The impact of two different-home based physical training interventions to reduce fatigue and improve, strength, dexterity, and activities of daily living in adults with Multiple Sclerosis.

1. Home-based physical training to reduce fatigue and improve strength, dexterity and activities of daily living in adults with Multiple Sclerosis. 2. This research project aims to investigate the effect of two different home-based physical training programs on the functional well-being of adults with Multiple Sclerosis (MS). Functional well-being is often hindered by MS, as it affects the ability to perform Activities of Daily Living (ADLs). ADLs are the tasks that one completes every day, such as using cutlery, tying shoelaces and brushing one’s teeth. These tasks require fine motor skills that involve the use of small intricate muscles in the hands and arms. When these muscles become tired, completing ADLs can feel taxing due to fatigue, which can result in losses of concentration and difficulty maintaining focus. Both yoga and strength training have separately been recognised as forms of therapy for their ability to improve body awareness, release tension and decrease fatigue. Fine motor training has also been reported as having an impact in improving ADL’s and reducing fatigue in adults with MS. For this project, we wish to combine a strength and yoga home program and compare it to a fine motor home program. The aim of this project is to examine the impact of two separate home-based physical training programs, (1) fine motor training and (2) strength and yoga training to determine which one has an impact in reducing fatigue, and improving ADLs, dexterity, and strength to hopefully maintain physical independence at home. 3. Each person/participant will be required to complete the Jamar Dynamometer, Modified Fatigue Impact Scale (MFIS) questionnaire, Nine-Hole Peg Test (9-HPT) and the Nottingham Extended Activities of Daily Living (NEADL) questionnaire before and after their allocated program. 4. Participants will either be randomly allocated to the Fine Motor group, or the Strength/yoga group. Each training program will run for a total of 4-weeks, taking approximately 30 minutes to complete and is required to be performed 4-days of the week. For those who are allocated the Fine Motor training program, they will complete six exercises, 4-days a week. For those allocated to the combination training of Strength and Yoga training program, the strength component will involve the use of a Theraband, which seven exercises will be performed. The Yoga requires seven poses to be performed, with modifications available. Orientation of the program prior to commencement: Each person will be required to visit the Multiple Sclerosis Society of Western Australia (MSWA), in Wilson to complete and an introductory/orientation session. This session will run for 60 to 90 minutes, allowing time for questions and queries to be answered. The aim of this orientation will to provide the participants with the opportunity to perform their required exercises and ask any questions about their chosen program. There will be multiple orientation sessions on offer for each person to attend at a time that suits their availability. After an orientation session is completed, each person will commence their program the following day by watching videos on an USB provided by the researcher/ watching videos posted on a personal YouTube channel. 5. The intervention provider will be conducted by the researcher, who has a Bachelor's degree in Exercise and Sport Science. 6. Each person must allocate approximately 30 minutes on 4 days of the week, for a period of 4 weeks to complete their allocated program. 7. This is a home-based physical training program. 8. Fine Motor Training Program was adapted from an Arm Ability Training program in people with mild arm paresis after stroke and traumatic brain injury. This program consists of six different exercises including finger tapping, crossing circles, turning discs, nuts on bolts and modelling clay (Platz et al., 2001; Plazt, 2006). Exercises 1-4 are to be performed as fast as possible with the time taken to complete each task being recorded. Exercises 5-6 are to be performed without measuring the time. Participants will record the quality of their movement. Strength Program involves seven upper extremity strength-training exercises using a Theraband. The tempo of each lift set at 5-0-2; where 5 sec indicates the length of the eccentric phase of the lift, 0 sec isometric (pause) within the lift, and 2 sec concentric phase of the lift (Dibble et al., 2006). The exercises include elbow-flexion, elbow extension, hand-abduction, hand pronation, hand-supination, hand-extension and hand-flexion (Romberg et al., 2004). The selection of the Therabands is in accordance with Santos et al. (2009). Each week participants will be given a new Theraband to increase their strength. Each band has a difference in resistance of 15 to 25% (Santos et al., 2009). Participants will start with the lowest (red) and then progress to blue, green and black (Santos et al., 2009) each week. The Theraband website (http://tbdev.performancehealthdev.com/media/theraband/instructions/Resistance_Band-Tubing_Instruction_Manual(1).pdf) prescribes a load calculation of the percentage of elongation of the Therabad. The calculation: % elongation = [(final length – initial length) / (initial length)] x 100 (Colado et al., 2010). The values produced are the values specific to each Theraband colour (Page et al., 2000). A protocol of three sets of ten repetitions for each exercise, with a 60-second rest interval between sets will be implemented (Areas et al., 2013). Each participant is to record the exercises they performed. If participants are not able to complete the required amount of repetitions they will record what repetitions they could complete and the reason why they had to stop, such as fatigue. Yoga program is Three elements of the home yoga program are outlined below, the completion of the program taking 15 minutes (Komatsu et al., 2015). The participants will progress through the three different programs over the first 3 weeks, which includes: 1. Fullbody stretching including isometrics and deep breathing (Week 1). 2. Low intensity with sedentary poses (Week 2) 3. Higher intensity with standing poses (Week 3) Week four will allow the participants to choose either one program or combining multiple programs to practice based on their preferences and how they are feeling (Komatsu et al., 2015). The participants will keep a diary and write down the date, the specific yoga program and the practice time (Komatsu et al., 2015). This will be noted for data analysis. Each pose will be held for 10-30seconds, followed by a resting period lasting from 30-seconds to 1-minute (Guner & Inanici, 2015).