نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشیار بیومکانیک ورزشی، دانشکده علوم ورزشی، دانشگاه بیرجند، بیرجند، ایران

2 کارشناسی ارشد فیزیولوژی ورزشی، دانشکده علوم ورزشی، دانشگاه بیرجند، بیرجند، ایران

3 استادیار دانشگاه آزاد اسلامی واحد جهرم

4 کارشناسی ارشد بیومکانیک ورزشی، دانشکده علوم ورزشی، دانشگاه بیرجند، بیرجند، ایران

چکیده

از ام‌اس به‌عنوان یکی از شایع­ترین بیماری­های مزمن و خود­ایمنی در سیستم عصبی مرکزی یاد می­شود. از مهم­ترین مشکلات این بیماران، نقص­های تعادلی و مشکلات مربوط به ضعف­های عضلانی و خستگی است؛ ازاین‌رو هدف اصلی پژوهش حاضر، بررسی تأثیر دوازده هفته تمرین پیلاتس بر تعادل، قدرت عضلانی و خستگی در بیماران مبتلا به ام‌اس بود. در پژوهش نیمه تجربی حاضر، 22 زن و مرد مراجعه‌کننده به انجمن ام‌اس استان فارس به‌صورت تصادفی و هدفمند به دو گروه مساوی یازده نفره تجربی و کنترل تقسیم شدند. اندازه­گیری تعادل در این تحقیق به‌وسیله آزمون برگ، اندازه­گیری خستگی با دستگاه الکترومیوگرافی و اندازه­گیری قدرت عضلانی به‌وسیله دینامومتر دستی قبل و بعد از انجام تمرینات پیلاتس صورت گرفت. تحلیل داده­ها با آزمون­های تی مستقل و وابسته انجام شد. نتایج پژوهش نشان داد که تمرینات پیلاتس به‌طور معناداری به کاهش خستگی عضلانی، بهبود شاخص­های تعادلی و بهبود قدرت عضلانی مبتلایان به ام‌اس منجر شده است. پیشنهاد نهایی محقق به این صورت بیان می­شود که این روش تمرینی می­تواند برای بهبود تعادل، قدرت عضلانی و کاهش خستگی در این بیماران مناسب باشد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

The Effect of a Pilates Exercise Training on Muscle Fatigue, Balance Indices and Muscle Strength in Patients with Multiple Sclerosis

نویسندگان [English]

  • Saeed Ilbeigi 1
  • mohamad reza haghiroodi 2
  • Asghar Nikseresht 3
  • Mehdi Alidoost 4

1 Associate professor of Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Birjand, Iran

2 Master of Exercise Physiology, Faculty of Sports Sciences, University of Birjand, Birjand, Iran

3 Assistant Professor of Islamic Azad University, Jahrom Branch

4 Master of Sports Biomechanics, Faculty of Sports Sciences, University of Birjand, Birjand, Iran

چکیده [English]

Background and Purpose
Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by the immune system mistakenly attacking the myelin sheath, the protective covering of nerve fibers in the central nervous system (CNS). This demyelination disrupts the efficient transmission of nerve signals, leading to a wide range of neurological symptoms that vary depending on the location and extent of the damage. Over time, the cumulative damage results in progressive motor and functional impairments, significantly impacting patients’ daily lives. Among the most debilitating symptoms of MS are balance disorders, muscle weakness, and fatigue, which collectively contribute to reduced mobility, increased risk of falls, and diminished independence. These symptoms not only affect physical health but also have profound psychological and social consequences, often leading to decreased quality of life and increased dependency on caregivers. Given the progressive and unpredictable nature of MS, managing its symptoms requires a multidisciplinary approach, including pharmacological treatments, physical therapy, and lifestyle modifications. Exercise has emerged as a promising non-pharmacological intervention to mitigate some of the physical challenges associated with MS. However, due to the variability in symptom severity and physical limitations among patients, finding an appropriate and effective exercise regimen is crucial. Pilates, a low-impact exercise method focusing on core strength, flexibility, balance, and controlled movements, has gained attention as a potential therapeutic tool for individuals with MS. Its adaptability to different fitness levels and emphasis on mindful movement make it particularly suitable for those with neurological conditions.
 Methods and Materials
This quasi-experimental study investigated the effects of a 12-week Pilates training program on balance, muscle fatigue, and muscle strength in individuals with MS. Twenty-two men and women were recruited from the Fars Province MS Association in Iran. Participants were purposively and randomly assigned to either an experimental group (n = 11), which underwent the Pilates intervention, or a control group (n = 11), which continued their usual daily activities without structured exercise. The experimental group participated in supervised Pilates sessions three times per week for 12 weeks, with each session lasting approximately 60 minutes. Exercises were tailored to accommodate participants’ physical capabilities, ensuring safety and gradual progression in intensity. Outcomes were assessed before and after the intervention. Balance was evaluated using the Berg Balance Scale (BBS), a widely used clinical tool assessing static and dynamic balance through functional tasks such as standing on one leg, reaching forward, and turning. Muscle fatigue was measured via electromyography (EMG), recording electrical activity during muscle contractions to assess endurance and fatigue patterns. Muscle strength was assessed using a manual dynamometer, focusing on key muscle groups involved in posture and mobility, including the quadriceps, hamstrings, and core muscles.
 Results
Following the 12-week Pilates intervention, the experimental group demonstrated significant improvements. Balance, as measured by the BBS, showed statistically significant enhancement (p < 0.05), indicating better postural stability and reduced fall risk. EMG assessments revealed a significant reduction in muscle fatigue (p < 0.05), suggesting improved muscular endurance and delayed fatigue onset during physical activities. Muscle strength, measured by dynamometry, increased notably (p < 0.05), particularly in the lower extremities and core muscles critical for maintaining upright posture and coordinated movement. These findings align with previous research highlighting the benefits of mind-body exercises like Pilates in enhancing neuromuscular function and physical performance in neurological disorders. The focus on core stabilization likely contributed to improved balance by maintaining the center of gravity and preventing falls. Controlled, rhythmic Pilates movements promote better muscle coordination and efficiency, which may explain reduced muscle fatigue. Additionally, the progressive resistance inherent in Pilates supports muscle strengthening without excessive strain on weakened or spastic muscles, making it a safe and effective option for MS patients.
 Conclusion
Pilates is a viable exercise intervention for managing MS-related symptoms, particularly due to its low-impact nature and adaptability to individual needs. Unlike high-intensity workouts that may exacerbate fatigue or trigger muscle spasms, Pilates offers a balanced approach that enhances physical function without overwhelming the nervous system. Furthermore, the mind-body connection fostered by Pilates can positively affect mental well-being, reducing stress and improving overall mood—benefits especially valuable for individuals coping with chronic conditions like MS. Despite promising results, limitations include the relatively small sample size and short intervention duration. Future research should explore long-term effects of Pilates in larger, more diverse MS populations, including individuals at various disease stages. Investigating potential neuroprotective effects, such as impacts on neuroplasticity and cognitive function, could expand Pilates’ therapeutic applications. Comparative studies with other exercise forms, such as yoga or conventional physical therapy, would help identify the most effective strategies for symptom management in MS.
Article Message
Pilates, as a low-impact and adaptable exercise method, can enhance balance, muscle strength, and fatigue resistance in individuals with MS, making it a recommended intervention for managing MS-related symptoms.

کلیدواژه‌ها [English]

  • Multiple Sclerosis
  • Pilates
  • Balance
  • Muscle Fatigue
  • Muscle Strength
  1. Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, Milanov I. The epidemiology of multiple sclerosis in Europe. European Journal of Neurology. 2006;13(7):700-22.
  2. Rae-Grant A, Fox R, Béthoux F. Multiple sclerosis and related disorders: diagnosis, medical management, and rehabilitation. Demos Medical Publishing; 2013.
  3. Hauser SL. Multiple sclerosis and other demyelinating diseases. Harrison's Principles of Internal Medicine. 1994;2287.
  4. Dyment DA, Ebers GC, Sadovnick AD. Genetics of multiple sclerosis. The Lancet Neurology. 2004;3(2):104-10.
  5. Svensson B, Gerdle B, Elert J. Endurance training in patients with multiple sclerosis: five case studies. Physical Therapy. 1994;74(11):1017-26.
  6. Hale L, Schou E. Piggot j, Littman A, Tumilty S. The effect of combined exercise program for people with Multiple sclerosis: a Case series. Newzeland Jornal of Physiotherapy. 2003;31(3):130-8.
  7. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabilitation and Neural Repair. 2009;23(2):108-16.
  8. Morris ME, Cantwell C, Vowels L, Dodd K. Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. 2002;72(3):361-5.
  9. White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports Medicine. 2004;34:1077-100.
  10. Frzovic D, Morris ME, Vowels L. Clinical tests of standing balance: performance of persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation. 2000;81(2):215-21.
  11. Olgiati R, Burgunder J-M, Mumenthaler M. Increased energy cost of walking in multiple sclerosis: effect of spasticity, ataxia, and weakness. Archives of Physical Medicine and Rehabilitation. 1988;69(10):846-9.
  12. Rodgers MM, Mulcare JA, King DL, Mathews T, Gupta SC, Glaser RM. Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program. Journal of Rehabilitation Research and Development. 1999;36(3):183-8.
  13. Thompson AJ. Symptomatic management and rehabilitation in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. 2001;71(suppl 2):ii22-ii7.
  14. Cameron MH, Nilsagård YE. Measurement and treatment of imbalance and fall risk in multiple sclerosis using the international classification of functioning, disability and health model. Physical Medicine and Rehabilitation Clinics. 2013;24(2):337-54.
  15. Berg K, Wood-Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304-11.
  16. Ford H, Trigwell P, Johnson M. The nature of fatigue in multiple sclerosis. Journal of Psychosomatic Research. 1998;45(1):33-8.
  17. Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. Journal of Pain and Symptom Management. 2000;20(5):374-87.
  18. Lamers F, Vogelzangs N, Merikangas K, De Jonge P, Beekman A, Penninx B. Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry. 2013;18(6):692-9.
  19. Galea MP, Cofré Lizama LE, Butzkueven H, Kilpatrick TJ. Gait and balance deterioration over a 12-month period in multiple sclerosis patients with EDSS scores≤ 3.0. NeuroRehabilitation. 2017;40(2):277-84.
  20. Feinstein A. Is there a cognitive signature for multiple sclerosis-related fatigue? London, England: SAGE Publications; 2015, pp. 353-4.
  21. Asgari AH, Akbari HAN. Multiple sclerosis. Razi Magazine. 2007;18(5):24-32. (in Persian).
  22. Bayer Sharing Ph. Introduction to multiple sclerosis. (Bayer Sharing Ph Co., Translator). Tehran, Iran: Jalal Publications, 2010. (in Persian).
  23. Shaygannejad V, Sadr-Ameli M. Successful life with multiple sclerosis. Iran: Vajiran, Mashhad; 2010, pp. 68-94. (in Persian).
  24. Shoorideh AZ, Foroozan SH, Eshgh ZM, Saniei M. The effect of sport exercises on the ability of doing the daily activities in women with Multiple sclerosis referred to the multiple sclerosis association of Iran between the years of 2001 and 2002. Med Sci Uni J Rafsanjan. 2003; 8:164-71. (in Persian).
  25. Taylor N, Dodd K, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disability and Rehabilitation. 2006;28(18):1119-26.
  26. DeBolt LS, McCubbin JA. The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. Archives of Physical Medicine and Rehabilitation. 2004;85(2):290-7.
  27. Hayes HA, Gappmaier E, LaStayo PC. Effects of high-intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized controlled trial. Journal of Neurologic Physical Therapy. 2011;35(1):2-10.
  28. White L, McCoy S, Castellano V, Gutierrez G, Stevens J, Walter G, Vandenborne K. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Sclerosis Journal. 2004;10(6):668-74.
  29. Pilates JH, Miller WJ. Return to life through Contrology. Ravenio Books; 1945.
  30. Atri B, Shafiee M. Pilates exercise (based science Cotrology), Tehran: Talia; 2007; 221-6.
  31. Caldwell K, Harrison M, Adams M, Triplett T. Effect of pilates and taiji quan training on self-
  32. efficacy, sleep quality, mood and physical performance of college students. Bodywork and
  33. Movement Therapies 2009;13:155-63.
  34. Kloubec JA. Pilates for improvement of muscle endurance, flexibility, balance, and posture. The Journal of Strength & Conditioning Research. 2010;24(3):661-7.
  35. White LJ, Castellano V. Exercise and brain health implications for multiple sclerosis: part 1 neuronal growth factors. Sports Medicine. 2008;38:91-100.
  36. Mokhtarzadeh M, Majdinasab N, Ranjbar R, Negaresh R. The effect of regular physical activity on cytokine in people with multiple sclerosis: a systematic review. Sport Physiology. 2018;10(37):99-122. (in Persian).
  37. Asvar S, Taghian F. The effect of an eight-week Pilates training on interleukine-18 level, fatigue, and balance in women with multiple sclerosis. Journal of Research and Health. 2020;10(6):383-92. (in Persian).
  38. Baquet L, Hasselmann H, Patra S, Stellmann J-P, Vettorazzi E, Engel AK, et al. Short-term interval aerobic exercise training does not improve memory functioning in relapsing-remitting multiple sclerosis a randomized controlled trial. PeerJ. 2018;6:e6037.
  39. Salehzadeh K, Ayromlou H, Khajei S, Saberi Y. Effects of pilates on changes in balance, body composition, and vital signs including dual blood pressure and resting heart rate in females with Multiple Sclerosis in Tabriz, Iran. Iran J Nurs Res. 2018;13(2):17-24. (in Persian).
  40. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175-91.
  41. Norris C. Functional load abdominal training: part 1. Physical Therapy in Sport. 2001;2(1):29-39.
  42. Hajilou B, Anbarian M, Esmaili H, Sadeghi S. The effect of quadriceps fatigue on electromyographic activity of some knee joint muscles during stance phase of walking. Sport Sciences and Health Research. 2014;6(1):73-88. (in Persian).
  43. Smedal T, Lygren H, Myhr KM, Moe‐Nilssen R, Gjelsvik B, Gjelsvik O, Strand LI. Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept. Physiotherapy Research International. 2006;11(2):104-16.
  44. Berg K, Wood-Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304-11.
  45. Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2007;37(5):232-8.
  46. Cichanowski HR, Schmitt JS, Johnson RJ, Niemuth PE. Hip strength in collegiate female athletes with patellofemoral pain. Medicine & Science in Sports & Exercise. 2007;39(8):1227-32.
  47. Penelope L. Updating the principles of the Pilates method—Part 2. Journal of Bodywork & Movement Therapies. 2002;2(6):94-101.
  48. Cancela JM, Mollinedo Cardalda I, Ayán C, de Oliveira IM. Feasibility and efficacy of mat pilates on people with mild-to-moderate Parkinson's disease: a preliminary study. Rejuvenation Research. 2018;21(2):109-16.
  49. Roshandelpour Z, Abedanzadeh R. The effect of 12 weeks of training Pilates on balance and fatigue in women with multiple sclerosis. Navid No. 2018;20(64):1-12
  50. Marandi SM, Nejad VS, Shanazari Z, Zolaktaf V. A comparison of 12 weeks of pilates and aquatic training on the dynamic balance of women with mulitple sclerosis. International Journal of Preventive Medicine. 2013;4(Suppl 1): S110.
  51. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Physical Therapy. 2008;88(5):559-66.
  52. Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62(11):2058-64.
  53. Strang AJ, Berg WP. Fatigue-induced adaptive changes of anticipatory postural adjustments. Experimental Brain Research. 2007; 178:49-61.
  54. Äng BO. Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain–A clinical approach. Journal of Electromyography and Kinesiology. 2008;18(4):538-49.
  55. Szeto GPY, Straker LM, O’Sullivan PB. EMG median frequency changes in the neck–shoulder stabilizers of symptomatic office workers when challenged by different physical stressors. Journal of Electromyography and Kinesiology. 2005;15(6):544-55.
  56. Shanazari Z, Marandi SM, Minasian V. Effect of 12-week Pilates and aquatic training on fatigue in women with multiple sclerosis. Journal of Mazandaran University of Medical Sciences. 2013;22(98):257-64.
  57. Bastiaens H, Alders G, Feys P, Notelaers S, Coninx K, Kerkhofs L, Truyens V, Geers R, Goedhart A. Facilitating robot-assisted training in MS patients with arm paresis: a procedure to individually determine gravity compensation. IEEE Int Conf Rehabil Robot. 2011;2011:5975507.
  58. Tarakci E, Yeldan I, Huseyinsinoglu BE, Zenginler Y, Eraksoy M. Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clinical Rehabilitation. 2013;27(9):813-22.
    Rahmani S. The effect of group mindfulness-based stress reduction program and conscious yoga on the quality of life and fatigue in patients with multiple Sclerosis. Clinical Psychology and Personality. 2020;16(2):141-50. (in Persian).
  59. De Groot MH, Phillips SJ, Eskes GA. Fatigue associated with stroke and other neurologic conditions: implications for stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2003;84(11):1714-20.
  60. Beer RF, Ellis MD, Holubar BG, Dewald JP. Impact of gravity loading on post‐stroke reaching and its relationship to weakness. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2007;36(2):242-50.
  61. Shea S, Moriello G. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke. Journal of Bodywork and Movement Therapies. 2014;18(3):332-60.
  62. Sánchez-Lastra MA, Martínez-Aldao D, Molina AJ, Ayán C. Pilates for people with multiple sclerosis: a systematic review and meta-analysis. Multiple Sclerosis and Related Disorders. 2019; 28:199-212.
  63. Bullo V, Bergamin M, Gobbo S, Sieverdes J, Zaccaria M, Neunhaeuserer D, Ermolao A. The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: a systematic review for future exercise prescription. Preventive Medicine. 2015; 75:1-11.
  64. Barker AL, Bird M-L, Talevski J. Effect of pilates exercise for improving balance in older adults: a systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation. 2015;96(4):715-23.
  65. Fox EE, Hough AD, Creanor S, Gear M, Freeman JA. Effects of pilates-based core stability training in ambulant people with multiple sclerosis: multicenter, assessor-blinded, randomized controlled trial. Physical Therapy. 2016;96(8):1170-8.