Document Type : Original Article
Authors
1 MSc Student in Exercise Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
2 Assistant Professor, Department of Exercise Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
Abstract
Background and Aim: Studies have shown that pilates exercises play a role in the treatment and prevention of neurological diseases, such as multiple sclerosis (MS). However, the possible mechanism for this effect is unclear. Therefore, this study aimed to investigate the effect of 8 weeks of pilates training on serum brain-derived neurotrophic factor (BDNF) and dynamic balance of men with MS. Materials and Methods: This study was a semi-experimental study with pre-test and post-test design. Twenty-two men with mean age of 34.9 ±3.7 years, mean expanded disability status scale (EDSS) of 3.6 ±1.07 and mean body mass index (BMI) of 24.07 ±4.3 kg/m2 were selected and randomly assigned into pilates exercise training (n=12) and control (n=10) groups. The experimental group performed three sessions per week of pilates exercise training for 8 weeks. The timed up and go balance test (TUG) was used to evaluate the patients’ balance, moreover, the sandwich ELISA method was applied to measure serum BDNF levels. For statistical analysis, the t-test was used to compare the intra-group changes and the ANCOVA method to compare between the groups changes at the significant level of p < 0.05. Results: intra-group changes showed that serum BDNF levels in pilates group increased significantly (p=0.03) and duration of TUG test also decreased significantly (p=0.02); neither of these two variables displayed a significant change in the control group (p>0.05). There was a significant difference between two groups after 8 weeks of training in the serum level of BDNF (p=0.04) as well as the balance test (p=0.01). Conclusions: Pilates exercises can be considered as important part of rehabilitation programs for patients with MS because of the increase in BDNF and the improvement of balance in the intervention group.
Keywords
Abasıyanık, Z., Ertekin, Ö., Kahraman, T., Yigit, P., & Özakbaş, S. (2020). The effects of clinical pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: a randomized controlled trial. Explore, 16(1), 12-20.
Adlard, P. A., & Cotman, C. W. (2004). Voluntary exercise protects against stress-induced decreases in brain-derived neurotrophic factor protein expression. Neuroscience, 124(4), 985-92.
Alicja, A., & Losy, J. (2012). The role of neurotrophins in multiple sclerosis-pathological and clinical implications. International Journal of Molecular Sciences, 1(3), 13713-13725.
Azami, M., YektaKooshali, M. H., Shohani, M., Khorshidi, A., & Mahmudi, L. (2019). Epidemiology of multiple sclerosis in Iran: a systematic review and meta-analysis. PloS One, 14(4), e0214738.
Bayraktar, D., Guclu-Gunduz, A., Yazici, G., Lambeck J, B., & Batur-Caglayan, H, Z., Irkec, C., & Nazliel, B. (2013). Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: a pilot study. NeuroRehabilitation, 33 (3), 431-7.
Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul, C., Irkec, C., Nazliel, B. i. J. E. N., & Batur-Caglayan, H. Z. (2017). The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413-422.
Caldwell, K., Harrison, M., Adams, M., & Triplett, NT. (2009). Effect of pilates and taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students. Journal of Bodywork and Movement Therapies, 13(2), 155-163.
Chevrel, G., Hohlfeld, R., & Sendtner, M. (2006). The role of neurotrophins in muscle under physiological and pathological conditions. Muscle & Nerve, 33(4), 462–476.
Compston, A., & Coles, A. (2002). Multiple sclerosis. Lancet, 359(9313), 1221-31.
Döring, A., Pfueller, C. F., Paul, F., & Dörr, J. (2012). Exercise in multiple sclerosis-an integral component of disease management. Epma Journal, 3(1), 2.
Esvald, E. E., Tuvikene, J., Sirp, A., Patil, S., Bramham, C. R., & Timmusk, T. (2020). CREB family transcription factors are major mediators of BDNF transcriptional autoregulation in cortical neurons. Journal of Neuroscience, 40(7), 1405-26.
Farrell, P. A., Joyner, M. J., & Caiozzo, V. (2011). ACSM’s advanced exercise physiology. Wolters Kluwer Health Adis (ESP). Freeman, J., Fox, E., Gear, M., & Hough, A. (2012). Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurology, 12(1), 1-6.
Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy. Cell Journal (Yakhteh), 19(1), 1. [Persian]
Gheitasi, M., Bayattork, M., Andersen, L. L., Imani, S., & Daneshfar, A. (2021). Effect of twelve weeks pilates training on functional balance of male patients with multiple sclerosis: randomized controlled trial. Journal of Bodywork and Movement Therapies, 25, 41-5.
Gold, S. M., Schulz, K. H., Hartmann, S., Mladek, M., Lang, U. E., Hellweg, R., ... & Heesen, C. (2003). Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls. Journal of Neuroimmunology, 138(1-2), 99-105.
González-Gutiérrez, A., Lazo, O. M., & Bronfman, F. C. (2020). The Rab5–Rab11 endosomal pathway is required for BDNF-Induced CREB transcriptional regulation in hippocampal neurons. Journal of Neuroscience, 40(42), 8042-54.
Kaesler, D. S., Mellifont, R. B., Kelly P. S., & Taaffe, D. R. (2007). A novel balance exercise program for postural stability in older adults: A pilot study. Journal of Bodywork and Movement Therapies, 11(1), 37-43.
Kalinowska-Lyszczarz, A., & Losy, J. (2012). The role of neurotrophins in multiple sclerosis-pathological and clinical implications. International Journal of Molecular Sciences, 13(10), 13713-25.
Karege, F., Schwald, M., & Cisse, M. (2002). Postnatal developmental profile of brain-derived neurotrophic factor in rat brain and platelets. Neuroscience Letters, 328(3), 261-4.
Khademosharie, M., Tadibi, V., Behpoor, B., & Hamedinia, M. R. (2019). The effect of a 12-week resistance and endurance training on the serum levels BDNF, hematological factors and some immune system indices in women with multiple sclerosis. Journal of Applied Exercise Physiology, 15(29), 43-55. [Persian]
Khanbabazade, M., Ebrahimi Atri, A., & Rashidlamir, A. (2015). Comprision of the effect of aerobic and weight resistance training protocols on balance and neuron growth factor (NGF) on the neuropathy–diabetic men. Journal of Shahid Sadoughi University of Medical Sciences, 23(2),1866-1877. [Persian]
Kloubec, J. A. (2010). Pilates for improvement of muscle endurance, flexibility, balance, and posture. Journal of Strength and Conditioning Research, 24(3), 661-667.
Kurtzke J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11),1444.
Latey, P. (2001). The Pilates method: history and philosophy. Journal of Bodywork and Movement Therapies, 5(4), 275-282. Lommatzsch, M., Zingler, D., Schuhbaeck, K., Schloetcke, K., Zingler, C., Schuff-Werner, P., & Virchow, J. C. (2005). The impact of age, weight and gender on BDNF levels in human platelets and plasma. Neurobiology of Aging, 26(1), 115-23. Loprinzi, P. D., & Frith, E. (2019). A brief primer on the mediational role of BDNF in the exercise-memory link. Clinical Physiology and Functional imaging, 39(1), 9-14.
Moghadasi, M., Edalat Manesh, M. A., Moeini, A., & Namatollahzadeh, M. (2015). Effects of eight weeks of resistance training on brain derived neurotrophic factor in female patients with multiple sclerosis. Koomesh, 17(1), 152-159. [Persian]
Mohali, Z., Ebrahimi atri, A., & Khoshraftar Yazdi, N. (2013). The effect of Tai Chi training on women balance with multiple sclerosis. Medical Surgical Nursing Journal, 2(3,4), 81-85. [Persian]
Mohamadi Dinani, Z., Nezakatolhossaini, M., Esfarjani, F., & Etemadifar, M. (2013). The effect of 8-week pilates training on motor function and depression in subjects with multiple sclerosis (MS). Journal of Research in Rehabilitation Sciences, 9(2), 308-317. [Persian]
Molteni, R., Wu, A., Vaynman, S., Ying, Z., Barnard, R. J., & Gómez-Pinilla, F. (2004). Exercise reverses the harmful effects of consumption of a high-fat diet on synaptic and behavioral plasticity associated to the action of brain-derived neurotrophic factor. Neuroscience, 123(2), 429-40.
Muscolino, J. E., & Cipriani, S. (2004). Pilates and the “powerhouse”. Journal of Bodywork and Movement Therapies, 8(1), 15- 24.
Nakhzari Khodakheir, J., Haghighi, A. H., & Hamedinia, M. R. (2018). The effects of combined exercise training with aerobic dominant and coenzyme Q10 supplementation on serum BDNF and NGF levels in patients with multiple sclerosis. Journal of Arak University of Medical Sciences, 21(3), 94-103. [Persian]
Neeper, S. A., Gómez-Pinilla, F., Choi, J., & Cotman, C. W. (1996). Physical activity increases mRNA for brain-derived neurotrophic factor and nerve growth factor in rat brain. Brain Research, 726(1-2), 49-56.
Norbye, A. D., Midgard, R., & Thrane, G. (2020). Spasticity, gait, and balance in patients with multiple sclerosis: A cross-sectional study. Physiotherapy Research International, 25(1), e1799.
Oliff, H. S., Berchtold, N. C., Isackson, P., & Cotman, C. W. (1998). Exercise-induced regulation of brain-derived neurotrophic factor (BDNF) transcripts in the rat hippocampus. Molecular Brain Research, 61(1-2), 147-53.
Pan, W., Banks, W. A., Fasold, M. B., Bluth, J., & Kastin, A. J. (1998). Transport of brain-derived neurotrophic factor across the blood-brain barrier. Neuropharmacology, 37(12), 1553-61.
Phillips, C., Baktir, M. A., Srivatsan, M., & Salehi, A. (2014). Neuroprotective effects of physical activity on the brain: a closer look at trophic factor signaling. Frontiers in Cellular Neuroscience, 8, 170.
Reichard, L. F. (2006). Neurotrophin-regulated signalling pathways. Philosophical transactions of the Royal Society B: Biological Sciences, 361(1473), 1545-65.
Sadi Zadeh, S., Avandi, S. M., & Ebrahimi, M. (2017). The effects of eight weeks of yoga training on serum levels of BDNF in women with multiple sclerosis. Journal of Applied Health Studies in Sport Physiology, 4(2), 81-88. [Persian]
Saghebjoo, M., Dehghani Firouzabadi, M., Etesami, M., & Mahmudzadeh, T. (2016). Effect of pilates training on serum levels of brain-derived neurotrophic factor, malondialdehyde and total antioxidant capacity in women with multiple sclerosis. Exercise Physiology, 30, 143-158. [Persian]
Sánchez-Lastra, M. A., Martínez-Aldao, D., Molina, A. J., & Ayán, C. (2019). Pilates for people with multiple sclerosis: A systematic review and meta-analysis. Multiple Sclerosis and related Disorders, 28, 199-212.
Shams, A., Taherii, H., Nikkhah, K., & Samad Zadeh, S. (2016). The effects of one period of selective exercise training with instructions focus of attention on motor function of multiple sclerosis patients. Journal of Mashhad University of Medical Sciences, 18(61), 28-34. [Persian]
Shanazari, Z., Marandi, S. M., & Minasian, V. (2013). Effect of 12-week pilates and aquatic training on fatigue in women with multiple sclerosis. Journal of Mazandaran University of Medical Sciences, 23(98), 257-264. [Persian]
Sheikholeslami-Vatani, D., & Ghaderi Almaneh, G. (2019). Positive effects of progressive resistance training on physical fitness indices in patients with multiple sclerosis. Journal of Practical Studies of Biosciences in Sport, 7(13), 31-42. [Persian]
Smith, M. A., Makino, S., & Kvetnansky, R. (1995). Effects of stress on neurotrophic factor expression in the rat brain. Annals of the New York Academy of Sciences, 771, 234-9
Soltani, M., Hejazi, S. M., Noorian, A., Zendedel, A., & Ashkanifar, M. (2010). The effect of aerobic training on the improvement of expanded disability status scale (EDSS) in multiple sclerosis patients. Journal of Medical Science of Mashhad, 1(17), 15-20. [Persian]
Vega, R. S., Struder, H. K., Wahrmann, V. B., Schmidt, A. B., Bloch, W., & Hollmann, W. (2006). Acute BDNF and cortisol response to low intensity exercise and following ramp incremental exercise to exhaustion in humans. Brain Research, 11(21), 59-65.
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., ... & Baneke, P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal, 26(14), 1816-1821.
White, L. J., McCoy, S. C., Castellano, V., Gutierrez, G., Stevens, J. E., Walter, G. A, & Vandenborne, K. (2004). Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Sclerosis, 10(6), 668-74.
Adlard, P. A., & Cotman, C. W. (2004). Voluntary exercise protects against stress-induced decreases in brain-derived neurotrophic factor protein expression. Neuroscience, 124(4), 985-92.
Alicja, A., & Losy, J. (2012). The role of neurotrophins in multiple sclerosis-pathological and clinical implications. International Journal of Molecular Sciences, 1(3), 13713-13725.
Azami, M., YektaKooshali, M. H., Shohani, M., Khorshidi, A., & Mahmudi, L. (2019). Epidemiology of multiple sclerosis in Iran: a systematic review and meta-analysis. PloS One, 14(4), e0214738.
Bayraktar, D., Guclu-Gunduz, A., Yazici, G., Lambeck J, B., & Batur-Caglayan, H, Z., Irkec, C., & Nazliel, B. (2013). Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: a pilot study. NeuroRehabilitation, 33 (3), 431-7.
Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul, C., Irkec, C., Nazliel, B. i. J. E. N., & Batur-Caglayan, H. Z. (2017). The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413-422.
Caldwell, K., Harrison, M., Adams, M., & Triplett, NT. (2009). Effect of pilates and taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students. Journal of Bodywork and Movement Therapies, 13(2), 155-163.
Chevrel, G., Hohlfeld, R., & Sendtner, M. (2006). The role of neurotrophins in muscle under physiological and pathological conditions. Muscle & Nerve, 33(4), 462–476.
Compston, A., & Coles, A. (2002). Multiple sclerosis. Lancet, 359(9313), 1221-31.
Döring, A., Pfueller, C. F., Paul, F., & Dörr, J. (2012). Exercise in multiple sclerosis-an integral component of disease management. Epma Journal, 3(1), 2.
Esvald, E. E., Tuvikene, J., Sirp, A., Patil, S., Bramham, C. R., & Timmusk, T. (2020). CREB family transcription factors are major mediators of BDNF transcriptional autoregulation in cortical neurons. Journal of Neuroscience, 40(7), 1405-26.
Farrell, P. A., Joyner, M. J., & Caiozzo, V. (2011). ACSM’s advanced exercise physiology. Wolters Kluwer Health Adis (ESP). Freeman, J., Fox, E., Gear, M., & Hough, A. (2012). Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurology, 12(1), 1-6.
Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy. Cell Journal (Yakhteh), 19(1), 1. [Persian]
Gheitasi, M., Bayattork, M., Andersen, L. L., Imani, S., & Daneshfar, A. (2021). Effect of twelve weeks pilates training on functional balance of male patients with multiple sclerosis: randomized controlled trial. Journal of Bodywork and Movement Therapies, 25, 41-5.
Gold, S. M., Schulz, K. H., Hartmann, S., Mladek, M., Lang, U. E., Hellweg, R., ... & Heesen, C. (2003). Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls. Journal of Neuroimmunology, 138(1-2), 99-105.
González-Gutiérrez, A., Lazo, O. M., & Bronfman, F. C. (2020). The Rab5–Rab11 endosomal pathway is required for BDNF-Induced CREB transcriptional regulation in hippocampal neurons. Journal of Neuroscience, 40(42), 8042-54.
Kaesler, D. S., Mellifont, R. B., Kelly P. S., & Taaffe, D. R. (2007). A novel balance exercise program for postural stability in older adults: A pilot study. Journal of Bodywork and Movement Therapies, 11(1), 37-43.
Kalinowska-Lyszczarz, A., & Losy, J. (2012). The role of neurotrophins in multiple sclerosis-pathological and clinical implications. International Journal of Molecular Sciences, 13(10), 13713-25.
Karege, F., Schwald, M., & Cisse, M. (2002). Postnatal developmental profile of brain-derived neurotrophic factor in rat brain and platelets. Neuroscience Letters, 328(3), 261-4.
Khademosharie, M., Tadibi, V., Behpoor, B., & Hamedinia, M. R. (2019). The effect of a 12-week resistance and endurance training on the serum levels BDNF, hematological factors and some immune system indices in women with multiple sclerosis. Journal of Applied Exercise Physiology, 15(29), 43-55. [Persian]
Khanbabazade, M., Ebrahimi Atri, A., & Rashidlamir, A. (2015). Comprision of the effect of aerobic and weight resistance training protocols on balance and neuron growth factor (NGF) on the neuropathy–diabetic men. Journal of Shahid Sadoughi University of Medical Sciences, 23(2),1866-1877. [Persian]
Kloubec, J. A. (2010). Pilates for improvement of muscle endurance, flexibility, balance, and posture. Journal of Strength and Conditioning Research, 24(3), 661-667.
Kurtzke J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11),1444.
Latey, P. (2001). The Pilates method: history and philosophy. Journal of Bodywork and Movement Therapies, 5(4), 275-282. Lommatzsch, M., Zingler, D., Schuhbaeck, K., Schloetcke, K., Zingler, C., Schuff-Werner, P., & Virchow, J. C. (2005). The impact of age, weight and gender on BDNF levels in human platelets and plasma. Neurobiology of Aging, 26(1), 115-23. Loprinzi, P. D., & Frith, E. (2019). A brief primer on the mediational role of BDNF in the exercise-memory link. Clinical Physiology and Functional imaging, 39(1), 9-14.
Moghadasi, M., Edalat Manesh, M. A., Moeini, A., & Namatollahzadeh, M. (2015). Effects of eight weeks of resistance training on brain derived neurotrophic factor in female patients with multiple sclerosis. Koomesh, 17(1), 152-159. [Persian]
Mohali, Z., Ebrahimi atri, A., & Khoshraftar Yazdi, N. (2013). The effect of Tai Chi training on women balance with multiple sclerosis. Medical Surgical Nursing Journal, 2(3,4), 81-85. [Persian]
Mohamadi Dinani, Z., Nezakatolhossaini, M., Esfarjani, F., & Etemadifar, M. (2013). The effect of 8-week pilates training on motor function and depression in subjects with multiple sclerosis (MS). Journal of Research in Rehabilitation Sciences, 9(2), 308-317. [Persian]
Molteni, R., Wu, A., Vaynman, S., Ying, Z., Barnard, R. J., & Gómez-Pinilla, F. (2004). Exercise reverses the harmful effects of consumption of a high-fat diet on synaptic and behavioral plasticity associated to the action of brain-derived neurotrophic factor. Neuroscience, 123(2), 429-40.
Muscolino, J. E., & Cipriani, S. (2004). Pilates and the “powerhouse”. Journal of Bodywork and Movement Therapies, 8(1), 15- 24.
Nakhzari Khodakheir, J., Haghighi, A. H., & Hamedinia, M. R. (2018). The effects of combined exercise training with aerobic dominant and coenzyme Q10 supplementation on serum BDNF and NGF levels in patients with multiple sclerosis. Journal of Arak University of Medical Sciences, 21(3), 94-103. [Persian]
Neeper, S. A., Gómez-Pinilla, F., Choi, J., & Cotman, C. W. (1996). Physical activity increases mRNA for brain-derived neurotrophic factor and nerve growth factor in rat brain. Brain Research, 726(1-2), 49-56.
Norbye, A. D., Midgard, R., & Thrane, G. (2020). Spasticity, gait, and balance in patients with multiple sclerosis: A cross-sectional study. Physiotherapy Research International, 25(1), e1799.
Oliff, H. S., Berchtold, N. C., Isackson, P., & Cotman, C. W. (1998). Exercise-induced regulation of brain-derived neurotrophic factor (BDNF) transcripts in the rat hippocampus. Molecular Brain Research, 61(1-2), 147-53.
Pan, W., Banks, W. A., Fasold, M. B., Bluth, J., & Kastin, A. J. (1998). Transport of brain-derived neurotrophic factor across the blood-brain barrier. Neuropharmacology, 37(12), 1553-61.
Phillips, C., Baktir, M. A., Srivatsan, M., & Salehi, A. (2014). Neuroprotective effects of physical activity on the brain: a closer look at trophic factor signaling. Frontiers in Cellular Neuroscience, 8, 170.
Reichard, L. F. (2006). Neurotrophin-regulated signalling pathways. Philosophical transactions of the Royal Society B: Biological Sciences, 361(1473), 1545-65.
Sadi Zadeh, S., Avandi, S. M., & Ebrahimi, M. (2017). The effects of eight weeks of yoga training on serum levels of BDNF in women with multiple sclerosis. Journal of Applied Health Studies in Sport Physiology, 4(2), 81-88. [Persian]
Saghebjoo, M., Dehghani Firouzabadi, M., Etesami, M., & Mahmudzadeh, T. (2016). Effect of pilates training on serum levels of brain-derived neurotrophic factor, malondialdehyde and total antioxidant capacity in women with multiple sclerosis. Exercise Physiology, 30, 143-158. [Persian]
Sánchez-Lastra, M. A., Martínez-Aldao, D., Molina, A. J., & Ayán, C. (2019). Pilates for people with multiple sclerosis: A systematic review and meta-analysis. Multiple Sclerosis and related Disorders, 28, 199-212.
Shams, A., Taherii, H., Nikkhah, K., & Samad Zadeh, S. (2016). The effects of one period of selective exercise training with instructions focus of attention on motor function of multiple sclerosis patients. Journal of Mashhad University of Medical Sciences, 18(61), 28-34. [Persian]
Shanazari, Z., Marandi, S. M., & Minasian, V. (2013). Effect of 12-week pilates and aquatic training on fatigue in women with multiple sclerosis. Journal of Mazandaran University of Medical Sciences, 23(98), 257-264. [Persian]
Sheikholeslami-Vatani, D., & Ghaderi Almaneh, G. (2019). Positive effects of progressive resistance training on physical fitness indices in patients with multiple sclerosis. Journal of Practical Studies of Biosciences in Sport, 7(13), 31-42. [Persian]
Smith, M. A., Makino, S., & Kvetnansky, R. (1995). Effects of stress on neurotrophic factor expression in the rat brain. Annals of the New York Academy of Sciences, 771, 234-9
Soltani, M., Hejazi, S. M., Noorian, A., Zendedel, A., & Ashkanifar, M. (2010). The effect of aerobic training on the improvement of expanded disability status scale (EDSS) in multiple sclerosis patients. Journal of Medical Science of Mashhad, 1(17), 15-20. [Persian]
Vega, R. S., Struder, H. K., Wahrmann, V. B., Schmidt, A. B., Bloch, W., & Hollmann, W. (2006). Acute BDNF and cortisol response to low intensity exercise and following ramp incremental exercise to exhaustion in humans. Brain Research, 11(21), 59-65.
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., ... & Baneke, P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal, 26(14), 1816-1821.
White, L. J., McCoy, S. C., Castellano, V., Gutierrez, G., Stevens, J. E., Walter, G. A, & Vandenborne, K. (2004). Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Sclerosis, 10(6), 668-74.
)