The effect of the combined functional training on serum levels of IL-17, IL-10, fatigue, and body composition in multiple sclerosis women

Multiple sclerosis (MS) is an autoimmune disease and chronic inflammation of the central nervous system that is associated with inflammation, demyelination, and destruction of axons. These symptoms potentially harmed the quality of life and day-to-day activities in MS persons. Therefore, therapeutic interventions that modulate the immunity system can help to relieve these symptoms and prevent disease progression. Pro-inflammatory cytokines such as interleukine-17 (IL-17) and anti-inflammatory cytokines such as interleukine-10 (IL-10) have an important role in MS progression. Exercise training as non-pharmaceutical intervention seems to have a good potential for the treatment and control of neuroinflammation disease symptoms, especially MS via upregulation of cytokines. Fatigue one of the common symptoms in MS peoples that correlated with cytokines. However, the effectiveness of exercise training types on MS peoples not investigated obviously. Recently, the use of functional training has become common in patients and the elderly. Previous studies were reported efficiency of this functional training for rehabilitation, physical fitness, and wellness. Functional training are any exercises that tried to train the muscles in coordinated, multi-axis, multi-articulated movement patterns, with dynamic tasks and by constantly changing the support base of the movement to improve performance. TRX suspension training, elastic band training, and rhythmic aerobic are components of functional training.  To our knowledge, no study has investigated the effect of functional training with TRX suspension training, elastic band training, and rhythmic aerobic training on inflammatory factors, fatigue, and body composition in MS persons. Therefore, the purpose of the present study was to investigate of the effect of the combined functional training on serum levels of IL-17, IL-10, fatigue, and body composition in MS women.

Twenty relapsing-remitting MS women with expanded disability status scale (EDSS) ˂5.0. The participant EDSS evaluated by an experienced neurologist. Inclusion criteria were the lack of regular exercise, no relapse of the disease for the last six months, lack of pregnancy, non-smoking, non-addiction to drugs and alcohol, no history of cardiovascular, metabolic, mental, cancer, and orthopedic diseases. Exclusion criteria were relapse of disease, inability to performing training program, and had signs of any diseases. Participants were randomly divided into combined functional training and control group. Just 16 subjects could complete all stages of the present study. The combined functional training group participated in eight weeks with 3 days per week. After standard warm-up, subjects performed rhythmic aerobic training with an intensity of 55-70% of maximum heart rate. Session duration was 15 minutes (min) in the 1 and 2 weeks and 20 min from the 3-8 weeks. Afterwards, resistance training includes of elastic band training, TRX suspension training, and bodyweight training performed after 5-10 min resting break. Participants used one of the resistance training modes after aerobic training in each session. They performed 1 set in 1-4 weeks and 2 sets in 5-8 weeks. 1-2 min of resting breaks were considered between the exercises and sets. Elastic band exercises include of flexion of biceps, triceps, and thigh muscles. Training intensity was determined by color and elongation rate of the bands. Participants were used of blue color Theraband according to their condition and ability (25-100% elongation with a resistance of 1.3 to 2.3 kg).  TRX suspension exercises also include of rowing, squat, lung, and sit-ups. Bodyweight training was consisting of active and passive movements to strengthen and improve the balance of arms, legs, and trunk. After main training, standard cool-down was done. The training intensity was monitored every week by the Borg 6-20 category rate of perceived exertion (RPE) scale. The RPE for first 4 weeks was light to moderate (10-13), and the last 4 weeks intensity was moderate to hard (13-16). The control group had no regular physical activity during this period. Blood samples were taken 48 hours before and after the training intervention from all participants in pre and posttest to determine serum levels of IL-17 and IL-10 by electrochemiluminescence enzyme-linked immunosorbent assay method with commercial ELISA kits (Shanghai crystal day biotech co, China). Fatigue severity and body composition were evaluated using a fatigue severity scale (FSS) questionnaire and bioelectrical impedance analyses (BIA) method by Inbody-3 device made in Korea, respectively. For data analyses, two-way mixed ANOVA with independent and paired samples T-tests were used. A significant time X group interaction in the multivariate tests of the ANOVA was considered to indicate a significant training effect. Delta changes (posttest-pretest) were calculated and analyzed for variables that have significant differences in between-subjects factor. The significance level in all analyses was set at P≤0.05.

Mixed ANOVA analysis indicated significant differences in time x group interaction between IL-10, 1L-17, and fatigue. Between-group changes showed that combined functional training resulted in a significant reduction of IL-17, fatigue, and significant increase in IL-10 levels compared with the control group.  Time interaction demonstrated significant changes in IL-10, IL-17, fatigue and body-fat percentage. IL-17, fatigue, and body-fat percentage in the combined functional training group were significantly decreased compared with the pre-test. IL-10 in the combined functional training group was significantly increased compared with the pre-test. However, fat-free mass did not change significantly in multiple sclerosis women.

Today, aerobic, anaerobic, and resistance exercise has been considered as the most promising non-pharmacological treatment for MS patients with disabilities to reduce fatigue and depression and improve the quality of life of these people without aggravating symptoms. Previous studies have reported that exercise may have indirect anti-inflammatory effects and may be useful in the activity of the MS immune system. Exercise can mediate immune function through local and systemic production of cytokines. With the results obtained after eight weeks of combined functional training in the present study, it can be concluded that the selected functional training along with a benefiting variety of training and combination of applied exercises, could reduce and prevent the exacerbation of symptoms such as fatigue. It was also effective in reducing inflammatory markers and may be effective in reducing disease progression, nerve cell destruction and reducing disease relapsing. It also reduced body-fat percentage. Therefore, the combined functional training program which has a home-base nature, can be recommended to MS patients along with another medical intervention to control and treatment of the disease symptoms.