Adaptations of fatigue and fatigability after a short intensive, combined rehabilitation program in patients with multiple sclerosis

Abstract

OBJECTIVE: Fatigue and fatigability are common problems in patients with multiple sclerosis, which might be improved by rehabilitation. The aim of this pilot study was to assess changes in the fatigue and fatigability of knee extensors in patients with multiple sclerosis after a short intensive, combined rehabilitation programme (including physiotherapy primarily focused on gait and balance, endurance and resistance training). METHODS: Twenty-three patients with multiple sclerosis (10 men, 13 women) underwent isokinetic evaluations of fatigability of the knee extensor muscles during concentric contractions and rated a self-reported fatigue scale (Modified Fatigue Impact Scale; MFIS) before and after a rehabilitation programme. Patients performed rehabilitation for 150 min, 4 days per week for 4 weeks, with physiotherapy focused primarily on gait and balance, endurance training and resistance training. RESULTS: After rehabilitation, perception of fatigue decreased significantly (median MFIS scores [1st; 3rd quartiles], pre: 44 [33; 53] vs post: 33.5 [16; 43]; <0.00025). Moment fatigue index increased (pre: 37.70±13.40 vs post: 48.10±9.39; p<0.0125), but end-test moment did not change. After rehabilitation, strength increased during both isometric and concentric contraction (mean first 5 and mean 50 contractions of the fatigue protocol) (p<0.0125). After rehabilitation, neuromuscular efficiency improved (p<0.0125). CONCLUSION: After a short, intensive, combined rehabilitation programme, fatigue decreased but fatigability increased (moment fatigue index). Indeed, fatigability increased because strength in the initial state increased and strength in the fatigued state did not change. Although the rehabilitation programme was designed so that resistance training was carried out after endurance training to specifically train muscles in a fatigued state, no improvements in strength in the fatigued state were measured.