (CAM) to help symptom management and to improve quality of life is growing among MS patients. Yoga is widely used as one of these CAM interventions, however, the number of studies that show the efficacy of yoga training in MS is inadequate. In this study, we aimed to evaluate the effects of a short term yoga program on fatigue, balance and gait in patients with MS.

Method

Eight volunteer ambulatory MS patients with clinically definite relapsing remitting MS whose Expanded Disability Status Score (EDSS) is less than or equal to 6.0, and eight healthy subjects were included in the study. Patients participated in 12 weeks of a bi-weekly yoga program under supervision. At their baseline and after yoga therapy, the Fatigue Severity Scale (FSS) and Berg Balance Scale (BBS) are used to assess fatigue and balance. Three dimensional gait analysis is done using the Vicon 612 system with six cameras and two Bertec force plates, before and after therapy.

Results

After short term yoga therapy, statistically significant achievements were obtained in fatigue, balance, step length and walking speed. Although sagittal plane pelvis and hip angles, ankle plantar flexor moment, powers generated at the hip and ankle joints at the pre-swing were improved, the improvements were not statistically significant.

Conclusion

Yoga therapy is a safe and beneficial intervention for improving fatigue, balance and spatiotemporal gait parameters in patients with MS. Further studies with a larger sample size and longer follow-up will be needed to evaluate the long term effects of yoga therapy.

Introduction

Fatigue, balance and gait disturbances are among the most common problems in patients with multiple sclerosis (MS) which cause important personal, social and economic burdens, such as difficulties in the activities of daily living, reduced productivity, unemployment and reduced quality of life (Chandraratna, 2010, Heesen et al., 2008, Paltamaa et al., 2007). Seventy-five to ninety percent of patients with MS report fatigue and 55% describe it as one of their worst symptoms, and 85% of patients report gait disturbance as their main complaint (Flachenecker et al., 2002, Fisk et al., 1994a, Fisk et al., 1994b, Lerdal et al., 2007, Scheinberg et al., 1980). Within 15 years of the onset of MS, almost half of patients require walking assistance and 10% become wheelchair dependent (Weinshenker et al., 1989). Since currently there is no cure with pharmacological treatment, and drug therapy has a limited effect on the disability, symptomatic and supportive therapies are important (Bourdette et al., 2004, Riley, 2004).

There is a progressive trend towards the use of yoga as a mind-body complementary and alternative medicine intervention, adjunct to medical treatment by MS patients (Esmonde and Long, 2008, Oken et al., 2004, Winterholler et al., 1997). Although it is popular and reported as highly satisfactory by patients with MS, there are few yoga studies in MS using objective quantitative outcome measures.

Exercise is extremely important for individuals with MS. Although findings are heterogeneous, many studies support the beneficial effects of different types of exercise, i.e. endurance and resistance training, combined programs, and aquatic exercises, on strength, endurance, fatigue, balance, walking, mood, and health-related quality of life in patients with MS (Andreasen et al., 2011, Dalgas et al., 2009, Garrett and Coote, 2009, Garrett et al., 2013, Oken et al., 2004, Petajan et al., 1996, Sutherland et al., 2001).

Since MS is characterized by various neurologic deficits, an optimal exercise modality does not exist. The benefits of yoga postures (asanas), working with the breath (pranayama) and meditation may include increased body awareness, release of muscular tension, increased coordination and balance, increased flexibility and strength, control over fatigue, improved circulation and breathing. Yoga focuses on improving a person's physical, mental and spiritual well-being. The main aim of yoga is to harmonize the body, mind and spirit through a combination of poses, meditation and breathing exercises. Unifying body, mind and spirit allows one to achieve a sense of wholeness, peace and self-realization. Yoga poses are constructed in a way that works towards a common goal, such as battling fatigue, reducing spasticity, improving cognitive function and increasing range of motion (Fishman and Small, 2007, Velikonja et al., 2010).

The purpose of this study was to determine the effects of 12 weeks of short term yoga therapy on fatigue, balance and gait parameters in people with multiple sclerosis (MS).

Section snippets

Methods

After getting informed consent, eight volunteer ambulatory patients with multiple sclerosis (MS), with clinically definite relapsing remitting MS (which presents with fluctuations of symptoms and mild disability), and whose Expanded Disability Status Score (EDSS) was less than or equal to 6.0, and eight age, gender and body mass index similar healthy subjects were included in the study. Three patients were on Interferon beta 1a; two on Glatiramer acetate; one on Tizanidine, and one on

Results

Demographic and anthropometric features of the patients and healthy controls are shown in Table 2. All patients attended every yoga session and completed the 12 week bi-weekly yoga program. Related to the intervention, no adverse effect is observed or reported. Compared to baseline measurements, fatigue and balance scales improved significantly in patients with MS (Table 3).

Baseline spatiotemporal parameters of gait, i.e. cadence, step length and walking speed were lesser, while double support

Discussion

The objective of this study was to assess the effects of 12 weeks of yoga therapy on fatigue, balance and gait in ambulatory patients with MS. This is the first study that evaluates the effect of yoga on mobility by using three-dimensional quantitative gait analysis in patients with multiple sclerosis.

The gait analysis findings in patients with MS are in agreement with literature. Patients with MS have typically walked slowly, with a shorter stride length and prolonged double support phase,

Conclusion

Several limitations of this study should be noted. A major limitation of the present study is that the study group was relatively small. Despite the limitations of the small sample size and short term follow up, yoga therapy is found beneficial for improving fatigue, balance, step length and walking velocity in patients with MS in this study. Not significant, but visible improvements in peak pelvic tilt, peak hip extension and ankle power at push off are thought to be the resulting improvement

Acknowledgments

We wish to thank Yoga instructors Feride Gul Cakiroglu and Ece Akay for guidance and helping in this study.

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