ECSS Paris 2023: CP-MH09
INTRODUCTION: Multiple sclerosis (MS), a chronic disease of the central nervous system, is characterized by a range of symptoms and impairments that affect performance in everyday activities and social participation. Targeted promotion of activities and participation can be achieved through exercise-based interventions, while the implementation of Patient-Reported Outcomes provide valuable insights into treatment effects at the individual level. This study investigates the effectiveness of hippotherapy on the components activities and participation of the International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization (WHO) in individuals with multiple sclerosis. METHODS: This investigation is part of the MS-HIPPO II study, a prospective, multicenter, randomised controlled trial. A total of 103 participants with MS (age: 55.7±9.79 years; 91 women, 12 men; Expanded Disability Status Scale (EDSS) between 4.0 and 6.0; mean EDSS: 5.36 ±0.71) were included. Participants were randomly assigned to either the intervention group (IG: 12 weeks of hippotherapy (DKThR)®, additional to treatment as usual; n = 55) or the control group (CG: treatment as usual; n = 48). Global functioning was assessed with the ICF-based World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at baseline, post-intervention, and at 6-week follow-up. RESULTS: Repeated-measures ANOVA revealed significant time x group interaction effects, indicating significant improvements in the IG across all six WHODAS 2.0 domains (cognition, mobility, self-care, getting along, life activities (household and work), participation), as well as the 32-item summary score. Holm-adjusted post-hoc tests revealed significantly higher functioning in the IG compared to the CG at post-test for mobility (MDiff = -14.872, d = -0.818, pholm < 0.001) and for self-care (MDiff = -12.125, d = -0.575, pholm = 0.036). At follow-up, significant differences in favour of the IG were observed for mobility (MDiff = -15.426, d = -0.849, pholm < 0.001), self-care (MDiff = -13.481, d = -0.639, pholm = 0.028), and life activities (household) (MDiff = -16.803, d = -0.668, pholm = 0.021). For the 32-item WHODAS summary score, the IG showed significantly higher global functioning than the CG at both post-test (MDiff = -10.198, d = -0.638, pholm = 0.018) and the follow-up (MDiff = -10.789, d = -0.674, pholm = 0.017). CONCLUSION: Global functioning improved and WHODAS 2.0 disability score decreased following hippotherapy across ICF domains activities and participation, with effects maintained at follow-up. The findings support hippotherapy as an effective adjunct to rehabilitation for individuals with MS to maintain mobility in everyday life and underline the value of ICF-based outcome measures for evaluating equine-assisted interventions within a rehabilitative context using a standardized and internationally comparable framework.
Read CV Franca RosinyECSS Paris 2023: CP-MH09
INTRODUCTION: With the progresses in healthcare and the slowly advancing base of research involving people with Down syndrome (DS), this current generation might be the first to outlive their parents and caregivers. Previous work (MinDSets) [1,2] demonstrated that prescribed aerobic exercise over an eight-week period led to both physical and cognitive improvements in adults with DS. The purpose of this study was to return to the MinDSets population 18-months later and examine the degree of sustainability in these physical and cognitive indices. METHODS: Thirty-two participants (19 females, 13 males; age: 28.4 ± 7.9 years) who had completed the MinDSets study agreed to repeat the physical and cognitive assessment battery and provide details on physical activity (PA) habits 18-months later. Participants were asked to record two 6-minute walk tests (6MWT). Cognitive and executive function was assessed through Corsi block test (CORSI), Sustained Attention to Response Task (SART), and Stroop Task (STROOP). Participants also completed the satisfaction with life (SWLS) and generalised self-efficacy (GSE) scales, as well as the 65-item Profile of Mood States (POMS) instrument. RESULTS: Self-reported participation in PA and exercise increased, with significance in participation in vigorous daily PA from 9 to 28% (Z=-2.121, p=0.034) (pre- to 18-month post-intervention); number of days, time per day and week were unchanged. For the measures from post-intervention to 18-months post, 6MWT dropped from 527±98 to 510±82 m (p=0.330) but stayed above baseline (490±105 m). CORSI span increased from 3.9±1.4 to 4.2±1.1 (p=0.456); SART GO response time decreased (Z=-2.139, p=0.032) with number of correct and incorrect responses remaining similar for both GO and NO-GO trials (p>0.05); non-significant changes were observed for all STROOP variables. There were non-significant increases in SWLS (0.1±2.9) and decreases in GSE (-0.6±4.7). Negative changes were seen for mood states of depression (Z=-2.557, p=0.011), fatigue (Z=-2.281, p=0.023), and confusion (Z=-2.077, p=0.038), whilst a positive change was found in vigour (Z=-3.224, p=0.001). CONCLUSION: Overall, positive short-term effects of the MinDSets study on physical, cognitive, and psychosocial health were maintained 18-months after the end of the intervention. There is the potential that the prescribed programme of the MinDSets study helped in forming habits for regular physical and cognitive training and instilled the significance of improving and maintaining physical and mental wellbeing which is particularly important given the greater decline in those factors with age in people with DS. 1. Merzbach V, et al., Int J Environ Res Public Health 2023; 20:7121. 2. Merzbach V, et al., Int J Environ Res Public Health 2024; 21:610.
Read CV Dan GordonECSS Paris 2023: CP-MH09
INTRODUCTION: Wheelchair athletes require significant upper-body power. Although the relationship between maximal strength and body composition in para powerlifters has been studied [1], the relationship between muscle power and body composition in wheelchair athletes remains unclear, particularly whether regional rather than whole-body composition is more relevant. This study aimed to clarify the relationship between regional body composition and upper-limb push power in wheelchair athletes. METHODS: Twenty-one female wheelchair athletes underwent maximal upper-limb push power testing on a servo-controlled isokinetic dynamometer (Medimo Co., Ltd., Japan) in the seated position. Five velocities (0.6, 0.7, 0.8, 0.9, and 1.0 m/s) were tested twice. The maximum value was recorded as absolute maximal push power. Subsequently, the relative maximal push power normalized to body weight was also calculated. Lean body mass (LBM) and fat mass (FM) were obtained using dual-energy X-ray absorptiometry (DXA) for the entire body and specific regions (upper limbs and upper limbs plus trunk). The LBM and FM indices were calculated by dividing the respective values by the square of the height (or arm span when height was unavailable) (kg/m²). Spearman’s rank correlation coefficients were calculated for LBM and FM with absolute maximal push power, and for LBM and FM indices with relative maximal power. RESULTS: Absolute maximal push power showed significant positive correlations with upper-limb LBM (ρ = 0.666, p = 0.001), and upper-limb plus trunk LBM (ρ = 0.471, p = 0.031), but was not significantly correlated with whole-body LBM (ρ = 0.382, p = 0.088). Relative maximal push power showed a significant positive correlation with upper-limb LBM index (ρ = 0.535, p = 0.012) but significant negative correlations with whole-body FM index (ρ = −0.714, p < 0.001), upper-limb FM index (ρ = −0.575, p = 0.006), and upper-limb plus trunk FM index (ρ = −0.688, p < 0.001). CONCLUSION: These results suggest that a higher upper-limb LBM index is associated with higher relative maximal upper-limb push power, whereas higher fat mass indices are associated with lower relative power. This pattern indicates that excess fat may impose an additional load that does not contribute to power production, thereby reducing relative power when expressed relative to body mass. Our results are consistent with prior work in para-powerlifters reporting a strong relationship between upper-limb LBM and maximal strength [1], and extend this concept by linking upper-limb muscle size to push power outcomes in wheelchair athletes. Notably, upper-limb lean mass was significantly correlated with push power, whereas whole-body lean mass was not, which may reflect the primary reliance on the upper limbs for sport-specific propulsion and wheelchair maneuvers. Collectively, these results suggest that upper-limb lean mass may be an important body-composition factor related to push power performance in wheelchair athletes. REFERENCE: [1] Fahs et al., 2020
Read CV Mai KamedaECSS Paris 2023: CP-MH09