Neurological Sciences

, Volume 40, Issue 4, pp 733–743 | Cite as

Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals

  • Tanja Grubić KezeleEmail author
  • Matea Babić
  • Dinko Štimac
Original Article



To evaluate the feasibility of a combined upper limb and breathing exercise for a home-based program and to explore its effect on primary fatigue and quality of life in ambulatory and non-ambulatory individuals with multiple sclerosis (MS) in a short time.


Nineteen individuals with MS were assigned into semi-controlled pre-post feasibility study based on Expanded Disability Status Scale (EDSS) status and divided into two groups: exercise (five ambulatory, five non-ambulatory; EDSS 1.0–8.0) and related control with no exercise (four ambulatory, five non-ambulatory; EDSS 1.0–7.5). Exercise group performed combined upper limb and breathing exercise in a controlled group (2 days/week, 60 min/session) accompanied by independent home exercise (3 days/week, ≥ 20 min/session). Participants underwent measures of fatigue impact (Modified Fatigue Impact Scale (MFIS) and quality of life (RAND Medical outcomes study 36-item short-form health survey (SF-36)) before and after a 4-week period.


The MFIS (physical, psychosocial, total) showed statistically significant group-by-time interaction in ambulatory (p = 0.033, d = 1.60; p = 0.039, d = 1.59; p = 0.033, d = 1.62) and non-ambulatory individuals (p = 0.009, d = 2.42; p = 0.018, d = 1.96; p = 0.0008, d = 3.92). Physical functioning (SF-36) showed statistically significant group-by-time interaction in ambulatory (p = 0.014, d = 2.14) but no significance in non-ambulatory (p = 0.368, d = 0.68) individuals. Despite the absent statistical significance, there were large intervention effects on MFIS cognitive scores for ambulatory (d = 1.28) and non-ambulatory (d = 1.47), and on other SF-36 scores for ambulatory (general health: d = 1.76 and pain: d = 1.02) and non-ambulatory (physical limitation: d = 1.03 and emotional well-being: d = 0.94) individuals.


Our 4-week program reduced some aspects of fatigue and improved some aspects of quality of life in a small group of ambulatory and non-ambulatory individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.

Trial registration

Name of the registry: The Impact of Exercise Training on Living Quality in Multiple Sclerosis. Registration: The study was registered at on July 14, 2017. First participant enrollment: August 28, 2017. URL: 602-01/17-01-147; Trial registration ID: NTC03222596.


Multiple sclerosis Ambulatory Non-ambulatory Quality of life Fatigue Exercise program 



Central nervous system


Expanded Disability Status Scale


Home exercise


Multiple sclerosis


MS Society Center


Modified Fatigue Impact Scale


Quality of life


Medical Outcomes Study 36-Item Short-Form Health Survey


Upper limb



We want to thank the volunteers and the Multiple Sclerosis Society in Rijeka, Croatia, for the accomplished results, Martina Budanko, PT, and Dijana Ivanišević, BEcon, for assistance and support with recruiting participants.

Compliance with ethical standards

All subjects signed written informed consent and the study was approved by the local ethical committee (602-01/17-01-147) and registered in the (

Conflict of interest

The authors declare that they have no conflicts of interest.


The authors alone are responsible for the content and writing of the paper.

Supplementary material

10072_2019_3707_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Physiology and ImmunologyUniversity of Rijeka Faculty of MedicineRijekaCroatia
  2. 2.Department of PhysiotherapyUniversity of Rijeka Faculty of Health StudiesRijekaCroatia
  3. 3.Department of NeurosurgeryClinical Hospital CenterRijekaCroatia

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