The effect of aerobic exercise on some coronary artery disease risk factors in moderate multiple sclerosis (MS) patients.

Dissertation for Master's Degree in Physical Education and Sports Science, Sports Physiology.

Abstract

The purpose of this research was to study the effect of aerobic exercise on some risk factors of coronary artery disease in moderate multiple sclerosis (MS) patients. In this practical study, 15 women (33.68 ± 8.22 years old) with EDSS>4 were randomly divided into control (7 people) and experimental (8 people) groups. The patients of the experimental group performed aerobic exercise on the treadmill for 8 weeks, 3 days a week and every day, which included 5-10 minutes of warming up and then 20-40 minutes with an intensity of 60-80% of the maximum heart rate; While the control group continued their normal life. Blood samples and functional tests were used in both groups to measure some factors of coronary artery disease and the subjects' performance. All statistical operations were performed using SPSS 19 software. Their analysis and analysis showed that 8 weeks of aerobic exercise led to a significant reduction of coronary artery disease risk factors (triglycerides, cholesterol, LDL and HDL respectively) p=0.01, p=0.21, p=0.00 and p=0.02), decrease in blood pressure (systolic and diastolic, respectively, p=0.45 and p=0.03), decrease in physiological cost index (p=0.01), decrease in body fat percentage (p=0.00) and significant increase in functional capacity (walking endurance, walking speed, balance and maximum oxygen consumption respectively) p=0.00, p=0.00, p=0.00 and p=0.00) in patients with MS (p?0.05). According to the findings of this study, it can be stated that aerobic exercise can be a non-invasive treatment method, an effective factor in improving secondary diseases and the ability to perform daily life activities with more optimal energy expenditure, which can be recommended to patients with MS along with taking medication.

Introduction

Physical education as a science has a close relationship and cooperation with other sciences and it is in the shadow of this relationship that it has maintained its dynamism and has become wider and more advanced day by day, and finally newer sub-branches have also announced their existence in this field. One of the interesting and very important fields that has attracted the attention of many researchers today; Research is in the field of sports medicine. Today's way of life has caused people to spend a significant amount of time without physical activity, willingly or unwillingly. Therefore, to compensate for this inactivity, it is necessary to include proper physical activity in people's lives. In this regard, encouraging participation in physical activities can be beneficial in improving the health level of society and managing diseases related to inactivity. Along with the increasing decrease in sports activity in human societies, the prevalence of many chronic physical and mental diseases related to lifestyle is increasing. People with lack of physical activity face serious health risks.

Nervous system diseases have high prevalence, huge economic losses and cause various disorders and complications. The severity and variety of disorders in these patients depend on the location and extent of the lesion. The research field of sports sciences as one of the custodians of health and public health, considering the development and progress it has achieved; Today, along with other sciences, it tries to find therapeutic methods to improve the disorders caused by diseases and sports injuries, as well as to improve the health status of people in the society. So that exercise and physical activity is an important and non-pharmacological treatment method to help the recovery of multiple sclerosis (MS) patients [1] (1 and 3). This disease is unpredictable and one of the most important diseases that change a person's life; Because, it usually hurts the best period of a person's life, and in fact, this disease often affects people who are in the productive stage of their life and gradually leads to disability, which unfortunately has no definitive treatment. Research showed that physical activity including aerobic exercise prevents secondary diseases including coronary artery disease in affected people and also prevents the consequences of this disease (104 and 99). It is hoped that the scope of physical training and sports sciences, especially the branch of sports physiology, will become more apparent from this passage.

Statement of the problem

Multiple sclerosis (MS) is a chronic and incurable demyelination disease [2] of the central nervous system that causes many complications and problems for affected patients and leads them to motor disability.(2,5 and 58).  MS is derived from a Greek word sclerosis[3] meaning hardening, where scar tissue replaces the disintegrated myelin, resulting in a 1 cm thick white matter in the brain and spinal cord (192, 197). According to its type and severity, MS disease can affect many aspects of people's lives, such as interpersonal communication, job performance, spiritual beliefs, and the way of socializing (5, 49). The symptoms of MS are unclear, and as mentioned, the myelin destroys the central nervous system (brain and spinal cord), and after that, part of the body's muscles gradually lose their ability (2, 4, 193). Gait impairment in people with MS has been documented using physical performance and multiple clinical motor measures. The symptoms observed in MS may lead to abnormal walking or immobility and have negative effects on physical activity (156).

Given that MS sufferers, even with a low level of disease, usually lead a sedentary life (179), this inactivity can increase secondary diseases such as diabetes, osteoporosis, and coronary artery disease in these people (174, 104); Because coronary artery disease occurs due to the increase of triglycerides, cholesterol and low-density lipoprotein cholesterol in the blood resulting from inactivity (102); Therefore, it can be expected that a low level of cardiovascular fitness leads to a decrease in the quality of life, a decrease in aerobic capacity, and finally, an increase in fatigue and poor sleep in people with MS (17, 102, 156).

Inactivity is one of the risk factors for coronary artery disease. Coronary heart disease is a disease in which the walls of the arteries that supply blood to the heart muscles are thickened. This thickening caused by the formation of lesions in the vessel wall is called atherosclerosis[4]. These vascular wall lesions are called plaque [5]. Atherosclerosis can limit the blood supply to the heart muscle (myocardium) (6). In addition, along with known factors such as smoking, age, sex, high blood pressure, obesity, increased cholesterol, triglycerides, etc., inactivity and lack of proper physical activity are also controllable risk factors for coronary artery diseases, which have attracted the attention of physiologists, doctors, and cardiologists for years. On the other hand, a person's ability to perform sports activities depends on the efficiency and performance of different body systems, including the cardiovascular system. Therefore, with regular and long-term exercise, the heart undergoes changes. Such changes are called the phenomenon of adaptation of the heart in response to sports training or physiological changes (72). Meanwhile, sports physiology researchers have always sought to develop the most effective and effective methods of sports activity in order to make the recommendations of sports activities efficient and updated, as an important part of a healthy and hygienic lifestyle and a complementary part in the prevention and treatment of many diseases related to inactivity, including cardiovascular diseases. Among the training methods, most of the conducted studies have confirmed continuous aerobic sports activity (6). It is clear that there is a relationship between the risk of coronary artery disease and physical activity. Possible changes in lipoprotein structure during exercise training may be an important change that could explain the relationship between exercise and reduced risk of coronary artery disease. High-density lipoprotein (HDL) [6] is thought to be a major risk factor for coronary artery disease, and a low level of this lipoprotein is associated with an increased risk of coronary artery disease. Those who exercise steadily and permanently have a high level of HDL compared to their inactive counterparts. Therefore, the suggestion that exercise encourages these beneficial changes can be justified (100).

In the past, doctors advised their patients to refrain from exercising, as they were of the opinion that fatigue and increased body temperature are among the side effects of these exercises, which will worsen patients with MS (126, 152). Recently, many studies have shown that correct exercise or other rehabilitation techniques can be effective in improving these patients. Although exercise cannot stop the process of myelin loss or restore it; However, it supports and helps the person with MS with other methods (6,100).