Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients
Abstract
Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions.
Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS.
Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software.
Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages.
Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.
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7. Lotti N, Missiroli F, Galofaro E, Tricomi E, Di Domenico D, Semprini M, et al. Soft Robotics to Enhance Upper Limb Endurance in Individuals with Multiple Sclerosis. Soft Robot. 2024;11(2):338-46. [PubMed ID:37870773]. https://doi.org/10.1089/soro.2023.0024.
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14. Singh J, Metri K, Tekur P, Mohanty S, Singh A, Raghuram N. Teleyoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial. Complement Ther Clin Pract. 2023;50:101672. [PubMed ID:36395635]. https://doi.org/10.1016/j.ctcp.2022.101672.
15. Naisby J, Wilson-Menzfeld G, Baker K, Morris R, Robinson J, Barry G. Yoga and Multiple Sclerosis: Maintaining engagement in physical activity. PLoS One. 2023;18(7):e0288319. [PubMed ID:37467234]. [PubMed Central ID:PMC10355448]. https://doi.org/10.1371/journal.pone.0288319.
16. Saifan AR, Aburuz ME, Dhaher EA, Rayyan A, Jaberi MA, Masa’Deh R. The Effect of Benson Relaxation Technique on Depression, Anxiety, and Stress of Jordanian Patients Diagnosed with Multiple Sclerosis: A Cross-Sectional Study. Depress Res Treat. 2021;2021:8300497. [PubMed ID:34691780]. [PubMed Central ID:PMC8528579]. https://doi.org/10.1155/2021/8300497.
17. Hamdi Kamal Khalil N, Mohmmed Abouelala F, Hemed Hamad A, Mohamed Elesawy F. Effect of Benson Relaxation Technique on Sleep Quality and Fatigue for Multiple Sclerosis Patients. Egypt J Health Care. 2021;12(2):1694-704. https://doi.org/10.21608/ ejhc.2021.226267.
18. Kneebone, II, Van Zanden BE, Dorstyn DS, Roberts RM, Lord SR, Querstret D, et al. Relaxation and related therapies for people with multiple sclerosis (MS): A systematic review. Clin Rehabil. 2022;36(7):883-99. [PubMed ID:35410503]. https://doi.org/10.1177/02692155221091509.
19. Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021;18:17. [PubMed ID:34325496]. [PubMed Central ID:PMC8441096]. https://doi.
org/10.3352/jeehp.2021.18.17.
20. Aghili SM, Afzali S. [The Effect of Yoga Yoga Breathing Exercises on chronic Low Pain, Anxiety, Psychological and Physical Wellbeing of Women with MS]. Health Psychology. 2017;5(20):109-24. Persian.
21. Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res. 2007;62(4):427-37. [PubMed ID:17383494]. https://doi.org/10.1016/j.jpsychores.2006.10.012.
22. Bernstein DA, Borkovec TD, Hazlett-Stevens H. New directions in progressive relaxation training: A guidebook for helping professionals. Westport: Greenwood Publishing Group; 2000.
23. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315-25. [PubMed ID:7636775]. https://doi.org/10.1016/0022-3999(94)00125-o.
24. Shamsi A, Yaghmaei F, Zayeri F. [Validity and reliability of “Multidimensional Symptoms Fatigue Inventory-Short Form”(MSFISF)]. J Ilam Univ Medic Sci. 2014;22(5):63-9. Persian.
25. Cohen-Mansfield J. Instruction manual for the Cohen-Mansfield agitation inventory (CMAI). Res Inst Hebrew Home Great Washington. 1991;1991.
26. Zare M, Ebrahimi AA, Birashk B. The effects of music therapy on reducing agitation in patients with Alzheimer’s disease, a prepost study. Int J Geriatr Psychiatry. 2010;25(12):1309-10. [PubMed ID:21086543]. https://doi.org/10.1002/gps.2450.
27. Savary K, Oraki M. [Construction and validitation of concentration skill questionnaire]. Qtly Edu Measur. 2015;6(22):69-84. Persian. https://doi.org/10.22054/jem.2016.4015.
28. Karimi S, Hossieni E, Naziri GH. Effectiveness of group music therapy on agitatedbehaviors in elderlies with Alzheimer’s disease. Qtly Horizon Med Sci. 2016;22(4):275-81. https://doi.
org/10.18869/acadpub.hms.22.4.275.
29. Donnelly KZ, Jeffreys C, MacKenzie T, McDonnell L, Black H, Bruce ML, et al. A crossover pilot trial of the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga for community-dwelling adults with multiple sclerosis. Complement Ther Clin Pract.
2022;49:101607. [PubMed ID:35780542]. https://doi.org/10.1016/j. ctcp.2022.101607.
30. Kesik G, Ozdemir L, Mungan Ozturk S. The Effects of Relaxation Techniques on Pain, Fatigue, and Kinesiophobia in Multiple Sclerosis Patients: A 3-Arm Randomized Trial. J Neurosci Nurs.
2022;54(2):86-91. [PubMed ID:35149625]. https://doi.org/10.1097/ JNN.0000000000000620.
31. Stritter W, Everding J, Luchte J, Eggert A, Seifert G. Yoga, Meditation and Mindfulness in pediatric oncology - A review of literature. Complement Ther Med. 2021;63:102791. [PubMedID:34808385]. https://doi.org/10.1016/j.ctim.2021.102791.
32. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbacher M, Kohls N, et al. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021;2021:5924040. [PubMed ID:34306146]. [PubMed Central ID:PMC8272667]. https://doi.org/10.1155/2021/5924040.
33. Gothe NP, Khan I, Hayes J, Erlenbach E, Damoiseaux JS. Yoga Effects on Brain Health: A Systematic Review of the Current Literature. Brain Plast. 2019;5(1):105-22. [PubMed ID:31970064]. [PubMed Central ID:PMC6971819]. https://doi.org/10.3233/BPL- 190084.
34. Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci. 2021;28(1-2):29-38. [PubMed ID:34733052]. [PubMed Central ID:PMC8558981]. https://doi.org/10.1177/09727531211023754.
35. Veiga G, Dias Rodrigues A, Lamy E, Guiose M, Pereira C, Marmeleira J. The effects of a relaxation intervention on nurses’ psychological and physiological stress indicators: A pilot study. Complement Ther Clin Pract. 2019;35:265-71. [PubMed ID:31003668]. https://doi.org/10.1016/j.ctcp.2019.03.008.
36. Fasczewski KS, Garner LM, Clark LA, Michels HS, Migliarese SJ. Medical Therapeutic Yoga for multiple sclerosis: examining selfefficacy for physical activity, motivation for physical activity, and quality of life outcomes. Disabil Rehabil. 2022;44(1):106-13. [PubMed ID:32393075]. https://doi.org/10.1080/09638288.2020.1
760364.
37. Armer JS, Lutgendorf SK. The Impact of Yoga on Fatigue in Cancer Survivorship: A Meta-Analysis. JNCI Cancer Spectr.
2020;4(2):pkz098. [PubMed ID:32368719]. [PubMed Central ID:PMC7190209]. https://doi.org/10.1093/jncics/pkz098.
38. Sreenivas SB, M U S, D T, Selvam R, Shashidhara YN. Effectiveness of yoga on attention of medical students: A prospective study. Biomedicine. 2022;42(1):91-7. https://doi.org/10.51248/.v42i1.1021.
39. Valianto B, Suprayetno, Verawati I. The Effects of Progressive Muscle Relaxation on Concentration in Archery Atheletes at the UNIMED Club. Proceedings of the 1st Unimed International Conference on Sport Science (UnICoSS 2019). 2020. p. 70-3.
2. Wang Y, Wang J, Feng J. Multiple sclerosis and pregnancy: Pathogenesis, influencing factors, and treatment options. Autoimmun Rev. 2023;22(11):103449. [PubMed ID:37741528]. https://doi.org/10.1016/j.autrev.2023.103449.
3. Salehi Kalatesadat M, Estiri Z, Shahabi Kaseb MR. [Effect of six week Pilates exercise with music on balance and concentration in Multiple Sclerosis patients]. J Sport Biomotor Sci. 2022;14(27):53-63. Persian. https://doi.org/10.22034/sbs.2022.162717.
4. Rahimi H, Pirmoradi M, Lavasani FF, Farahani H. The effectiveness of group intervention focused on intolerance of uncertainty on psychological distress and quality of life in multiple sclerosis patients. J Educ Health Promot. 2023;12:29. [PubMed ID:37034881]. [PubMed Central ID:PMC10079199]. https://doi.org/10.4103/jehp.jehp_521_22.
5. Aghili M, Al Rasool T, Asghari A. [The Effectiveness of Self-care Therapy on Psychic Restlessness and Tolerance of Emotional Distress in Women with Multiple Sclerosis]. Family and Health. 2023;12(4):152-62. Persian.
6. Fisher PL, Salmon P, Heffer-Rahn P, Huntley C, Reilly J, Cherry MG. Predictors of emotional distress in people with multiple sclerosis: A systematic review of prospective studies. J Affect Disord. 2020;276:752-64. [PubMed ID:32736185]. https://doi.org/10.1016/j. jad.2020.07.073.
7. Lotti N, Missiroli F, Galofaro E, Tricomi E, Di Domenico D, Semprini M, et al. Soft Robotics to Enhance Upper Limb Endurance in Individuals with Multiple Sclerosis. Soft Robot. 2024;11(2):338-46. [PubMed ID:37870773]. https://doi.org/10.1089/soro.2023.0024.
8. Hubbard AL, Golla H, Lausberg H. What’s in a name? That which we call Multiple Sclerosis Fatigue. Mult Scler. 2021;27(7):983-8. [PubMed ID:32672087]. [PubMed Central ID:PMC8142120]. https:// doi.org/10.1177/1352458520941481.
9. 9. Penner IK, McDougall F, Brown TM, Slota C, Doward L, Julian L, et al. Exploring the Impact of Fatigue in Progressive Multiple Sclerosis: A Mixed-Methods Analysis. Mult Scler Relat Disord. 2020;43:102207. [PubMed ID:32505026]. https://doi.org/10.1016/j. msard.2020.102207.
10. Rooney S, Wood L, Moffat F, Paul L. Prevalence of fatigue and its association with clinical features in progressive and nonprogressive forms of Multiple Sclerosis. Mult Scler Relat Disord. 2019;28:276-82. [PubMed ID:30639830]. https://doi.org/10.1016/j. msard.2019.01.011.
11. Virgilio E, Vecchio D, Crespi I, Puricelli C, Barbero P, Galli G, et al. Cerebrospinal fluid biomarkers and cognitive functions at multiple sclerosis diagnosis. J Neurol. 2022;269(6):3249-57. [PubMed ID:35088141]. https://doi.org/10.1007/s00415-021-10945-4.
12. Wojcik C, Fuchs TA, Tran H, Dwyer MG, Jakimovski D, Unverdi M, et al. Staging and stratifying cognitive dysfunction in multiple sclerosis. Mult Scler. 2022;28(3):463-71. [PubMed ID:33951975]. https://doi.org/10.1177/13524585211011390.
13. Wilson-Menzfeld G, Naisby J, Baker K, Morris R, Robinson J, Barry G. Yoga provision for individuals living with Multiple Sclerosis: Is the future online? PLoS One. 2022;17(4):e0266786. [PubMed ID:35486611]. [PubMed Central ID:PMC9053771]. https://doi.org/10.1371/journal.pone.0266786.
14. Singh J, Metri K, Tekur P, Mohanty S, Singh A, Raghuram N. Teleyoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial. Complement Ther Clin Pract. 2023;50:101672. [PubMed ID:36395635]. https://doi.org/10.1016/j.ctcp.2022.101672.
15. Naisby J, Wilson-Menzfeld G, Baker K, Morris R, Robinson J, Barry G. Yoga and Multiple Sclerosis: Maintaining engagement in physical activity. PLoS One. 2023;18(7):e0288319. [PubMed ID:37467234]. [PubMed Central ID:PMC10355448]. https://doi.org/10.1371/journal.pone.0288319.
16. Saifan AR, Aburuz ME, Dhaher EA, Rayyan A, Jaberi MA, Masa’Deh R. The Effect of Benson Relaxation Technique on Depression, Anxiety, and Stress of Jordanian Patients Diagnosed with Multiple Sclerosis: A Cross-Sectional Study. Depress Res Treat. 2021;2021:8300497. [PubMed ID:34691780]. [PubMed Central ID:PMC8528579]. https://doi.org/10.1155/2021/8300497.
17. Hamdi Kamal Khalil N, Mohmmed Abouelala F, Hemed Hamad A, Mohamed Elesawy F. Effect of Benson Relaxation Technique on Sleep Quality and Fatigue for Multiple Sclerosis Patients. Egypt J Health Care. 2021;12(2):1694-704. https://doi.org/10.21608/ ejhc.2021.226267.
18. Kneebone, II, Van Zanden BE, Dorstyn DS, Roberts RM, Lord SR, Querstret D, et al. Relaxation and related therapies for people with multiple sclerosis (MS): A systematic review. Clin Rehabil. 2022;36(7):883-99. [PubMed ID:35410503]. https://doi.org/10.1177/02692155221091509.
19. Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021;18:17. [PubMed ID:34325496]. [PubMed Central ID:PMC8441096]. https://doi.
org/10.3352/jeehp.2021.18.17.
20. Aghili SM, Afzali S. [The Effect of Yoga Yoga Breathing Exercises on chronic Low Pain, Anxiety, Psychological and Physical Wellbeing of Women with MS]. Health Psychology. 2017;5(20):109-24. Persian.
21. Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res. 2007;62(4):427-37. [PubMed ID:17383494]. https://doi.org/10.1016/j.jpsychores.2006.10.012.
22. Bernstein DA, Borkovec TD, Hazlett-Stevens H. New directions in progressive relaxation training: A guidebook for helping professionals. Westport: Greenwood Publishing Group; 2000.
23. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315-25. [PubMed ID:7636775]. https://doi.org/10.1016/0022-3999(94)00125-o.
24. Shamsi A, Yaghmaei F, Zayeri F. [Validity and reliability of “Multidimensional Symptoms Fatigue Inventory-Short Form”(MSFISF)]. J Ilam Univ Medic Sci. 2014;22(5):63-9. Persian.
25. Cohen-Mansfield J. Instruction manual for the Cohen-Mansfield agitation inventory (CMAI). Res Inst Hebrew Home Great Washington. 1991;1991.
26. Zare M, Ebrahimi AA, Birashk B. The effects of music therapy on reducing agitation in patients with Alzheimer’s disease, a prepost study. Int J Geriatr Psychiatry. 2010;25(12):1309-10. [PubMed ID:21086543]. https://doi.org/10.1002/gps.2450.
27. Savary K, Oraki M. [Construction and validitation of concentration skill questionnaire]. Qtly Edu Measur. 2015;6(22):69-84. Persian. https://doi.org/10.22054/jem.2016.4015.
28. Karimi S, Hossieni E, Naziri GH. Effectiveness of group music therapy on agitatedbehaviors in elderlies with Alzheimer’s disease. Qtly Horizon Med Sci. 2016;22(4):275-81. https://doi.
org/10.18869/acadpub.hms.22.4.275.
29. Donnelly KZ, Jeffreys C, MacKenzie T, McDonnell L, Black H, Bruce ML, et al. A crossover pilot trial of the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga for community-dwelling adults with multiple sclerosis. Complement Ther Clin Pract.
2022;49:101607. [PubMed ID:35780542]. https://doi.org/10.1016/j. ctcp.2022.101607.
30. Kesik G, Ozdemir L, Mungan Ozturk S. The Effects of Relaxation Techniques on Pain, Fatigue, and Kinesiophobia in Multiple Sclerosis Patients: A 3-Arm Randomized Trial. J Neurosci Nurs.
2022;54(2):86-91. [PubMed ID:35149625]. https://doi.org/10.1097/ JNN.0000000000000620.
31. Stritter W, Everding J, Luchte J, Eggert A, Seifert G. Yoga, Meditation and Mindfulness in pediatric oncology - A review of literature. Complement Ther Med. 2021;63:102791. [PubMedID:34808385]. https://doi.org/10.1016/j.ctim.2021.102791.
32. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbacher M, Kohls N, et al. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021;2021:5924040. [PubMed ID:34306146]. [PubMed Central ID:PMC8272667]. https://doi.org/10.1155/2021/5924040.
33. Gothe NP, Khan I, Hayes J, Erlenbach E, Damoiseaux JS. Yoga Effects on Brain Health: A Systematic Review of the Current Literature. Brain Plast. 2019;5(1):105-22. [PubMed ID:31970064]. [PubMed Central ID:PMC6971819]. https://doi.org/10.3233/BPL- 190084.
34. Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci. 2021;28(1-2):29-38. [PubMed ID:34733052]. [PubMed Central ID:PMC8558981]. https://doi.org/10.1177/09727531211023754.
35. Veiga G, Dias Rodrigues A, Lamy E, Guiose M, Pereira C, Marmeleira J. The effects of a relaxation intervention on nurses’ psychological and physiological stress indicators: A pilot study. Complement Ther Clin Pract. 2019;35:265-71. [PubMed ID:31003668]. https://doi.org/10.1016/j.ctcp.2019.03.008.
36. Fasczewski KS, Garner LM, Clark LA, Michels HS, Migliarese SJ. Medical Therapeutic Yoga for multiple sclerosis: examining selfefficacy for physical activity, motivation for physical activity, and quality of life outcomes. Disabil Rehabil. 2022;44(1):106-13. [PubMed ID:32393075]. https://doi.org/10.1080/09638288.2020.1
760364.
37. Armer JS, Lutgendorf SK. The Impact of Yoga on Fatigue in Cancer Survivorship: A Meta-Analysis. JNCI Cancer Spectr.
2020;4(2):pkz098. [PubMed ID:32368719]. [PubMed Central ID:PMC7190209]. https://doi.org/10.1093/jncics/pkz098.
38. Sreenivas SB, M U S, D T, Selvam R, Shashidhara YN. Effectiveness of yoga on attention of medical students: A prospective study. Biomedicine. 2022;42(1):91-7. https://doi.org/10.51248/.v42i1.1021.
39. Valianto B, Suprayetno, Verawati I. The Effects of Progressive Muscle Relaxation on Concentration in Archery Atheletes at the UNIMED Club. Proceedings of the 1st Unimed International Conference on Sport Science (UnICoSS 2019). 2020. p. 70-3.
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| Issue | Vol 8 No 4 (2024) | |
| Section | Articles | |
| Keywords | ||
| Yoga Relaxation Therapy Restlessness Fatigue Lack of Concentration Multiple Sclerosis Patients | ||
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1.
Azhdari A, Mardani N, Javanbakht M, Mombeni T, Ahmadi M. Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients. Health Tech Ass Act. 2024;8(4).
