Exercise as it relates to Disease/Does aquatic exercise training impact the functional capacity, balance and fatigue in female patients with Multiple Sclerosis?

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In this Wikibook is fact sheet provides a summary and critiques of the article ‘Randomized controlled trial to examine the impact of aquatic exercise training on functional capacity, balance, and perceptions of fatigue in female patients with multiple sclerosis’ by Kargarfard, M.et.al' (2017) [1]

Research Background[edit]

Multiple Sclerosis is the third most common neurological disease disrupting sensation, mobility, balance, vision and cognitive function. [2] World Health Organisation survey in 2013 highlighted the increase in Multiple Sclerosis from 2.1 million in 2008 to 2.3 million in 2013.[3]Diagnosis of Multiple Sclerosis is seen between 20-50 years with the peak diagnosis age at 30 years.[4] The neurodegenerative disease is separated into two classifications

• Relapsing- remitting (a dysfunctional neurological episode lasting at least 24 hours in the absence of an infection or fever followed by a period of remission)

• Primary progressive (a slow progressive decline in neurological disability).[5]

Currently there is no cure for the neurological disease. Research for treatment continues as the projected number impacted is increasing worldwide with an estimated 2.5 million adult’s world affected.1 In 2011, the estimated cost of Multiple Sclerosis in the United States was 24.2 billion dollars annually.[6]

In relation to multiple sclerosis exercise has been recommend in helping control and improve symptoms.1 This article aim is to “To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis”1

Origin of Research?[edit]

The research study included 32 female Iranian participants diagnosed with relapsing- remitting Multiple Sclerosis. There was no clear explanation on where the study took place only the pre-assessment being undertaken at an Isfahan community-based group, Multiple Sclerosis Society.

Authors have previously conducted research around the benefit of exercise on Multiple Sclerosis however have limited experience in aquatic exercise. A larger portion of research conducted by the authors have been completed in Iran.

Research Type?[edit]

The study was conducted as a randomized control trial research intervention. Random Control Trial (RCT) have less risk of errors due to its unbiased nature which places these trials under the highest ranked level of evidence.2

What did the research involve?[edit]

The aim of the research was to assess effects of an 8-week aquatic exercise program on the functional capacity, balance, and perception of fatigue in Iranian women with multiple sclerosis.1

Research Methodology and Limitations[edit]

The study included 32 females diagnosed with relapsing- remitting Multiple Sclerosis.

Prior to the commencement of the study all participants participated in pre-assessment screening. Participants were required to have been diagnosed with Multiple Sclerosis at least 2 years prior to the research and have a magnitude of neurologic impairment and disability score ≤ 3.5. If these requirements were achieved the participants moved onto part two partaking in five-assessment, 6-minute walking test, berg balance scale, sit- to- stand test, push-up test and modified fatigue impact scale.1

The participants separated into two groups, controlled and experimental.

   Controlled Group: Continued in their normal routine and did not participate in the 8- week designed program however was required to see the neurologist 2-3 week for 30-40 minutes and received weekly educational sessions. 
   Experimental Group:  Participated in an 8- week aquatic exercise training program in addition to their normal care. Furthermore, participants saw the neurologic physical therapist during the 2-3 times a week for 30-40 minutes and also received a weekly educational session. Aquatic training consisted of 3 sessions a week for 60 minutes with an intensity between 50%- 75% of their estimated heart rate reserve, focusing on joint mobility, functional exercises, balance and different walking intensities performing 10-12 repetitions.  

Limitations within the research methodology of the study:

  • Small sample size of this study with only 32 participants creates a large margin for error.
  • Test was only conducted on female participants displaying a gender imbalance in the research.
  • The controlled group had no structural exercise to participate in which displayed a decline in their pre-assessment test. A land based structured exercise program could have been more beneficial in assisting their performance decrease.
  • The study only being specific to Iranian woman limited the culture diversity of the study.

Basic Results?[edit]

The aquatic 8- week intervention displayed a positive effect in the assessment conducted prior to the intervention. The aquatic structured exercise program displayed a positive improvement in functional capacity, balance and fatigue.1

The impact of 30-40-minute meeting with neurologist was inconclusive as there was no evidence of what was performed during those times.

Findings align with another study on implementing an aquatic exercise programs to improve balance, fatigue management and functional capacity.[7]The duration of the study delivered an extended amount of time compared to other research projects, allowing additional time for improvement to be seen.1

Aquatic exercise impact on Multiple Sclerosis is an ever-growing research area with the positive research evidence increasing.

Research Conclusions[edit]

In reviewing the research article, the results show the positive impact aquatic exercise can have on Multiple Sclerosis symptoms improving the functional capacity, balance and fatigue.

The symptoms of Multiple Sclerosis can be debilitating for those effected but research into the implementing exercise to assist balance and strength is seen to have a positive impact in assisting symptoms and walking capacity.1,[8]

Research in a greater population with a high percentage of Multiple Sclerosis would be increase the soundness of the research. Iran is seen to be a low risk area of Multiple Sclerosis in the world.[9]

Further study into the area of aquatic exercise with a larger experimental group and the addition of diversity of both gender and culture within the group would give validity to the research.

Practical advice?[edit]

It is important to obtain advice from your general practitioner and obtain medical clearance before partaking in physical activity.

Physical activity provides benefits not only for overall health but also assist in fatigue and muscle stiffness management.8

Understanding the level of intensity, duration and requirements of the exercise intervention is important information to know before accepting to participate.

Further Information[edit]



https://www.msaustralia.org.au/file/268/download?token=Cm3n9EVz .


  1. Kargarfard, M.,Shariat, A., Ingle,, L., Cleland, J.,& Kargarfard, M.(2017). Randomized controlled trial to examine the impact of aquatic exercise training on functional capacity, balance, and perceptions of female patients with multiple sclerosis. American Congress of Rehabilitation Medicine. 99(2) 234-241
  2. 2. Burns PB, Rohrich RJ, Chung KC. (2011) ‘The Levels of Evidence and their Role in Evidence-Based Medicine’. Plast Reconstr Surg. 128(1):305-310.
  3. 3. Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C.,Taylor, B., & Thompson, A. Neurology Sep 2014, 83 (11): 1022-1024; DOI:10.1212/WNL.0000000000000768
  4. 4. Habibi M, Kuttab H-M. Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems. American Journal of Health-System Pharmacy; 73(11):811–9.
  5. 5. Brownlee, W., Hardy, T., Fazekas, F., & Miller, D. (2017) Diagnosis of multiple sclerosis: progress and challenges. The Lancet, 389 (10076):1336-1346.
  6. 6. Gooch, C., Pracht, E., & Borenstein, A. (2017) The burden of neurological disease in the United States: A summary report and call to action. American Neurological Association. 81 (4): 479-484
  7. 7. Methajarunon, P., Eitivipart, C., Diver, C., Foongchomcheay, A. (2016). Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, parkinson’s disease, and hemiplegia. Hong Kong Physiotherapy Journal; 35: 12-20.
  8. 8. Saeideh Aminian, Victor E. Ezeugwu, Robert W. Motl & Patricia J. Manns (2017) Sit less and move more: perspectives of adults with multiple sclerosis, Disability and Rehabilitation, DOI: 10.1080/09638288.2017.1416499
  9. 9. Moghtaderi, A., Rakhshanizadeh, F., & Shahraki-Ibrahimi, S. (2001) Incidence and prevalence of multiple sclerosis in southeaster Iran. Clinical Neurology and Neurosurgery. 115 (3): 304-308