اثر تمرینات مقاومتی بر محور هیپوتالاموس- هیپوفیز- آدرنال، وضعیت روانی و میزان افسردگی در زنان مبتلا به بیماری مولتیپل اسکلروزیس (ام اس)

مقدسی, مهرزاد

doi:10.22034/sbs.2020.161231

اثر تمرینات مقاومتی بر محور هیپوتالاموس- هیپوفیز- آدرنال، وضعیت روانی و میزان افسردگی در زنان مبتلا به بیماری مولتیپل اسکلروزیس (ام اس)

نویسنده

مهرزاد مقدسی

گروه تربیت بدنی، واحد شیراز، دانشگاه آزاد اسلامی، شیراز، ایران

10.22034/sbs.2020.161231

چکیده

مقدمه و هدف: اختلالات محور هیپوتالاموس- هیپوفیز- آدرنال (محور HPA) و در نتیجه اختلالات روانی و افسردگی از جمله مشکلات رایج در بیماران مبتلا به ام اس هستند. ممکن است فعالیت های ورزشی موجب تنظیم محور HPA و بهبود وضعیت روانی این دسته از بیماران مؤثر باشد. هدف مطالعه حاضر بررسی اثر هشت هفته تمرینات مقاومتی بر محور HPA، وضعیت روانی و میزان افسردگی زنان مبتلا به بیماری ام اس بود.
مواد و روش‌ها: 27 زن جوان مبتلا به بیماری ام اس (میانگین سنی 6.9 ± 32.3 سال) و با میانگین مقیاس وضعیت ناتوانی گسترده (EDSS) 2±1.3 به صورت هدفمند انتخاب شدند. آزمودنی ها به طور تصادفی و بر اساس EDSS به دو گروه تمرینات مقاومتی (14 نفر) و کنترل (13 نفر) تقسیم شدند. آزمودنی‎های گروه تمرین به مدت 8 هفته، 3 روز در هفته، به مدت 45 دقیقه و با محدوده 50 تا 70 درصد حداکثر قدت در تمرینات برنامه‎ریزی شده مقاومتی پیشرونده شرکت کردند. وضعیت روانی، میزان افسردگی و غلظت هورمون های آدرنوکورتیکوتروپین (ACTH) و کورتیزول قبل و پس از دوره تمرینی اندازه‎گیری شد. برای بررسی اختلاف میانگین ها از آزمون آماری t مستقل و حداقل سطح معنی داری 0.05 استفاده شد.
یافته‎ها: نتایج نشان داد پس از هشت هفته تمرین مقاومتی، وضعیت روانی (11.2 درصد، 0.04=P < span lang="FA">) و میزان افسردگی (27.4 درصد، 0.01=P < span lang="FA">) در گروه تمرین نسبت به گروه کنترل بهبود معنی‌دار و سطوح ACTH (11.6 درصد، 0.03=P < span lang="FA">) و کورتیزول (9.9 درصد، 0.04=P < span lang="FA">) کاهش معنی‌دار پیدا کرده است.
بحث و نتیجه‎گیری: به طور کلی به نظر می‎رسد تمرینات مقاومتی به کار رفته در مطالعه حاضر به واسطه تنظیم محور HPA می‌تواند در بهبود وضعیت روانی و میزان افسردگی زنان مبتلا به بیماری ام اس مؤثر باشد.

کلیدواژه‌ها

بیماری ام اس

اختلالات روانی

افسردگی

تمرین مقاومتی

محور HPA

عنوان مقاله English

Effect of 8 weeks resistance training on hypothalamo-pituitary-adrenal axis, psychological status and depression level in female patients with Multiple Sclerosis (MS)

نویسنده English

Mehrzad Moghadasi

چکیده English

Introduction and purpose: Disrupted hypothalamo – pituitary - adrenal (HPA) axis, psychological impairment and depression are widespread comorbidity in patients with multiple sclerosis (MS). Exercise training may regulate HPA axis and improve psychological status in these patients. The aim of this study was to examine the effect of 8 weeks resistance training on HPA axis, psychological status and depression level in female patients with MS.
Materials and Methods: Twenty-seven women with MS disease (32.3 ± 6.9 year of old) and Expanded Disability Status Scale (EDSS) of 2.0 ± 1.3 participated in this study. Subjects were divided into control group (n=13) or training group (n=14) randomly, according their EDSS scores. The training group performed progressive resistance training program, 45 min with 50-70% 1RM, 3 days a week for 8 weeks. Psychological status, depression level and ACTH and cortisol concentration were assessed before and after the intervention. Independent sample t-test was used for mean differences between groups.
Results: The results demonstrated that psychological status (11.2%, P=0.04) and depression level (27.4%, P=0.01) improved and ACTH (11.6%, P=0.03) and cortisol (9.9%, P=0.04) concentration reduced significantly after 8 weeks resistance training.
Discussion and Conclusion: In summary it seems that resistance training utilized in this study effective for psychological status and depression level improvement in female patients with MS by regulating HPA axis.

کلیدواژه‌ها English

Multiple Sclerosis

Psychological impairment

depression

resistance training

HPA axis

1. Huseby E, Kamimura D, Arima Y, Parello CS, Sasaki K, Murakami. Role of T cell-glial cell interactions in creating and amplifying central nervous system inflammation and multiple sclerosis disease symptoms. Front Cell Neurosci. 2015; 5: 295. 2. Kobelt G, Thompson A, Berg J, Gannedahl M, Eriksson J, MSCOI Study Group. European Multiple Sclerosis Platform New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler. 2017; 23(8): 1123–36. 3. Walton V, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Multiple Sclerosis J. 2020; 14: 1816–21. 4. Rahmani M, Rahimian Boogar I, Talepasand S, Nokani M. The effect of combined cognitive rehabilitation interventions (computer and manual) on improving the information processing speed and psychological status of women with multiple sclerosis (MS). J Cognitive Psychol. 2018; 6: 47-56. 5. Bittner S, Ruck T, Wiendl H, Grauer OM, Meuth SG. Targeting B cells in relapsing–remitting multiple sclerosis: from pathophysiology to optimal clinical management. Therapeutic Advance Neurol Disorder. 2017; 10(1): 51-66. 6. Snell SR. Clinical neuroanatomy. 7th ed. Lippincott Williams & Wilkins, 2010. 7. Opara JA, Jaracz K, Brola W. Quality of life in multiple sclerosis. J Med Life. 2010; 4: 352-358. 8. White CA. Cognitive behavior therapy for chronic medical problems: A guide to assessment and treatment in practice. 1thed. New York: JohnWiley: 16- 11, 2001. 9. Chiaravalloti N, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008; 7: 1139-1151. 10. Rahn K, Slusher B, Kaplin A. Cognitive impairment in multiple sclerosis: a forgotten disability remembered. Cerebrum. 2012; 14: 1-19. 11. Rao SM, Ellington L, Nauertz T, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology 1991; 41(5): 692-696. 12. Yousefiyan Z, Aminnasab A, Sehati M. Effectiveness of self-compassion-based therapy on depression and psychological capital in the people with MS. J Analitical Cognitive Psychol. 2019; 10: 45-57. 13. Dennison L, Moss-Moris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009; 29: 141-153. 14. Heesen C, Gold SM, Raji A, Wiedemann K, Schulz KH. Cognitive impairment correlates with hypothalamo-pituitary-adrenal axis dysregulation in multiple sclerosis. Psychoneuroendocrinology. 2002; 27(4): 505-17. 15. Pereira GM, Soares NM, de Souza AR, Becker J, Finkelsztejn A, de Almeida RMM. Basal cortisol levels and the relationship with clinical symptoms in multiple sclerosis: a systematic review. Arq Neuro-Psiquiatr. 2018; 76 (9): 622-634. 16. Powell DJ, Moss-Morris R, Liossi C, Schlotz W. Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis. Psychoneuroendocrinology. 2015; 56: 120-31. 17. Motl R W. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study. J Neurol Phys Ther. 2012; 36: 32–37. 18. Kern S, Schultheiss T, Schneider H, Schrempf W, Reichmann H, Ziemssen T. Circadian cortisol, depressive symptoms and neurological impairment in early multiple sclerosis. Psychoneuroendocrinology. 2011; 36(10): 1505-12. 19. Gold SM, Krüger S, Ziegler KJ, Krieger T, Schulz KH, Otte C, et al. Endocrine and immune substrates of depressive symptoms and fatigue in multiple sclerosis patients with comorbid major depression. J Neurol Neurosurg Psychiatry. 2011; 82(7): 814-8. 20. Ahadi F, Tabatabaee SM, Rajabpour M, Ghadamgahi A, Pouryosef Kaljahi M. Effect of 8-week aerobic exercise and yoga training on depression, anxiety, and quality of life among multiple sclerosis patients. Iran Rehab J. 2013; 11: 75-80. 21. Stroud NM, Minahan CL. The impact of regular physical activity on fatigue, depression and quality of life in persons with multiple sclerosis. Health Qual Life Outcomes. 2009; 7: 68. 22. Carotenuto A, Scandurra C, Costabile T, Lavorgna L, Borriello G, Moiola L, et al. Physical exercise moderates the effects of disability on depression in people with multiple sclerosis during the COVID-19 outbreak. J Clin Med. 2021; 1-7. 23. Oken, BS, Kishiyama, S, Zajdel, D. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004; 62: 2058–2064. 24. Sutherland, G, Andersen, MB, Stoové, MA. Can aerobic exercise training affect health-related quality of life for people with multiple sclerosis? J Sport Exerc Psychol. 2001; 23: 122–135. 25. Eftekhari E, Mostahfezian M, Etemadifar M, Zarifi A. Resistance training and vibration improve muscle strength and functional capacity in female patients with multiple sclerosis, Asian J Sports Med. 2012; 3: 279-284. 26. Zorzon M, Masi R, Nasuelli D, Ukmar M, Mucelli RP, Cazzato G, et al. Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects. J Neurology. 2001; 284(5): 416-42. 27. Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med. 2002; 32 (12): 741-760. 28. Zheng H, Liu Y, Li W, Yang B, Chen D, Wang X, et al. Beneficial effects of exercise and its molecular mechanisms on depression in rats. Behav Brain Res. 2006; 168(1): 47-55. 29. Bandura A. Social foundations of thought and action: A social cognitive theory. New Jersey: Prentice-Hall Inc; 1986. 30. Bergh FT, Kümpfel T, Grasser A, Rupprecht R, Holsboer F, Trenkwalde C. Combined treatment with corticosteroids and moclobemide favors normalization of hypothalamo-pituitary-adrenal axis dysregulation in relapsing-remitting multiple sclerosis: a randomized, double blind trial. Clin Endocrinol Metab. 2001; 86(4): 1610-5. 31. Moazzami M, Fathi M, Soltani M, Gelard N. The effects of aerobic exercise in water on cortisol levels and TGF-β in patients with multiple sclerosis. Quarter J Sabzevar Uni Med Sci. 2014; 21: 207-215.