Multiple sclerosis (MS) is a chronic and debilitating disease of the central nervous system. Chronic illness and lack of definitive treatment reduce all aspects of physical and social functioning and thus reduce quality of life. The aim of this study was to compare the effectiveness of a group of yoga and psychotherapy group exercises based on acceptance and commitment to fatigue and quality of life of patients with MS.


 

In the present quasi-experimental study (pre-test-post-test design), 60 women with MS referred to the Neshat Clinic in Hamadan were selected randomly, considering entry criteria and then divided into two equal groups of yoga exercises and acceptance and commitment-based therapy groups (both 12 sessions each). To analyze the findings, we used independent t-test, Chi-square and Fisher's exact test, analysis of covariance and LSD with 95% confidence level with the help of SPSS software version 22 (SPSS Inc., Chicago, Ill., USA).

The results showed that compared to group psychotherapy based on acceptance and commitment, yoga group demonstrated -5.29±0.69 units of reduction in the fatigue score and 8.39±1.11 units of decrease in quality of life score which was statistically significant (P <0.001).

 

Table 1. Comparison of the characteristics of yoga and psychotherapy groups based on acceptance and commitment

P	Act N (%)	Yoga N (%)	Total N (%)	Characteristics
0.535	(56.7)17	(43.3)13	(50.0)30	5-0	Duration of illness (years)
	(26.7)8	(23.3)7	(25.0)15	10-5
	(10.0)3	(23.3)7	(16.7)10	15-10
	(6.7)2	(10.0)3	(8.3)5	15≤
0.052	(83.3)25	(100.0)30	(91.7)55	No	Family history
	(16.7)5	0 (0)	(8.3)5	Yes
0.044	(53.3)16	(23.3)7	(38.3)23	A symptom	Number of symptoms
	(26.7)8	(53.3)16	(40.0)24	Two symptoms
	(20.0)6	(23.3)7	(21.7)13	Three and more

 
 
 
Table 2. Mean and standard deviation of characteristics of yoga and act groups before treatment

P	Act M (SD)	Yoga M (SD)	Total M (SD)	Characteristics
0.049	(4.0)32.9	(6.9)30.0	(5.8)31.5	Fatigue
0.012	(16.4)98.7	(21.2)111.5	(19.0)105.0	Quality of Life

 
Table 3. Analysis of covariance table (effect of treatment on fatigue score and quality of life)

P	F	Cure	Characteristics
<0.001	59.26	Cure	Fatigue
<0.001	179.05	Primary fatigue
<0.001	56.96	Cure	Quality of Life
<0.001	845.72	Early quality of life

 
Table 4. Comparison of the difference between the mean score of fatigue and quality of life based on treatment

P	Mean	Characteristics	Yoga-Act
< 0.001	(0.69)5.29 -	Fatigue
<0.001	(1.11) 8.39	Quality of Life

 
 

Figure 1 Mean fatigue before and after treatment



Figure 2. Average quality of life before and after treatment

 

According to yoga research, compared to group psychotherapy based on acceptance and commitment, yoga significantly reduced fatigue. The results of Mostert and Kesselring studies also reported the effect of a short period of exercise (yoga) on the health progression and activity level of MS patients in Valence Rehabilitation Center with P-value<0.009 and P-value<0.005, which is consistent with the findings of the present study [11]. In confirmation of the present study with the research of Guner et al., a significant effect of yoga exercises on fatigue and maintaining balance of patients can be seen [12]. In order to determine the effect of yoga practice on reducing fatigue, Shahrjerdi et al. studied central stability and yoga exercises on the balance of 36 women with MS for two months in Arak, which presented the significant effects of yoga exercises [14] and is in line with the present study. Pazokian et al. also investigated the effect of stretching exercises for 6 weeks on the fatigue rate of MS patients, the results of which confirmed the significant effectiveness of 80 patients with MS in Tehran [20], which is consistent with the findings of the present study. In confirmation of the present study, Oken et al. reported that the effect of yoga on the well-being of patients with MS in the United States was reported to be significant [21]. These results, however, in the study of Daglas et al., Kileff et al did not change the rate of fatigue in patients [23, 22]. The discrepancy in reducing the severity of fatigue with exercise can be due to the type of scale used to measure fatigue or due to differences in the manner and severity of the disease and the underlying factors of the disease. However, in explaining the general results, it can be said that yoga exercises increase gamma butyric acid, dopamine, serotonin and decrease cortisol in the body, which together with these changes in chemical and hormonal mediators reduces fatigue and improves the condition [24]. On the other hand, yoga exercises focus and maintain awareness of muscle and muscle movements, which reduces stiffness and tension in the muscles and creates more flexibility in the muscles, and leads to reducing fatigue [15].
Another finding of the study was the effect of yoga on increasing the quality of life of patients compared to group psychotherapy based on acceptance and commitment. The results of a study by Najafi Dollatabadi et al., which examined the effect of yoga on the quality of life of 60 women with MS for three months, confirm that yoga causes a relative improvement in the quality of life of patients. So that the average range of activities related to perception from 15.6 ± 5.5 to 18.3 ± 4.45 (P=0.001), social relations from 3.5 ± 1.2 to 4.12 ± 1 (P=0.001) and sexual activity was changed from 5.8 ± 6.15 to 4.8 ± 5.18 (P=0.007) [25]. These results are consistent with the present study. But conflicting results in a systematic evaluation and meta-analysis showed that the short-term effects of yoga cannot be clearly related to quality of life [26]. But in general, in explaining these results, we can say that the nature of yoga exercises is the control of the mind and central nervous system. Unlike other sports, yoga has a moderating effect on the functioning of the internal nervous system and the regulation of nerve messages. Therefore, by increasing the adaptive capacity of psycho-nervous-immune systems, modulating the autonomic nervous system, increasing physical stability and resistance of the body and modulating the immune system affect the increase of quality of life [24].

 

It can be concluded that yoga and group psychotherapy based on acceptance and commitment reduce fatigue and increase the quality of life of patients with MS. It is effective that these results can promise a new development in interventions, so that in addition to drug treatment, complementary therapies can be used to reduce the complications of the disease.

 

This article is taken from the doctoral dissertation of Psychology of Islamic Azad University, Boroujerd Branch, number 95300774. We would like to thank the esteemed professors and colleagues of Boroujerd Branch of Azad University and Hamadan University of Medical Sciences, the head of the Hamadan MS Association, Dr. Mazdeh, and women with MS who helped with the presence and serious participation in achieving this research. The present study has research ethics confirmation with the code IR.IAU.B.REC.1398.043 from Islamic Azad University, Boroujerd Branch (https://ethics.research.ac.ir/ProposalViewEn.php?id=107080) and clinical trial with the code IRCT20200423047176N1.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.