Intervention Program of Physical Activity in the Prevention of Fatigue in Multiple Sclerosis Luisa Pedro 1; J. Pais-Ribeiro 2; J. Páscoa Pinheiro3 1
ESTESL-IPL Lisboa - Portugal; 2 FPCE-UP/UIPES Porto - Portugal; 3 FMUC/HUC Coimbra- Portugal
[email protected] ; 00351967770077
Introduction: Multiple Sclerosis (MS) is a chronic disease of the central nervous system, most often in female adults with no cure and of unknown cause1,2,3. The most common symptoms are: fatigue, muscle weakness, changes in sensation, ataxia, impaired balance, difficulty walking, memory problems, cognitive dysfunction and difficulties in problem solving1,2,4,5,6,7 . MS is a progressive disease and unpredictable, resulting in some cases, disability and activity limitations daily life, causing irreparable damage to individuals. This disease can occur of relapsing–remitting or progressive5,6,7. Fatigue in multiple sclerosis is defined as subjective lack of Physical or Mental energy that is perceived by the individual or caregiver to interfere with activities of life. The source of fatigue could be a power failure production at muscle (peripheral fatigue) or a failure to sustain the required neural drive to muscle (central fatigue). It is likely that both extremes of the fatigue spectrum are important in M S 8. There are several studies that demonstrate the importance of physical activity, prevention of fatigue in MS patients9, 10. The intervention program based on self-regulation model is based on a sequence of actions and / or orientation processes to achieve a personal goal. This model fully three procedural stages: first phase, individuals due to establish the goals they wish to achieve, in a second phase is necessary to seek objectives to implement active strategies to achieve pre-established goals, a third phase it is important to the achievement of
objectives, as well as maintenance. In all these phases are involved in emotional and cognitive aspects of the individual11. This intervention program for MS patients, aims to promote physical activity, using as the basis of the conceptual model of self-regulation to improve the perception of fatigue on these individuals. Material and Methods: This is a prospective study evaluates the perception of fatigue, through an intervention program. We carried out an assessment at the beginning of the intervention program and a second evaluation at the end. The intervention group consists of 27 people with diagnosis of more than one year. They met the inclusion criteria were individuals living in the community without cognitive impairment, with levels in Expanded Disability Status Scale (EDSS) 12 to 6 (moderate neurological dysfunction). The variables: demographic variables, disease variables and outcome variable fatigue. Instruments: a demographic questionnaire (age, sex, profession, marital status, education), illness variables (disease severity, year of diagnosis and auxiliary gear), and Fatigue Severity Scale developed by Krupp, Nicholas, Muir-Nash, Steinberg in 1989, consisting of 9 items13. This intervention program is developed in groups 8-10 people with MS, seven times a week for about 90 minutes. The sample was carried through three intervention groups, attended the Portuguese Society of Multiple Sclerosis (SPEM) and Service of Physical Medicine and Rehabilitation Hospital of the University of Coimbra (HUC). We followed the procedures of the Declaration of Helsinki. Each session consisted of 3 distinct parts: the first part aims to foster a group discussion about a theme that reflects the inability or limitation will be physical activity, as well as to discuss strategies to
minimize these limitations. In the second part, we make an exercise session, members will be streamlined theme that was before and the third part asked participants to establish individual strategies that will be held until the next session. Exercises were conducted, based on studies to promote physical activity in people with MS14,15,16. Proceeding to statistical analysis using the program "Statistical Package for Social Sciences - SPSS", versions 20, the data on the demographic questionnaire were treated descriptively taking into account the frequency distribution of the variables into account. To verify the difference between means at two different times, for paired samples, we used the Wilcoxon test. Results: Of the 24 participants (58.3%) are women with a mean age M = 44, 75, SD = 10.71, mean schooling with M = 12.50 SD = 5, 71. We found that (37.5%) are married and most (66, 7%) are retired and (45, 8%) live with their parents. The difficulties in moving, it appears that (50%) has difficulties in moving at home, however, most move with an auxiliary running inside, preferably a stick. Most states that have difficulties in moving away from home (58, 3%) of these (33.3%) prefer a stick. For the year of diagnosis showed a mean M = 7.21 and about (52, 1%) had an outbreak last year. There are significant differences in the perception of fatigue (p
