title: High-intensity resistance training in multiple sclerosis - An exploratory study of effects on immune markers in blood and cerebrospinal fluid, and on mood, fatigue, health-related quality of life, muscle strength, walking and cognition.
abstract: BACKGROUND
  High-intensity resistance training is unexplored in people with multiple sclerosis.
  
  
  OBJECTIVE
  To evaluate effects of high-intensity resistance training on immune markers and on measures of mood, fatigue, health-related quality of life, muscle strength, walking and cognition. Further, to describe participants' opinion and perceived changes of the training.
  
  
  METHODS
  Twenty patients with relapsing-remitting multiple sclerosis performed high-intensity resistance training at an intensity of 80% of one-repetition maximum, twice a week for 12 weeks. Blood and optional cerebrospinal fluid samples, and data on secondary outcome measures were collected before and after intervention. A study-specific questionnaire was used for capturing participants' opinion.
  
  
  RESULTS
  Seventeen participants completed the study. Plasma cytokine levels of tumor necrosis factor were significantly decreased post-intervention (p=0.001). Exploratory cytokine analyses in cerebrospinal fluid (n=8) did not reveal major changes. Significant and clinically important improvements were found in fatigue (p=0.001) and health-related quality of life (p=0.004). Measures of mood (p=0.002), muscle strength (p ≤ 0.001), walking speed (p=0.013) and cognition (p=0.04) were also improved. A majority of participants evaluated the training as very good and perceived changes to the better.
  
  
  CONCLUSIONS
  High-intensity resistance training in persons with relapsing remitting multiple sclerosis with low disability had positive effects on peripheral pro-inflammatory cytokine levels, led to clinically relevant improvements in measures of fatigue and health-related quality of life, and was well tolerated. These results provide a basis for a larger randomized trial.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23 100, S-141 83 Huddinge, Sweden; Department of Physiotherapy, A6:U1, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Electronic address: Marie.Kierkegaard@ki.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Kierkegaard
authors.affiliation: Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, Karolinska Institutet, S-171 76, Stockholm, Sweden. Electronic address: Ingrid.Lundberg@ki.se.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.affiliation: Department of Clinical Neurosciences, K8, Karolinska Institutet, CMM L8:04, S-171 76 Stockholm, Sweden; Department of Neurology, R3:04, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Electronic address: Tomas.Olsson@ki.se.
authors.forename: Tomas
authors.initials: T
authors.lastname: Olsson
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23 100, S-141 83 Huddinge, Sweden; Department of Physiotherapy, A6:U1, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Electronic address: Sverker.Johansson@ki.se.
authors.forename: Sverker
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Elevhemmet H2:00, Karolinska University Hospital, S171 76 Stockholm, Sweden. Electronic address: Sofia.Ygberg@karolinska.se.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ygberg
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23 100, S-141 83 Huddinge, Sweden; Department of Rheumatology, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Electronic address: Christina.Opava@ki.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Opava
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23 100, S-141 83 Huddinge, Sweden; Department of Physiotherapy, A6:U1, Karolinska University Hospital, S-171 76 Stockholm, Sweden; Department of Clinical Neurosciences, Division of Neurology, Karolinska Institutet, R54 Karolinska University Hospital, S-141 86 Stockholm, Sweden. Electronic address: Lotta.Holmqvist@ki.se.
authors.forename: Lotta Widén
authors.initials: LW
authors.lastname: Holmqvist
authors.affiliation: Department of Clinical Neurosciences, K8, Karolinska Institutet, CMM L8:04, S-171 76 Stockholm, Sweden; Department of Neurology, R3:04, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Electronic address: Fredrik.Piehl@ki.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Piehl
mesh_terms: D000293:Adolescent; D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation; D016207:Cytokines / Q000097:blood* / Q000134:cerebrospinal fluid*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000378:metabolism / Q000523:psychology / Q000534:rehabilitation; D053580:Muscle Strength / Q000502:physiology*; D009483:Neuropsychological Tests; D011788:Quality of Life / Q000523:psychology*; D055070:Resistance Training; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D016207:Cytokines
keywords: Exercise; Fatigue; Immunology; Multiple sclerosis; Quality of life; Resistance training