The Effect of Neuro-Functional Training on the Quality of Life and Physical Performance of Multiple Sclerosis Patients with Cognitive Impairment

Mardaniyan Ghahfarrokhi, Majid; Fallahi, Samin; Banitalebi, Ebrahim; Rezaei, Mahbod; Motl , Robert

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Volume 33, Issue 5 (11-2025)

Journal of Ilam University of Medical Sciences 2025, 33(5): 1-17

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The Effect of Neuro-Functional Training on the Quality of Life and Physical Performance of Multiple Sclerosis Patients with Cognitive Impairment

Majid Mardaniyan Ghahfarrokhi ^*¹

, Samin Fallahi²

, Ebrahim Banitalebi²

, Mahbod Rezaei²

, Robert Motl³

1- Dept of Exercise Physiology, Faculty of Sport Sciences, Arak University, Arak, Iran & Research Institute of Applied Studies in Sports Sciences, Arak University, Arak, Iran , m-mardanian@araku.ac.ir
2- Dept of Sport Science, Shahrekord University, Shahrekord, Iran
3- Dept of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, USA

Abstract: (33 Views)

Introduction: In conditions such as the COVID-19 pandemic, home-based exercises have been recommended as a suitable alternative to center-based exercises in patients with MS. The aim of the present study was to investigate the effect of six months of home-based neuro-functional training on the quality of life and physical performance of patients with MS with cognitive impairment.
Materials & Methods: In this quasi-experimental study, 62 patients with MS (age 38.79±9.03 years, disease duration 8.53±5.66 years, and disability scale score 4.32±1.22) were randomly divided into two groups of neuro-functional exercises and control after diagnosis of cognitive impairment. After one month of training in the center, the patients performed home-based exercises in three sessions per week for six months. Physical performance was assessed during monthly visits and a monthly exercise program was presented. Anthropometric and quality of life indicators were measured one week before and one week after the protocol. Inter-group comparisons of anthropometrics and quality of life were performed with independent t-tests, and physical function was performed with two-way ANOVA (group*time). Analyses were performed with SPSS V.25 and GraphPad Prism 7 at the 0.05 level.
Results: The results showed that six months of home-based neuro-functional training significantly improved walking ability (P≤0.001), lower limb-dominant leg function (P=0.009), and non-dominant leg (P≤0.001) compared to the control group. No significant difference was observed in the quality-of-life variable between the study groups (P≥0.059).
Conclusion: Long-term home-based neuro-functional training, following the principle of gradual overload with a low gradient, can be considered as an effective intervention to improve walking ability in patients with MS.

Keywords: Multiple sclerosis, Cognitive impairment, Functional training, Quality of life, Walking ability

Full-Text [PDF 1020 kb] (20 Downloads)

Type of Study: Research | Subject: Physical Education
Received: 2025/07/9 | Accepted: 2025/08/26 | Published: 2025/03/25

References

1. Negaresh R, Gharakhanlou R, Sahraian MA, Abolhasani M, Ghahfarrokhi MM, Motl RW. Body weight moderates the benefits of physical exercise on brain health in multiple sclerosis: An MR volumetric and spectroscopy study. Mult Scler Relat Disord. 2025;102:106621. doi: 10.1016/j.msard.2025.106621.

2. Lafarenko MY. Assessment of depression and anxiety in patients with multiple sclerosis depending on disease severity according to the EDSS. Int J Neurol. 2025;21:30-5. doi:10.22141/2224-0713.21.1.2025.1148.

3. Motl RW, Sandroff BM. Exercise as a countermeasure to declining central nervous system function in multiple sclerosis. Clin Ther. 2018;40:16-25. doi: 10.1016/j.clinthera.2017.12.001.

4. Monticone M, Ambrosini E, Laurini A, Rocca B, Foti C. In‐patient multidisciplinary rehabilitation for Parkinson's disease: a randomized controlled trial. Mov Disord. 2015;30:1050-8. doi: 10.1002/mds.26256.

5. Smaili SM, Bueno MEB, Barboza NM, Terra MB, Almeida IAd, Ferraz HB. Efficacy of neurofunctional versus resistance training in improving gait and quality of life among patients with Parkinson’s disease: a randomized clinical trial. Motriz: Revista de educação física. 2018;24:e1018123. doi:10.1590/S1980-6574201800020004.

6. Gharakhanlou R, Wesselmann L, Rademacher A, Lampit A, Negaresh R, Kaviani M, et al. Exercise training and cognitive performance in persons with multiple sclerosis: a systematic review and multilevel meta-analysis of clinical trials. Mult Scler. 2021;27:1977-93. doi: 10.1177/1352458520917935.

7. Afkar A, Ashouri A, Rahmani M, Emami Sigaroudi A. Effect of exercise therapy on quality of life of patients with multiple sclerosis in Iran: a systematic review and meta-analysis. Neurol Sci. 2017;38:1901-11. doi: 10.1007/s10072-017-3047-x.

8. Ghahfarrokhi MM, Banitalebi E, Faramarzi M, Dashtaki MG. 2019 novel coronavirus: emphasis on maintaining optimal levels of physical activity under self-quarantine conditions. 2020. doi:10.34172/ijer.2020.09.

9. Azin M, Zangiabadi N, Iranmanesh F, Baneshi MR. The comparison of information processing speed in the symbol digit modalities test and paced auditory serial addition test in relapse-remitting multiple sclerosis patients. Pensee. 2014;76:227-33.

10. Estiasari R, Melani S, Kusumawardhani AA, Pangeran D, Fajrina Y, Maharani K, et al. Validation of the Indonesian version of multiple sclerosis quality of life-54 (MSQOL-54 INA) questionnaire. Health Qual Life Outcomes. 2019;17:120. doi: 10.1186/s12955-019-1190-1.

11. Faramarzi M, Banitalebi E, Raisi Z, Samieyan M, Saberi Z, Ghahfarrokhi MM, et al. Effect of combined exercise training on pentraxins and pro-inflammatory cytokines in people with multiple sclerosis as a function of disability status. Cytokine. 2020;134:155196. doi: 10.1016/j.cyto.2020.155196.

12. Juhl C, Byskov K, Hvid LG, Dalgas U, Pommerich UM, Skjerbæk AG. Cut-points of the 6-min walk test, the six spot step test, and the timed-25-foot walk test discriminating impaired from non-impaired walking capacity in persons with Multiple sclerosis. Mult Scler J Exp Transl Clin. 2025;11. doi: 10.1177/20552173251324600.

13. Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 2017;17:185. doi: 10.1186/s12883-017-0960-9.

14. Kragt JJ. Measuring disease progression in MS: do'patients and physicians' perspectives match. 2010.

15. Mayr WT, Pittock SJ, McClelland RL, Jorgensen NW, Noseworthy JH, Rodriguez M. Incidence and prevalence of multiple sclerosis in Olmsted County, Minnesota, 1985–2000. Neurology. 2003;61:1373-7. doi: 10.1212/01.wnl.0000094316.90240.eb.

16. Pakdel M, Karin Hedström A, Bidkhori M, Hadei M, Kazemi Moghaddam V, Sarmadi M, et al. Do socioeconomic factors affect the prevalence of multiple sclerosis in Iran? Acta Neurol Scand. 2019;140:328-35. doi: 10.1111/ane.13148.

17. Negaresh R, Motl R, Zimmer P, Mokhtarzade M, Baker J. Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: a systematic review of intervention studies. Eur J Neurol. 2019;26:711-21. doi: 10.1111/ene.13929.

18. Wens I, Keytsman C, Deckx N, Cools N, Dalgas U, Eijnde BO. Brain derived neurotrophic factor in multiple sclerosis: effect of 24 weeks endurance and resistance training. Eur J Neurol. 2016;23:1028-35. doi: 10.1111/ene.12976.

19. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance-and combined training. Mult Scler. 2008;14:35-53. doi: 10.1177/1352458507079445.

20. Schulz K-H, Gold SM, Witte J, Bartsch K, Lang UE, Hellweg R, et al. Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis. J Neurol Sci. 2004;225:11-8. doi: 10.1016/j.jns.2004.06.009.

21. Liu Cj, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 2014;11:95-106. doi:10.1007/s11556-014-0144-1.

22. Law LL, Barnett F, Yau MK, Gray MA. Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial. Age Ageing. 2014;43:813-20. doi: 10.1093/ageing/afu055.

23. Schwenk M, Zieschang T, Englert S, Grewal G, Najafi B, Hauer K. Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial. BMC Geriatr. 2014;14:1-9. doi:10.1186/1471-2318-14-73.

24. Ghahfarrokhi MM, Banitalebi E, Negaresh R, Motl RW. Home-based exercise training in multiple sclerosis: A systematic review with implications for future research. Mult Scler Relat Disord. 2021;55:103177. doi:10.1016/j.msard.2021.103177.

25. Chtourou H, Trabelsi K, H'mida C, Boukhris O, Glenn JM, Brach M, et al. Staying Physically Active During the Quarantine and Self-Isolation Period for Controlling and Mitigating the COVID-19 Pandemic: A Systematic Overview of the Literature. Front Psychol. 2020;11:1708. doi: 10.3389/fpsyg.2020.01708.

26. Negaresh R, Motl RW, Mokhtarzade M, Dalgas U, Patel D, Shamsi MM, et al. Effects of exercise training on cytokines and adipokines in multiple sclerosis: a systematic review. Mult Scler Relat Disord. 2018;24:91-100. doi:10.1016/j.msard.2018.06.008.

27. Efird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health. 2011;8:15-20. doi: 10.3390/ijerph8010015.

28. Estiasari R, Melani S, Kusumawardhani AA, Pangeran D, Fajrina Y, Maharani K, et al. Validation of the Indonesian version of multiple sclerosis quality of life-54 (MSQOL-54 INA) questionnaire. Health Qual Life Outcomes. 2019;17:1-8. doi:10.1186/s12955-019-1190-1.

29. Turpin K, Carroll L, Cassidy J, Hader W. Deterioration in the health-related quality of life of persons with multiple sclerosis: the possible warning signs. Mult Scler. 2007;13:1038-45. doi:10.1177/1352458507078393.

30. SM N. The effect of Orem based self-care program on physical quality of life in multiple sclerosis patients. 2008.

31. Benedict RH, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, et al. Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol. 2012;12:1-7. doi:10.1186/1471-2377-12-55.

32. Flachenecker P, Bures AK, Gawlik A, Weiland A-C, Kuld S, Gusowski K, et al. Efficacy of an Internet-Based Program to Promote Physical Activity and Exercise after Inpatient Rehabilitation in Persons with Multiple Sclerosis: A Randomized, Single-Blind, Controlled Study. Int J Environ Res Public Health. 2020;17:4544. doi: 10.3390/ijerph17124544.

33. Tarakci E, Tarakci D, Hajebrahimi F, Budak M. Supervised exercises versus telerehabilitation. Benefits for persons with multiple sclerosis. Acta Neurol Scand. 2021;144:303-11. doi: 10.1111/ane.13448.

34. Tallner A, Streber R, Hentschke C, Morgott M, Geidl W, Mäurer M, et al. Internet-supported physical exercise training for persons with multiple sclerosis—a randomised, controlled study. Int J Mol Sci. 2016;17:1667. doi: 10.3390/ijms17101667.

35. McAuley E, Wójcicki TR, Learmonth YC, Roberts SA, Hubbard EA, Kinnett-Hopkins D, et al. Effects of a DVD-delivered exercise intervention on physical function in older adults with multiple sclerosis: A pilot randomized controlled trial. Mult Scler J Exp Transl Clin. 2015;1:2055217315584838. doi: 10.1177/2055217315584838.

36. Alphonsus KB, Su Y, D’Arcy C. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: systematic review and meta-analysis. Complement Ther Med. 2019;43:188-95. doi: 10.1016/j.ctim.2019.02.010.

37. Latimer-Cheung AE, Pilutti LA, Hicks AL, Ginis KAM, Fenuta AM, MacKibbon KA, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800-28. e3. doi: 10.1016/j.apmr.2013.04.020.

38. Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Ann Behav Med. 2008;35:111. doi: 10.1007/s12160-007-9006-7.

39. Gong X, Xue X, Gao R, Feng S, Ji X, Zheng J, et al. Application of telemedicine in fatigue management for patients with multiple sclerosis: A scoping review. PLoS One. 2025;20:e0327563. doi: 10.1371/journal.pone.0327563. eCollection 2025.

40. Farajnia S, Rajabi H, Ghaffari M, Beladi-Moghadam N, Fayazmilani R. The effects of dual-task training on inflammatory biomarkers, physical performance, fatigue, and quality of life in patients with multiple sclerosis. Mult Scler Relat Disord. 2025;99:106412. doi: 10.1016/j.msard.2025.106412.

41. Kołtuniuk A, Pawlak B, Krówczyńska D, Chojdak-Łukasiewicz J. The quality of life in patients with multiple sclerosis–Association with depressive symptoms and physical disability: A prospective and observational study. Front Psychol. 2023;13:1068421. doi: 10.3389/fpsyg.2022.1068421.

42. Silveira SL, Motl RW, Marquez DX, Lancia S, Salter A. Physical activity as a correlate of symptoms, quality of life, comorbidity, and disability status in Hispanics with multiple sclerosis. Disabil Health J. 2023;16:101398. doi: 10.1016/j.dhjo.2022.101398.

43. Costabile T, Carotenuto A, Lavorgna L, Borriello G, Moiola L, Inglese M, et al. COVID‐19 pandemic and mental distress in multiple sclerosis: Implications for clinical management. Eur J Neurol. 2021;28:3375-83. doi: 10.1111/ene.14580.

44. Hosseini SS, Rajabi H, Sahraian MA, Moradi M, Mehri K, Abolhasani M. Effects of 8-Week Home-Based Yoga and Resistance Training on Muscle Strength, Functional Capacity and Balance in Patients with Multiple Sclerosis: A Randomized Controlled Study. Asian J Sports Med. 2018;9:e68807. doi: 10.5812/asjsm.68807.

45. Novotna K, Janatova M, Hana K, Svestkova O, Preiningerova Lizrova J, Kubala Havrdova E. Biofeedback Based Home Balance Training can Improve Balance but Not Gait in People with Multiple Sclerosis. Mult Scler Int. 2019;2019:2854130. doi: 10.1155/2019/2854130.

46. Abbaspoor E, Zolfaghari M, Ahmadi B, Khodaei K. The effect of combined functional training on BDNF, IGF-1, and their association with health-related fitness in the multiple sclerosis women. Growth Horm IGF Res. 2020;52:101320. doi: 10.1016/j.ghir.2020.101320.

47. Sondell A, Littbrand H, Holmberg H, Lindelöf N, Rosendahl E. Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes? J Nutr Health Aging. 2019;23:1011-20. doi: 10.1007/s12603-019-1269-8.

48. Schranz C, Kruse A, Belohlavek T, Steinwender G, Tilp M, Pieber T, et al. Does home-based progressive resistance or high-intensity circuit training improve strength, function, activity or participation in children with cerebral palsy? Arch Phys Med Rehabil. 2018;99:2457-64. e4. doi: 10.1016/j.apmr.2018.06.010.

49. Oudenhoven LM, van Vulpen LF, Dallmeijer AJ, de Groot S, Buizer AI, van der Krogt MM. Effects of functional power training on gait kinematics in children with cerebral palsy. Gait Posture. 2019;73:168-72. doi: 10.1016/j.gaitpost.2019.06.023.

50. Kasser SL, Jacobs JV, Ford M, Tourville TW. Effects of balance-specific exercises on balance, physical activity and quality of life in adults with multiple sclerosis: a pilot investigation. Dis Rehabil. 2015;37:2238-49. doi: 10.3109/09638288.2015.1019008.

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Mardaniyan Ghahfarrokhi M, Fallahi S, Banitalebi E, Rezaei M, Motl R. The Effect of Neuro-Functional Training on the Quality of Life and Physical Performance of Multiple Sclerosis Patients with Cognitive Impairment. J. Ilam Uni. Med. Sci. 2025; 33 (5) :1-17
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