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Yıl:2023; Cilt: 60; Sayı: 4>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2023;60(4):335-343
Egzersiz Multipl Sklerozlu Hastalarda Fiziksel Kapasiteyi, Kognisyonu, Yaşam Kalitesini İyileştirir ve Nörotrofik Faktörleri Artırır
M Açık , S Şenışık , D Taşkıran , T Akşit , R Aydınoğlu , AN Yüceyar
Hatay Eğitim ve Araştırma Hastanesi, Hatay
Amaç: Bu çalışmadaki amacımız Multipl Skleroz (MS) hastalarında yapılan düzenli egzersizin aerobik kapasite, kuvvet değerleri ve Sinir Büyüme Faktörü (NGF), Nörotrofin-3 (NT-3) plazma düzeyleri üzerindeki etkisini değerlendirmek, bilişsel işlevlerdeki bozulma, yorgunluk, denge bozukluğu gibi MS semptomlarına, uyku ve yaşam kalitesi değerlerine etkisini araştırmaktı. Yöntem: Expanded Disability Status Scale (EDSS) skoru 4 ve altında olan 43 yineleyici MS (RRMS) hastası çalışmaya katıldı. Katılımcılar aerobik grup (AG), kuvvet grubu (KG) ve kontrol grubu olarak üç gruba ayrıldı. Egzersiz gruplarındaki hastalar üç ay boyunca, haftada üç gün egzersiz programlarını uyguladılar. Katılımcıların çalışma başında ve sonunda aerobik kapasite (maksimal VO2 değeri; VO2 maks) ve kuvvet ölçümleri, denge testleri yapıldı, ELISA yöntemi ile NGF ve NT-3 plazma değerleri analiz edildi. Multipl Skleroz Yaşam Kalitesi (MSYK-54) Enstrümanı, Yorgunluk Etki Ölçeği (YEÖ) ve Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ölçekleri hastalar tarafından dolduruldu. Kognitif fonksiyonu değerlendirmek için MS için Kısa Uluslararası Bilişsel Değerlendirme ölçeği uygulandı. Bulgular: Aerobik egzersiz ve kuvvet egzersizi gruplarında VO2 maks ve sırt ve bacak kuvveti değerlerinde, NGF ve NT-3 plazma düzeylerinde istatistiksel olarak anlamlı artışlar görüldü (p<0,01). Kognitif fonksiyon, yorgunluk, uyku ve yaşam kalitesi ölçeklerinde de egzersiz gruplarında istatistiksel olarak anlamlı düzelme görüldü (p<0,01). Denge değerlerinde aerobik grupta istatistiksel olarak anlamlı düzelme görülürken (p<0,01), kuvvet grubunda ise düzelme olmasına rağmen istatistiksel olarak anlamlı değildi (p>0,05). Sonuç: Çalışmamızda MS hastalarında düzenli egzersizin bilişsel fonksiyonlar, yorgunluk, yaşam ve uyku kalitesi üzerine olumlu etkileri gösterilmiştir. Nöral rejenerasyon ve remiyelinizasyonda önemli faktörler olan NGF ve NT-3 seviyeleri egzersiz sonrası yükselmiştir. Bu sonuçlarla egzersizin MS üzerine potansiyel bir etkisinin olabileceği ve hastalık sürecini yavaşlatabileceği ileri sürülebilir.
Exercise Improves Physical Capacity, Cognition, Quality of Life and Promotes NeurotrophicFactors in Patients with Multiple Sclerosis
Introduction: We aimed to determine the effect of regular exercise on aerobic capacity, strength values, and plasma levels of Nerve Growth Factor (NGF) and Neurotrophin-3 (NT-3) in patients with multiple sclerosis (MS) and investigate its effects on MS symptoms including cognitive impairment, fatigue, balance disorders, and quality of life (QOL). Methods: Forty-three relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score of 4 or less participated in the study. Participants were divided into three groups: aerobic group, strength group, and control group. The patients in the exercise groups had exercise programs three days a week for three months. Aerobic capacity (maximum VO2 value), strength measurements, and balance tests were done, and NGF and NT-3 plasma levels were analyzed in all participants at the beginning and end of the study. Multiple Sclerosis Quality of Life54 (MSQoL-54), fatigue impact scale, Pittsburgh Sleep Quality Index (PSQI) and, to evaluate cognitive functions, BICAMS scale were applied. Results: Aerobic exercise and strength exercise groups had significant increases in VO2 max, back and leg strength values, and NGF and NT-3 plasma levels (p<0.01). Cognitive functions, fatigue, sleep quality, and QOL significantly improved in the exercise groups (p<0.01). The balance values were also significantly improved in the aerobic group (p<0.01), and althoughimprovement although improvement was observed in the strength group, it was not statistically significant (p>0.05). Conclusions: Our study provides evidence that regular exercise improves quality of life, cognitive functions, fatigue, and sleep quality in MS patients. The levels of NGF and NT-3, which are important factors in neural regeneration and remyelination, were increased post exercise. It can be suggested that exercise may have a potential effect on MS and slow down the disease process with these results.

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