participants
The present study with a semi-experimental method and a pre-test-post-test design, without blinding, simple randomized targeted, was registered in the Iranian Clinical Trials Registry under the number (IRCT20211020052826N1). This study was conducted based on the principles of the Declaration of Helsinki. The research plan was approved by the research ethics committee of the Razi University of Kermanshah (IR.RAZI.REC.1399.073) of Iran. Written informed consent was signed by each patient before starting the study process. Women with MS were recruited through advertisements in the Kermanshah MS Association Center of Iran. 56 women with MS volunteered to participate in this study and were screened according to the inclusion criteria. The criteria for inclusion in the study were: age between 20–40 years, MS degree less than 4.5, no sensitivity to grape juice, no regular exercise 1 month before the start of the research, and not pregnant. Exclusion criteria include hospitalization, exercise intolerance, coronavirus, disease recurrence, smoking, non-regular attendance at the intervention, heart diseases, kidney disorders, cancer, and endocrine and metabolic diseases. Patients were divided into four groups of training (n = 12), supplement (n = 12), supplement + training (n = 12) and control group (n = 12)using a random number table.
Designing
Before attending the training program, the participants completed three questionnaires. Firstly, the questionnaire of demographic characteristics (age, height, weight, level of education, and employment status) was used. The second questionnaire was a 28-item questionnaire developed by Bedley, Harris, and Sunderland (1983) that measures everyday memory (reliability over 80%). The third questionnaire evaluates retrospective and prospective memory: this questionnaire is a 16-item self-report scale developed by Smith et al. in 2000. Three days before the start of the intervention and at the end of the study, the participants were familiarized with the study method and initial measurements including anthropometric parameters and body composition (BMI) and body weight (BW) were performed by the Inbody test using bioelectrical impedance analysis (9.9 Plus; Jawon Medical). Co. Ltd. Zeus Kungsang Bukdo, South Korea) was evaluated. Height was measured using a stadiometer (Detecto, Model 3Phtrod-Wm, USA) with an accuracy of 0.5 cm. Then the questionnaires were given to them.
Intervention
The experimental groups exercised at home three times a week for two months under online supervision (in the form of educational videos and brochures). All training sessions were performed under the supervision of a sports physiologist. Red grape juice supplement was taken based on standard amounts.
Endurance training
Endurance training was performed at home for eight weeks under online supervision (Table 1). Subjects were instructed to perform an exercise program consisting of walking on a treadmill or outdoors at moderate intensity three times a week. The training was done three sessions a week using initial training intensity of 50 to 70% of VO2-max corresponding to 60 to 80% of HRmax (training intensity was increased by 10% every two weeks). The duration of the training was 30 minutes. Each session included a 5-minute warm-up period and a 5-minute cool-down period. The HRmax formula was used to determine the target heart rate [HRmax = 220 − age]. Participants were instructed to monitor heart rate during a training session using a digital heart rate monitor (SM-66; Skynie, Tokyo, Japan). To ensure that the desired heart rate (exercise intensity) was achieved and maintained during the exercise phase, a scale of 10–12 Rate of Perceived Exertion (RPE) was taken into account. The subjects of the grape juice group and the control group were instructed that the level Do not change your physical activity [13].
Table 1
Endurance training protocol
|
Variables
|
|
|
|
|
|
|
|
week
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
Intensity(HRmax)
|
50–55%
|
50–55%
|
55–60%
|
55–60%
|
60–65%
|
60–65%
|
65–70%
|
65–70%
|
Tim(min)
|
30
|
30
|
30
|
30
|
30
|
30
|
30
|
30
|
Borg scale
|
10
|
10
|
10
|
11
|
11
|
11
|
12
|
12
|
Resistance training
Resistance training was done for eight weeks at home and immediately after aerobic training (Table 2). Subjects were instructed to perform an exercise program three times a week including sitting up from a chair, forward lunges, step-ups, toe-heel raises, and supine leg curls at moderate intensity. The traning consisted of 8 weeks of home training, which included a 4-week hypertrophy phase and a 4-week strength phase. The vest was used to increase the intensity of the training. Although the training intensity and training volume were different in each person, the study was designed as follows: (1): The initial resistance of the vest was set at 05% of the body weight and increased according to the percentage of body weight (05%-1.5%) every two weeks (2): In the first and second weeks of the study, the participants were instructed to do 2 sets of 8 to 12 repetitions, and in the third and fourth weeks of the study, the participants were instructed to do 3 sets of 8 to 12 repetitions. (hypertrophy phase) (3): During weeks 5 to 8, participants reduced the number of traning to 2 sets of 8 to 10 repetitions (strength and resistance phase). For both groups (traning and + traning supplementation) during the call, the researcher talked about the participants' fatigue levels and asked about changes in physical activity, medical conditions, medications, or stress related to home or work. 48 hours after the end of the intervention, both groups answered the questionnaires for the post-test [14].
Table 2
Resistance training protocol
|
Variables
|
|
|
|
|
|
|
|
week
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
Intensity(b.w)
|
0.5%
|
0.5%
|
1%
|
1%
|
1%
|
1.5%
|
1.5%
|
1.5%
|
Tim(min)
|
30
|
30
|
30
|
30
|
30
|
30
|
30
|
30
|
Borg scale
|
10
|
10
|
10
|
11
|
11
|
11
|
12
|
12
|
Set
|
2
|
2
|
3
|
3
|
2
|
2
|
2
|
2
|
Repetition
|
8–12
|
8–12
|
8–12
|
8–12
|
8–10
|
8–10
|
8–10
|
8–10
|
Red grape juice supplement
Red grape juice with Brix 14 was consumed three times a week for eight weeks. Subjects in the supplement and training + supplement groups consumed 250 ml of grape juice daily as a snack between morning and noon (3 sessions per week).
statistical analysis
All statistical analyzes were performed using SPSS version 26 statistical software and P < 0.05 was used at the significance level. The Shapiro-Wilk test was used to evaluate the normality of the distribution. To compare the average memory between groups and within groups, a two-way analysis of variance and correlated t-test was used. If a significant difference was observed, Tukey's post hoc test was used.