Before starting the test, the trunk was allowed to rest on a chair in front of the participant. The lower extremities were fixed at the hip, thigh, and knee on the plinth via straps. The trunk was off the plinth from the anterior superior iliac spine. Endurance was evaluated using three tests: the Sorenson test, the flexor endurance test, and the side bridge endurance test (Plunk test).įor the Sorenson test, the participant would lie prone on a plinth. 24 The participants randomly performed endurance and strength tests, with a 10-minute rest between the two trials. Muscle endurance is defined as the ability of a muscle or group to repeatedly move against submaximal resistance. 23 There is not a precise definition of endurance. Static endurance of trunk muscles is an important factor for mechanical support. The primary outcome measure of the study was the endurance of core muscles, and the secondary outcome was the strength of core muscles. Individuals were excluded if they participated in any regular exercise program or had a neuromuscular or musculoskeletal disease. The control group included 33 healthy people recruited using a convenience sample and matched with patients with MS on sex, age, and body mass index. Patients with noncorrected visual or hearing disturbances self-reported neurologic, musculoskeletal, or psychiatric disorders associated with MS exacerbations of MS symptoms within the past 3 months or current or recent participation in an exercise program were excluded from the study. All the patients signed an informed consent form before participating in the study. The study was approved by the ethics committee of Shiraz University of Medical Sciences in accordance with the standards of the Helsinki Declaration. Thirty-three patients with MS who were diagnosed by an expert neurologist as having an Expanded Disability Status Scale (EDSS) score ranging from 1.0 to 4.5 were recruited from the neurology center of Imam Reza Hospital (Shiraz, Iran) using a convenience sample. The sample size was calculated by conducting a pilot study of 60 individuals with an α level equal to. This cross-sectional group comparison study was conducted in the Rehabilitation School of Shiraz University of Medical Sciences (Shiraz, Iran) between February 1, 2014, and October 31, 2014. 21, 22 We hypothesized that these two parameters are decreased in patients with MS compared with healthy individuals therefore, the objective of this study was to investigate core muscle strength and endurance differences between patients with MS and a matched control group. 20 A limited number of studies have documented the strength and endurance of core muscles in individuals with MS. These strategies were likely to result in increased muscle energy cost and early fatigability. They suggested that patients with MS use compensatory mechanisms during walking to maintain balance and posture. 20 investigated the characteristics of some core muscles (the lateral flexor group, the external and internal obliques, and the rectus abdominis) during walking. 18 Core stability and strength are important components to maximize balance. 17 It involves coordinated stabilization of the lumbo-pelvic-hip complex via active (muscles) and passive (inert ligaments and capsules) components. 14– 16 Core is considered a kinetic link that facilitates the transfer of torques and angular momenta between the upper and lower extremities during the execution of body movements. 13 Because core stabilization is one of the main components of balance, balance disturbance might be attributed to core stabilization impairment. 13 People with MS had reduced trunk stability during arm movements in sitting, implying reduced core stability. 11 One component of balance is the postural stability of the trunk, which is known as core stability. 10– 12 Collectively, fatigue and imbalance impose challenges to rehabilitation management and quality of life in patients with MS. 9 Balance impairment has a high prevalence (up to 89.7%) in patients with MS, which constrains their daily routine activities and increases the risk of falling. 8 Fatigue can be considered one of the identified risk factors for falls in patients with MS. 3– 6 Fatigue is the most common symptom and one of the most disabling features in patients with MS, 7 with a prevalence of 53% to 90%. 1 Motor impairments, muscle weakness, spasticity, balance impairment, and visual disturbances are considered common symptoms of MS. 1 More than 2.5 million people around the world live with MS. 2 Women are more affected than men, with a ratio of 2:1 to 3:1. 1 The mean age at onset of the disease is approximately 30 years. Multiple sclerosis (MS) is the most common chronic demyelinating inflammatory disease of the central nervous system, with a high prevalence in young adults aged 20 to 35 years.
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