JURNAL

MATA KULIAH OLAHRAGA

“PENGGANTI PENILAIAN HARIAN TES RENANG”

OLEH:

ANNASAI NAURA VIDYA 11000119130764

KELAS J
PROGRAM STUDI ILMU HUKUM
UNIVERSITAS DIPONEGORO
2019
International Journal of Sports Science and Physical Education
2018; 3(4): 55-61
http://www.sciencepublishinggroup.com/j/ijsspe
doi: 10.11648/j.ijsspe.20180304.12
ISSN: 2575-226X (Print); ISSN: 2575-1611 (Online)

Report
Comparative Study of Individuals with and Without Multiple
Sclerosis: Overall Profile of Quality of Life, Exercise, Health
Behaviors
Anastasia Karageorgou1, *, Dimitrios Kokaridas1, Yiannis Theodorakis1, Sergios Mousiolis2,
Asterios Patsiaouras1, Marios Goudas1
1
Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
2
Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece

Email address:
*
Corresponding author

To cite this article:

Anastasia Karageorgou, Dimitrios Kokaridas, Yiannis Theodorakis, Sergios Mousiolis, Asterios Patsiaouras, Marios Goudas. Comparative
Study of Individuals with and Without Multiple Sclerosis: Overall Profile of Quality of Life, Exercise, Health Behaviors. International
Journal of Sports Science and Physical Education. Vol. 3, No. 4, 2018, pp. 55-61. doi: 10.11648/j.ijsspe.20180304.12

Received: November 16, 2018; Accepted: December 8, 2018; Published: January 16, 2019

Abstract: Multiple Sclerosis (MS) patients differ with healthy populations in quality of life parameters, physical activity
participation and health behaviors. However, no research has been conducted yet comparing such differences, outlining an
overall profile. The purpose of this study was to examine and compare the profile of Greek MS patients with healthy
individuals, as regards to the quality of life, physical activity involvement, adoption of health behaviors, and levels of
depression and anxiety. The sample consisted of 26 MS patients and 90 healthy individuals overall 116 participants.
Instruments used included the GLTE Questionnaire, habitual physical activity questionnaire, the SF 36, the Fagerström Test for
Nicotine Dependence, the Hospital Anxiety and Depression Scale, the Baecke and the Nutritional Behaviors questionnaire. T-
test for independent variables was used to locate differences between individuals with or without MS and according to gender.
Significance level was set at p<.05. The results showed MS patients as choosing light physical activity (PA) levels compared to
healthy participants choosing moderate levels of PA. Healthy individuals also achieved higher scores in leisure time, sport and
total physical activity index, exhibiting lower levels of anxiety and depression and better perceived quality of life compared to
patients with MS. The profile of MS patients was associated with light PA, lower perceived quality of life, higher anxiety and
depression as compared to healthy individuals. Future suggestions were made to examine application of exercise programs and
their effect on psychological parameters of individuals with and without MS.
Keywords: Physical Activity, Psychological Parameters, Multiple Sclerosis

1. Introduction corresponding to the average age of appearance and women

Multiple sclerosis (MS), a chronic inflammatory
demyelinating disease, is considered the third most common
cause of serious disability [1] and one of the most
representative and frequent neuromuscular conditions [2]
characterized by degeneration of the central nervous system
with various symptoms and unpredictable alternations of
recession and aggravation periods. In Greece, the number of
people affected ranges up to 7,000 people, with 27 years
exhibiting a higher incidence of the disease [3, 4].
MS seriously affects nerve conduction of both motor and
sensory nerves, causing varying degrees of disability related
with motion and sensation. During the acute phase of the
disease, the nerve conduction becomes slower or more
obstructed causing muscle weakness, loss of movement,
instability, blurred vision or diplopia, speech disorders, fatigue,
and in more severe situations partial or complete paralysis [5].
The severity of MS symptoms varies greatly from person to
56 Anastasia Karageorgou et al.: Comparative Study of Individuals with and Without Multiple Sclerosis:
Overall Profile of Quality of Life, Exercise, Health Behaviors
person depending on which nerves are affected and how
many "attacks" of the disease the person has suffered during
his life, making MS a purely personal issue experienced by
each patient differently [6]. In general, MS sufferers may
experience four different states progression of the disease,
which may be mild, moderate or severe, depending on the
causing symptoms [7], that in turn affect mental and physical
state of patients [8] and lead to family dependence and a
continuous decrease of their quality of life [9, 10].
In addition to psychosocial factors, MS patients often
present sleeping problems, lack of interest, eating disorders
and suicidal ideation at some point in their lives [11]. As
myelin and white matter areas of the brain that are
responsible for emotional expression are destroyed [12],
these symptoms are probably due to the disease itself.
Furthermore, MS patients experience intense anxiety due to
the threat imposed by the disease, with stress symptoms
influenced either by a sense of fear, lack of social support
and different residential placement [13]. These negative
feelings affect and in turn aggravate relative symptoms.
According to Tsungou, Tzinalis & Bellali, knowing and
accepting such symptoms is only a part of proper disease
treatment that could also include physical activity and a
balance diet as additional means to provide important support
to MS patients [1].
Indeed, recent research has shown that an organized,
systematic and well targeted form of exercise helps MS
patients to improve their mood state [14], quality of life and
functionality level [15, 16] and to reduce fatigue [17],
compared to patients who do not exercise [15]. According to
Garopoulou, MS patients is important to exercise frequently
so as to maintain or improve their health condition and
socialization, increase their energy and resistance to the
disease and reduce rehabilitation costs [18].
Smoking has also linked with environmental factors and
MS occurrence [19], reported that smokers are more likely to
develop MS than non-smokers, while in a research confirmed
smoking as a serious risk factor for MS appearance [20].
However, studies have not yet been conducted to examine the
effect of diet and smoking on the quality of life of MS
patients. In Greece, studies so far have focused on
examining the individual factors that shape the profile of
MS patients [21], noted that MS patients feel generally
exhausted and face difficulties in their daily activities,
exhibiting emotional instability, voraciousness, irritability or
even mental illness mainly in the form of manic depression.
All these psychological reactions cause dissatisfaction
especially in the case of patients with high intellectual
awareness who often
appear pessimistic and unable to set goals in life [22].
As regards to the quality of life of MS patients, Theofilou
identified female gender, old age, married life, low education
and most years of treatment as the main factors associated
with better mental health and better quality of life [23].
Researchers found that marital status and place of residence
are also factors that affect cognitive functioning, anxiety,
physical health and general quality of life of MS patients
[13]. In addition, since the decline in cognitive function and
retrospective memory affects quality of life regardless of
depression and the severity of MS [24], improving quality of
life and slowing the progression of the disease can be
achieved by adopting healthy eating habits [25].
However, reviewing the literature it seems that no research
has been conducted yet comparing MS patients with healthy
populations in terms of participation in physical activity and
adoption of appropriate health behaviors, outlining an overall
profile of Greek MS patients. The recording of knowledge
and attitudes of MS patients especially when compared with
those with no MS concerning their activity during leisure
time and the extent to which they adopt a healthy lifestyle,
represents the first systematic attempt to create a
comprehensive picture of habits prior implementing
interventional health, diet and exercise programs in Greek
MS patients, which in itself is a strong argument of the
research importance.
The purpose of this study was to examine and compare the
profile of Greek MS patients with healthy individuals, as
regards to the quality of life, physical activity involvement,
adoption of health behaviors, and levels of depression and
anxiety. This research is in fact the first step of a doctoral
study aiming to examine and compare the effect of exercise
on psychological parameters of trainees with and without
MS, after first outlining an overall profile of all participants
so as to create a fixed point of reference prior exercise
intervention.
2. Method
2.1. Sample
The sample consisted of 26 MS patients (8 men, 18
women) and 90 healthy individuals (26 men, 64 women),
overall 116 participants coming from the wider Thessaly
region who have agreed to participate voluntarily. Data co
llection date was set at 15/03/17. MS individuals were also
members of the Larissa MS club as well as patients of the
General University Hospital of Larissa under close medical
supervision and medication. All patients had confirmed
diagnosis of MS and did not have any accompanying
problems that would exclude them from participating in
exercise, as evaluated by a neurologist and ranked in the
EDSS range from 0 to 4 (fully ambulatory without
assistance).
2.2. Procedure
The participants were initially informed about the purpose,
the process and the voluntary basis of the study and they
were ensured that all questionnaires were confidential and
anonymous. Researchers were present during their
completion to answer any questions posed by participants,
without otherwise being involved during the process. Prior
completion of questionnaires, the study and its procedures
was evaluated and approved by the DPESS University of
Thessaly Ethics Committee Board (approval number: 1-5/5-
10-2016).
2.3. Instruments
The questionnaires administered to all individuals with and
without MS for research purposes, were:
i) The Godin Leisure-Time Exercise Questionnaire [26] a
 self-explanatory and brief four item query, measuring (male - female) with and without MS (Table 1).
(light, moderate or strenuous) intensity of weekly
leisure-time exercise habits, as used in the study of Table 1. Physical activity level of individuals with and without MS.
Theodorakis & Hassandra [27]. Variable N Mean SD
ii) The Baecke [28] habitual physical activity Exercise Intensity
questionnaire, as previously used by Theodoropoulos, Total
Healthy 90 2.1 .90
Kartelliotis, Gelada & Nasis [29] and Blatsis [30], that
MS 26 3.08 .63
asks questions and provides indexes regarding Male
occupational,
leisure and sport activities, based on frequency and Healthy 26 2.04 .87
perceived
iii) The Greekintensity
versionof exercise
[31] of during
SF-36the last month.
quality of life MS
Female 8 3.25 .46
.92
questionnaire [32], a self-assessment tool designed to Healthy 64 2.13 -3.76 80 .000

-3.7532

-5.17114

TDfP
examine individual’s perceptions regarding quality of MS 18 3.00 .69
life in relation to eight different areas, that is, physical
In relation to depression and anxiety experienced,
functioning, role limitations due to physical problems,
statistically significant differences were observed between
bodily pain, general health, social functioning,

1
00
.
0
00
.
men with and without MS, with male patients experiencing
energy/vitality, role limitations due to emotional
more intense anxiety and depression symptoms compared to
problems and mental health. These 8 domains are
healthy ones, whereas no differences were observed in
grouped into two main areas of physical and mental
women (Table 2).
component scores, with higher values indicating a
higher quality of life. Table 2. Anxiety and depression on individuals with and without MS.
iv) The "Nutritional Behaviors" questionnaire [33] that
examines the extent to which the patient feels confident
enough to replace unhealthy eating habits with healthy
ones. The responses of the 13 questions constituting a
single factor are given at a 10-degree Likert scale,
ranging from (1) not at all confident to (10) very

Anxiety Total
y
Health
Male
sion
Depres
y MS
Health
Female
y MS
Health
Male
Anxiety
y MS
Health
Total
sion
Depres
y MS
Health

VariableNMeanSDTDfP
confident.
v) The Fagerström Test for Nicotine Dependence [34], a
standard instrument for assessing the intensity of
6
2
8
1
4
6
8
6
2
6
2
0
9
6
2
0
9
physical addiction to nicotine (very low to very high)
per day, with six items evaluating the quantity of
42
4.
56
6.
14
13
6.
10.
5
4.8
2
6.9
80
4..
66
7.
77
5.
cigarette consumption, the compulsion to use and
dependence.
05
4.
34
4.
02
73
3.
4.
03
4.
26
3.
20
3.
68
4.
37
3.
vi) The Greek version [35] of the hospital anxiety and
depression scale [36], a reliable and easy to use
3
3.1
-

7
-.4
2
3.1
-

7
2.9
-

-2.29114

instrument for detecting states of depression and

anxiety
2
3

2
3
0
8

4
11

and measuring severity of emotional disorder in patients MS 8 9.13 2.17

2
00
.

2
00
.
3
64
.

2
00
.

2
01
.

who may need additional psychological evaluation and Female

2.81
support. Healthy 64 4.95 -1.28 80 .102
MS 18 5.95 3.23

2.4. Statistical Analysis

Statistical analysis was conducted using the 19.00 SPSS
version and included t test for independent variables to locate
differences between individuals with or without MS and
according to gender. Significance level was set at p<.05. The
questionnaires used in this study had all acceptable
psychometric characteristics.
As for quality of life, healthy participants demonstrated
higher score than MS patients in their perceptions regarding
quality of life in the two main areas of physical and
psychological health as expressed by physical functioning,
role physical, general health, vitality, social functioning, role
emotional and mental health. MS patients exhibited higher
values only in the 'negative' factor of bodily pain (Table 3).

Table 3. Quality of life between individuals with and without MS.

3. Results
As regards to the level of physical activity (PA) between
individuals with and without MS, statistically significant
differences were observed with MS patients choosing light
physical activity levels compared to healthy participants
choosing moderate levels of PA. Similarly significant
differences were also observed for each gender separately
Variable Mean SD T Df P
Role physical
Healthy 7.27 1.07 6.329 114 .000
MS 5.58 1.58
General Health
Healthy 18.31 3.27 7.519 114 .000
MS 12.85 3.26
 VariableMeanSDTDfP VariableNMeanSDTDfP
Vitality MS 8 2.25 .89
Healthy MS 16.95 3.85 Female
5.514114 .000
Mental health 12.31 3.50 Healthy 64 2.78 .45
3.9980 .000
Healthy MS 18 2.22 .73
MS 22.52 4.37
3.463 114 .001
19.08 4.80
Physical Functioning
Healthy
4. Discussion
MS 27.02 2.82 12.70
17.50 4.84 2
114 .000 The purpose of the study was to examine and compare
Role emotional
Healthy
quality of life, physical activity and adoption of health
MS 5.18 1.16
1.896 114 .030 behaviors between individuals with and without MS, in an
Bodily pain Healthy
4.69 1.12 effort to outline an overall profile of MS patients and to
MS
3.21 1.32
provide a fixed point of reference of these patients prior
Social Functioning
5.27 2.09
-6.073 114 .000 exercise intervention.
Healthy As a first finding, MS patients seemed to choose light
8.38 2.23
4.423114 .000 physical activities compared to moderate intensity activities
selected by people without MS, probably due to muscle
weakness, fatigue, loss of movement, and instability that MS
MS 6.23 1.99
114 .000
Physical Health patients usually experience, resulting in a more 'careful'
Healthy 55.81 5.33 11.64 approach to participate in exercise or recreation during
MSHealthy 53.36
41.19 10.22
6.63 2
4.977114 .000 leisure time [5]. Common barriers related to less participation
Psychological
MS Health 42.31 9.02 in exercise apart from the health factors often referred to by
MS patients, concern environmental factors such as lack of
Statistically significant differences were also observed in
relative infrastructure available to people with disabilities,
relation to index related to participation in leisure and sport
type of exercise and support by peers, as well as
activities and total PA between people with and without MS, psychological parameters related to feelings of internal
with healthy individuals having exhibiting higher score, disruption, concern and fear of loss of control [37].
whereas no differences on occupational PA index were noted The negative physiological effect of the disease and the
(Table 4). higher physical pain experienced by people with MS along
Table 4. PA Index during last month between participants with (N = 26) and with and their lower comparative educational attainment, did
without (N = 90) MS. not, however, seemed to have any impact on their physical
VariableMeanSDTDfP
effort during work, as their occupation index was equivalent
Leisure Index with the effort put by participants without MS. This best
Healthy 2.96 .76 illustrates the ongoing effort and professional zeal of people
6.178 114 .000 with MS to cope with their working role, despite the
MS 1.94 .67
Sport Index limitations often imposed by the disease.
Healthy 2.34 .72 Overall, participants without MS in this study have shown a
5.508 114 .000
MS 1.55 .30
Total PA
more positive attitude to their quality of life as this was
Healthy 7.67 1.54 expressed through their more optimistic perception
7.011 114 .000 concerning their general health and vitality, functionality
MS 5.40 1.10
level, social function, psychological well-being and their role
Furthermore, healthy individuals portrayed higher scores in all aspects of their everyday life.
in educational level as compared to participants with MS Previous studies have similarly reported people with MS as
with similar statistically significant differences observed having lower perceived quality of life compared to healthy
between men and women separately, with and without MS populations [38, 39] with many factors contributing to this
(Table 5). Finally, no statistically significant differences were result. For example, the lower educational level of people
observed between participants with and without MS, as with MS compared to people without MS reported in this
regards to smoking habits and their intention to adopt a study, has been previously found to be a factor influencing
healthier diet in the future. perceived quality of life, since people with a higher level of
education tend to exhibit a stronger perceived ability to cope
Table 5. Educational level differences between participants with and without with the disease and its challenges [8, 40, 41] much as the
MS.
lack of interest in life caused by the disease [11].
VariableNMeanSDTDfP In research efforts to understand and record behavioral,
Educational Level Total psychological, and social factors, exercise has been found to
indirectly and positively affect the quality of life of MS
Healthy 90 2.79 .44
26 2.23 .77
4.76114 .001 patients, through the reduction of depression, anxiety, pain
MS
Male and fatigue [42, 43] and the improvement of perceived
Healthy 26 2.81 .40 2.53 32 .009
self-efficacy and disease control [16]. The fact that MS
patients in this study tended to choose light levels of physical
activity compared to moderate exercise intensity selected by
participants without MS, may be indirectly related to the
lowest perceived quality of life also reported by this sample
of MS patients.
The purpose of the research was, however, to outline an
overall profile of people with MS and not to examine the
extent in which participation in exercise affects their
perceived quality of life. However, the results of the research
further highlight the need for the forthcoming doctoral study
to examine the effect of an intervention exercise program on
psychological parameters of MS participants.
Anxiety, depression and fatigue are common features in
MS with a tendency to interfere with each other [44].
Exercise can be a promising method either to prevent
depression in the future or to reliably reduce the already
existing symptoms of depression and anxiety that MS
patients often experience [45], although more future research
is needed for definitive conclusions [46]. In this sample, the
difference observed between depression and anxiety levels
among people with and without MS is due to the
corresponding statistically significant difference detected
solely between men with and without MS, and not between
women with and without MS. This finding is in agreement
with Casetta [47] study examining gender differences in
health-related quality of life in multiple sclerosis. The results
showed that the impact of disability was higher for men than
women especially in relation to parameters reflecting mental
health and emotional well being.
Furthermore, no differences were observed between the
participants with and without MS of this study, regarding
smoking habits and their intention to adopt a healthier diet in
the future probably due to the lack of information on
nutrition and smoking issues and their impact on the disease,
an issue that is internationally lacking scientific integration,
both as regards the recording of patient habits and complete
nutrition suggestions [48]. Only recently, researcher [49]
showed that MS progression is consistently associated with
low vitamin D diet while smoking is associated with a rapid
increase in the degree of disability, even mortality, caused by
the disease [50].
The results of the study highlight the essential need for
future researches using larger samples to examine and
compare the overall effect of factors such as exercise,
nutrition and smoking cessation on the improvement of
physical and psychological health parameters and the
perceived quality of life of patients with MS.
5. Conclusion
The examination and comparison of MS patients with
healthy individuals as regards to the physical activity
involvement, adoption of health behaviors, and levels of
depression and anxiety constitutes a necessity in the quality
of life determination and creation of a comprehensive picture
of habits concerning diet and exercise programs for both
populations, especially when outlining an overall profile of
Greek individuals with and without MS for the first time.
Result differences illustrated in this study, showing MS
patients as choosing light physical activity levels compared
to healthy participants who choose moderate levels of PA and
healthy individuals achieving higher scores in leisure time,
sport and total physical activity with lower levels of anxiety
and depression and better perceived quality of life compared
to patients with MS, exhibit the need to examine future
application of modified exercise programs adapted according
to the needs of MS patients. An organized, systematic and
well targeted form of exercise will help MS patients to
improve their perceived quality of life, mood state and
functionality level.
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Jurnal Internasional tentang Olahraga, Sains
dan Pendidikan Fisik
2018; 3(4): 55-61
http://www.sciencepublishinggroup.com/j/ijsspe
doi: 10.11648/j.ijsspe.20180304.12
ISSN: 2575-226X (Print); ISSN: 2575-1611 (Online)

Laporan
Studi Banding Individu dengan dan Tanpa Multiple
Sclerosis: Profil Keseluruhan Kualitas Hidup, Olahraga,
Perilaku Kesehatan
Anastasia Karageorgou1, *, Dimitrios Kokaridas1, Yiannis Theodorakis1, Sergios Mousiolis2,
Asterios Patsiaouras1, Marios Goudas1
1 Departemen Pendidikan Jasmani dan Ilmu Olah Raga, Universitas Thessaly, Trikala, Yunani
2 Fakultas Kedokteran, Sekolah Ilmu Kesehatan, Universitas Thessaly, Larisa, Yunani

Alamat Email:
*
Penulis yang sesuai

Kutipan artikel ini:

Anastasia Karageorgou, Dimitrios Kokaridas, Yiannis Theodorakis, Sergios Mousiolis, Asterios Patsiaouras, Marios Goudas. Comparative
Study of Individuals with and Without Multiple Sclerosis: Overall Profile of Quality of Life, Exercise, Health Behaviors. International
Journal of Sports Science and Physical Education. Vol. 3, No. 4, 2018, pp. 55-61. doi: 10.11648/j.ijsspe.20180304.12

Received: November 16, 2018; Accepted: December 8, 2018; Published: January 16, 2019

Abstraksi: Pasien Multiple Sclerosis (MS) berbeda arti dengan populasi sehat dalam kualitas parameter kehidupan,
partisipasi aktivitas fisik, dan perilaku kesehatan. Namun, belum ada penelitian yang dilakukan untuk
membandingkan perbedaannya, menguraikan dari profil keseluruhan. Tujuan dari penelitian ini adalah untuk menguji
dan membandingkan profil pasien MS di Yunani dengan individu yang sehat, sehubungan dengan kualitas hidup,
keterlibatan aktivitas fisik, adopsi perilaku kesehatan, dan tingkat depresi dan kecemasan. Sampel yang terdiri dari 26
pasien MS dengan 90 individu sehat secara keseluruhan 116 peserta. Instrumen yang digunakan termasuk Kuesioner
GLTE, kuesioner aktivitas fisik kebiasaan, SF 36, Tes Fagerström untuk Ketergantungan Nikotin, Skala Kecemasan
dan Depresi Rumah Sakit, kuesioner Baecke dan kuesioner Perilaku Gizi. T-test untuk variabel independen
digunakan untuk menemukan perbedaan antara individu dengan atau tanpa MS dan yang sesuai dengan jenis kelamin.
Level signifikansi ditetapkan pada p <0,05. Hasil penelitian menunjukkan bahwa pasien MS memilih tingkat
aktivitas fisik ringan (PA) dibandingkan dengan peserta sehat yang memilih PA yang tingkat sedang. Individu yang
sehat juga mencapai skor yang lebih tinggi dalam waktu senggang, olahraga dan indeks aktivitas fisik total,
menunjukkan tingkat kecemasan dan depresi yang lebih rendah dan kualitas hidup yang dipersepsikan lebih baik
dibandingkan dengan pasien dengan MS. Profil pasien MS dikaitkan dengan PA cahaya, kualitas hidup yang
dipersepsikan lebih rendah, kecemasan dan depresi yang lebih tinggi dibandingkan dengan individu yang sehat. Saran
untuk masa depan agar dibuat untuk memeriksa penerapan program latihan dan pengaruhnya terhadap parameter
psikologis individu dengan dan tanpa MS.

Kata kunci: Aktivitas Fisik, Parameter Psikologis, Multiple Sclerosis

1. Pembukaan juga kejengkelan yang tak terduga. Di Yunani, jumlah orang

Multiple sclerosis (MS), merupakan penyakit
demielinasi inflamasi kronis, yang dianggap sebagai
penyebab paling umum ketiga dari kecacatan serius [1] dan
salah satu kondisi neuromuskuler yang paling representatif
dan sering [2] ditandai dengan degenerasi sistem saraf pusat
dengan berbagai gejala dan pergantian periode resesi dan
yang terkena dampak berkisar hingga 7.000 orang, dengan 27
tahun
sesuai dengan usia rata-rata penampilan dan wanita
menunjukkan insiden penyakit yang lebih tinggi [3, 4]. MS
secara serius mempengaruhi konduksi saraf pada saraf motorik
dan sensorik, sehingga menyebabkan berbagai tingkat
kecacatan terkait dengan gerak dan sensasi. Selama fase akut
penyakit ini, konduksi saraf menjadi lebih lambat atau lebih
terhambat yang menyebabkan kelemahan otot, kehilangan
pergerakan, ketidakstabilan, penglihatan kabur atau diplopia,
gangguan bicara, kelelahan, dan dalam situasi yang lebih
parah, kelumpuhan parsial atau lengkap [5].
Tingkat keparahan gejala MS sangat bervariasi mulai
dari orang ke orang tergantung pada saraf mana yang
terpengaruh dan berapa banyak "serangan" penyakit yang
diderita orang tersebut selama hidupnya, menjadikan MS
sebagai masalah pribadi murni yang dialami oleh setiap
pasien secara berbeda [6]. Secara umum, penderita MS dapat
mengalami empat keadaan perkembangan penyakit yang
berbeda, yang mungkin ringan, sedang atau berat, tergantung
pada gejala yang menyebabkan [7], yang pada gilirannya
mempengaruhi keadaan mental dan fisik pasien [8] dan
menyebabkan keluarga ketergantungan dan penurunan
kualitas hidup mereka yang berkelanjutan [9, 10].
Selain faktor psikososial, pasien MS sering
mengalami masalah tidur, kurang minat, gangguan makan
dan keinginan bunuh diri di beberapa titik dalam hidup
mereka [11]. Saat myelin dan area materi putih otak yang
bertanggung jawab untuk ekspresi emosi yang dihancurkan
[12], gejala-gejala ini mungkin disebabkan oleh penyakit itu
sendiri. Selain itu, pasien MS mengalami kecemasan yang
intens karena ancaman yang ditimbulkan oleh penyakit,
dengan gejala stres dipengaruhi oleh rasa takut, kurangnya
dukungan sosial dan penempatan di tempat tinggal yang
berbeda [13]. Perasaan negatif ini mempengaruhi dan pada
gilirannya memperburuk gejala relatif. Menurut Tsungou,
Tzinalis & Bellali, mengetahui dan menerima gejala seperti
itu hanya bagian dari pengobatan penyakit yang tepat yang
juga dapat mencakup aktivitas fisik dan diet seimbang
sebagai sarana tambahan untuk memberikan dukungan
penting bagi pasien MS [1].
Benar jika penelitian terbaru menunjukkan bahwa
bentuk latihan yang terorganisir, sistematis dan tepat sasaran
membantu pasien MS untuk meningkatkan keadaan mood
mereka [14], kualitas hidup dan tingkat fungsionalitas [15,
16] dan untuk mengurangi kelelahan [17], dibandingkan
dengan pasien yang tidak berolahraga [15]. Menurut
Garopoulou, pasien MS penting untuk sering berolahraga
untuk menjaga atau meningkatkan kondisi kesehatan dan
sosialisasi mereka, meningkatkan energi dan ketahanan
mereka terhadap penyakit dan mengurangi biaya rehabilitasi
[18].
Merokok juga dikaitkan dengan faktor lingkungan
dan juga kejadian MS [19], dilaporkan bahwa perokok lebih
mungkin mengembangkan MS daripada bukan perokok,
sementara dalam penelitian dikonfirmasi bahwa merokok
sebagai faktor risiko serius untuk datangnya MS [20].
Namun, penelitian belum dilakukan untuk menguji efek diet
dan merokok pada kualitas hidup pasien MS. Di Yunani,
penelitian sejauh ini berfokus untuk memeriksa faktor
individu yang membentuk profil pasien MS [21], tercatat
bahwa pasien MS umumnya merasa lelah dalam menghadapi
kesulitan di kegiatan sehari-hari mereka, juga menunjukkan
ketidakstabilan emosional, sifat rakus, lekas marah atau
bahkan penyakit mental. Terutama dalam bentuk manik
depresi. Semua reaksi psikologis ini yang menimbulkan
ketidakpuasan terutama pada kasus pasien dengan kesadaran
intelektual tinggi yang sering tampil pesimis dan tidak
mampu menetapkan tujuan dalam hidup [22].
Sehubungan dengan kualitas hidup pasien MS,
Theofilou mengidentifikasi jenis kelamin perempuan, usia
tua, kehidupan pernikahan, pendidikan rendah dan sebagian
besar tahun pengobatan sebagai faktor utama yang terkait
dengan kesehatan mental yang lebih baik dan kualitas hidup
yang lebih baik [23]. Para peneliti menemukan bahwa status
perkawinan dan tempat tinggal juga merupakan faktor yang
mempengaruhi fungsi kognitif, kecemasan, kesehatan fisik dan
kualitas hidup pasien MS secara umum [13]. Selain itu, karena
penurunan fungsi kognitif dan memori retrospektif
mempengaruhi kualitas hidup terlepas dari depresi dan
beratnya MS [24], meningkatkan kualitas hidup dan
memperlambat perkembangan penyakit dapat dicapai dengan
mengadopsi kebiasaan makan yang sehat [25] .
Namun dengan meninjau literatur tampaknya belum
ada penelitian yang dilakukan yang membandingkan pasien
MS dengan populasi sehat dalam hal partisipasi dalam aktivitas
fisik dan adopsi perilaku kesehatan yang tepat, menguraikan
profil keseluruhan pasien MS Yunani. Rekaman pengetahuan
dan sikap pasien MS terutama ketika dibandingkan dengan
mereka yang tidak memiliki MS mengenai aktivitas mereka
selama waktu luang dan sejauh mana mereka mengadopsi gaya
hidup sehat, merupakan upaya sistematis pertama untuk
menciptakan gambaran yang komprehensif tentang kebiasaan
sebelum menerapkan kesehatan intervensi. , program diet dan
olahraga pada pasien MS Yunani, yang dengan sendirinya
merupakan argumen kuat tentang pentingnya penelitian.
Tujuan dari penelitian ini adalah untuk menguji dan
membandingkan profil pasien MS Yunani dengan individu
yang sehat, sehubungan dengan kualitas hidup, keterlibatan
aktivitas fisik, adopsi perilaku kesehatan, dan tingkat depresi
dan kecemasan. Penelitian ini sebenarnya adalah langkah
pertama dari studi doktoral yang bertujuan untuk menguji dan
membandingkan efek latihan pada parameter psikologis
peserta pelatihan dengan dan tanpa MS, setelah terlebih dahulu
menguraikan profil keseluruhan dari semua peserta sehingga
dapat membuat titik acuan tetap sebelum intervensi latihan.
2. Metode
2.1. Percobaan
Percoaan yang terdiri dari 26 pasien MS (8 pria, 18 wanita)
dan 90 individu yang sehat (26 pria, 64 wanita), keseluruhan
116 peserta berasal dari wilayah Thessaly yang lebih luas yang
telah setuju untuk berpartisipasi secara sukarela. Tanggal
pemilihan data ditetapkan pada 15/03/17. Individu MS juga
anggota dari klub MS Larissa serta pasien dari Rumah Sakit
Universitas Umum Larissa di bawah pengawasan medis dan
pengobatan yang ketat. Semua pasien telah mengkonfirmasi
diagnosis MS dan tidak memiliki masalah yang menyertainya
yang akan mengecualikan mereka dari berpartisipasi dalam
olahraga, sebagaimana dievaluasi oleh ahli saraf dan peringkat
dalam kisaran EDSS dari 0 hingga 4 (rawat jalan penuh tanpa
bantuan).
2.2. Tata Cara
Para peserta awalnya diinformasikan tentang tujuan, proses
dan dasar secara sukarela dari penelitian ini dan mereka
memastikan bahwa semua kuesioner bersifat rahasia dan
anonim. Peneliti hadir selama penyelesaian mereka untuk
menjawab pertanyaan yang diajukan oleh peserta, tanpa terlibat
selama proses. Sebelum menyelesaikan kuesioner, penelitian
dan prosedurnya dievaluasi dan disetujui oleh Dewan Komite
Etika Etika Universitas DPESS (nomor persetujuan: 1-5 / 5-10-
2016).
2.3. Instrumen
Kuesioner yang diberikan kepada semua individu dengan
dan tanpa MS untuk tujuan penelitian, adalah:
 i. The Godin Leisure- Kuesioner Latihan Waktu [26] wanita) dengan dan tanpa MS (Tabel 1).
kueri empat item yang cukup jelas dan singkat,
Table 1. Physical activity level of individuals with and without MS.
mengukur intensitas cahaya latihan waktu santai
mingguan (ringan, sedang atau berat), seperti yang
digunakan dalam studi tentang Theodorakis & Variabel N Rata- SD T Df P
Hassandra[27]. rata
Intensitas Latihan
ii. The Baecke [28] kuesioner aktivitas fisik kebiasaan, Total
seperti yang sebelumnya digunakan oleh Kesehatan 90 2.1 _90 -57 114 .000
Theodoropoulos, Kartelliotis, Gelada & Nasis [29] MS 26 3.08 _63
dan Blatsis [30], yang mengajukan pertanyaan dan Pria
memberikan indeks mengenai aktivitas pekerjaan,
Kesehatan 26 2.04 _87 -3.75 32 .001
rekreasi dan olahraga, berdasarkan frekuensi dan
MS 8 3.25 _46
intensitas yang dirasakan. latihan selama sebulan
terakhir. Perempuan
Kesehatan 64 2.13 _92 -3.76 80 .000
iii. Versi Yunani [31] dari kuesioner kualitas hidup SF- MS 18 3.00 _69
36 [32], alat penilaian diri yang dirancang untuk
memeriksa persepsi individu mengenai kualitas
hidup dalam kaitannya dengan delapan bidang yang Sehubungan dengan depresi dan kecemasan yang
berbeda, yaitu, fungsi fisik, keterbatasan peran dialami, perbedaan yang signifikan secara statistik diamati
karena untuk masalah fisik, sakit tubuh, kesehatan antara pria dengan dan tanpa MS, dengan pasien pria
umum, fungsi sosial, energi / vitalitas, keterbatasan mengalami lebih banyak kecemasan dan gejala depresi
peran karena masalah emosional dan kesehatan dibandingkan dengan yang sehat, sedangkan tidak ada
mental. 8 domain ini dikelompokkan ke dalam dua perbedaan yang diamati pada wanita (Tabel 2).
area utama skor komponen fisik dan mental, dengan
nilai yang lebih tinggi menunjukkan kualitas hidup Table 2. Anxiety and depression on individuals with and without MS
yang lebih tinggi. Variabel N Rata- SD T Df P
rata
Anxiety
iv. Kuesioner "Perilaku Gizi" [33] yang meneliti sejauh
Total
mana pasien merasa cukup percaya diri untuk
mengganti kebiasaan makan yang tidak sehat dengan Kesehatan 90 5.77 3.37 -2.29 114 .012
yang sehat. Tanggapan dari 13 pertanyaan yang MS 26 7.66 4.68
merupakan faktor tunggal diberikan pada skala Depresi
Likert 10 derajat, mulai dari (1) sama sekali tidak Total
percaya diri hingga (10) sangat percaya diri. Kesehatan 90 4.80 3.20 -2.97 114 .002
MS 26 6.92 3.26
v. Tes Fagerström untuk Ketergantungan Nikotin [34],
Anxiety
instrumen standar untuk menilai intensitas
kecanduan fisik terhadap nikotin (sangat rendah Pria
hingga sangat tinggi) per hari, dengan enam item Kesehatan 26 4.85 4.03 -3.12 32 .002
mengevaluasi jumlah konsumsi rokok, paksaan MS 8 10.13 4.73
untuk menggunakan dan ketergantungan. Perempua
n
vi. Versi Yunani [35] dari skala kecemasan dan depresi Kesehatan 64 6.14 3.02 -4.7 80 .643
rumah sakit [36], sebuah instrumen yang andal dan MS 18 6.56 4.34
mudah digunakan untuk mendeteksi keadaan depresi Depresi
dan kecemasan untuk mengukur tingkat keparahan Pria
gangguan emosional pada pasien yang mungkin Kesehatan 26 4.42 4.05
memerlukan evaluasi dan dukungan psikologis
-3.13 32 .002
MS 8 9.13 2.17
tambahan.
Perempua
2.4. Analisis Statistik n
Kesehatan 64 4.95 2.81
-1.28 80 .102
Analisis statistik dilakukan dengan menggunakan versi
MS 18 5.95 3.23
19.00 SPSS dan termasuk uji t untuk variabel independen
untuk menemukan perbedaan antara individu dengan atau
tanpa MS dan menurut jenis kelamin. Level signifikansi Adapun kualitas hidup, peserta yang sehat
ditetapkan pada p <0,05. Kuesioner yang digunakan dalam menunjukkan skor yang lebih tinggi daripada pasien MS dalam
penelitian ini memiliki semua karakteristik psikometrik yang persepsi mereka mengenai kualitas hidup di dua bidang utama
dapat diterima. kesehatan fisik dan psikologis sebagaimana dinyatakan oleh
fungsi fisik, peran fisik, kesehatan umum, vitalitas, fungsi
3. Hasil sosial, peran emosional dan kesehatan mental. Pasien MS
Sehubungan dengan tingkat aktivitas fisik (PA) antara menunjukkan nilai yang lebih tinggi hanya pada faktor 'negatif'
individu dengan dan tanpa MS, perbedaan signifikan secara dari nyeri tubuh (Tabel 3).
statistik diamati dengan pasien MS memilih tingkat aktivitas
fisik ringan dibandingkan dengan peserta sehat yang memilih Table 3. kualitas hidup antara individual dengan tanpa MS
PA tingkat sedang. Demikian pula perbedaan signifikan juga Variable Rata- SD T Df P
rata
diamati untuk setiap jenis kelamin secara terpisah (pria -
Peran fisik MS 5.40 1.10
Kesehatan 7.27 1.07 6.329 114 .000
MS 5.58 1.58 Selain itu, individu sehat menggambarkan skor yang
Kesehatan lebih tinggi di tingkat pendidikan dibandingkan dengan peserta
umum dengan MS dengan perbedaan yang signifikan secara statistik
Kesehatan 18.31 3.27 7.519 114 .000 diamati antara pria dan wanita secara terpisah, dengan dan
MS 12.85 3.26 tanpa MS (Tabel 5). Akhirnya, tidak ada perbedaan yang
Vitalitas signifikan secara statistik yang diamati antara peserta dengan
Kesehatan 16.95 3.85 dan tanpa MS, sehubungan dengan kebiasaan merokok dan niat
5.514 114 .000
MS 12.31 3.50
mereka untuk mengadopsi diet yang lebih sehat di masa depan.
Kesehatan Table 5. Educational level differences between participants with and without
mental MS.
Kesehatan 22.52 4.37 3.463 114 .001
MS 19.08 4.80
Variable N Rata SD T Df P
Fungsi -rata
fisik Level
Kesehatan 27.02 2.82 12.70 114 .000 pendidika
2 n
Total
MS 17.50 4.84
Kesehatan 90 2.79 .44 4.76 114 .001
Peran
emosi MS 26 2.23 .77
Kesehatan 5.18 1.16 1.896 114 .030 Pria
MS 4.69 1.12 Kesehatan 26 2.81 .40 2.53 32 .009
Sakit MS 8 2.25 .89
tubuh
Kesehatan 3.21 1.32 Wanita
-6.073 114 .000
MS 5.27 2.09 Kesehatan 64 2.78 .45 3.99 80 .000
Fungsi MS 18 2.22 .73
Sosial
Kesehatan 8.38 2.23 4.423 114 .000 4. Diskusi
MS 6.23 1.99 Tujuan dari penelitian ini adalah untuk menguji dan
Kesehatan membandingkan kualitas hidup, aktivitas fisik dan adopsi
Fisik perilaku kesehatan antara individu dengan dan tanpa MS, dalam
Kesehatan 55.81 5.33 11.64 114 .000 upaya untuk menguraikan profil keseluruhan pasien MS dan
2 untuk memberikan titik rujukan tetap dari pasien ini. intervensi
MS 41.19 6.63 latihan sebelumnya.
Kesehatan Sebagai temuan pertama, pasien MS tampaknya memilih
psikologi aktivitas fisik ringan dibandingkan dengan aktivitas intensitas
Kesehatan 53.36 10.22 4.977 114 .000 sedang yang dipilih oleh orang-orang tanpa MS, mungkin
Ms 42.31 9.02 karena kelemahan otot, kelelahan, kehilangan gerakan, dan
ketidakstabilan yang biasanya dialami pasien MS, sehingga
Perbedaan yang signifikan secara statistik juga lebih hati-hati. 'Pendekatan untuk berpartisipasi dalam olahraga
diamati dalam kaitannya dengan indeks yang berkaitan atau rekreasi selama waktu senggang [5]. Hambatan umum
dengan partisipasi dalam kegiatan rekreasi dan olahraga dan yang terkait dengan kurang partisipasi dalam berolahraga
total PA antara orang dengan dan tanpa MS, dengan orang terlepas dari faktor kesehatan yang sering disebut oleh pasien
sehat yang menunjukkan skor lebih tinggi, sedangkan tidak MS, menyangkut faktor lingkungan seperti kurangnya
adanya perbedaan pada indeks PA pekerjaan yang dicatat infrastruktur relatif yang tersedia untuk penyandang cacat, jenis
(Tabel 4) olahraga dan dukungan oleh rekan sebaya, serta parameter
psikologis terkait dengan perasaan gangguan internal,
kekhawatiran dan ketakutan kehilangan kontrol [37].
Table 4. PA Index during last month between participants with (N = 26) and Efek fisiologis negatif dari penyakit dan rasa sakit fisik
without (N = 90) MS.
yang lebih tinggi yang dialami oleh orang-orang dengan MS
dan pencapaian pendidikan komparatif yang lebih rendah,
bagaimanapun, tampaknya tidak memiliki dampak pada upaya
Variabel Rata- SD T Df P fisik mereka selama bekerja, karena indeks pekerjaan mereka
rata setara dengan upaya yang dilakukan oleh peserta tanpa MS. Ini
Indeks paling baik menggambarkan upaya berkelanjutan dan semangat
kesengganga
n profesional dari orang-orang dengan MS untuk mengatasi peran
Kesehatan 2.96 .76 6.178 114 .000 kerja mereka, meskipun keterbatasan sering dipaksakan oleh
MS 1.94 .67 penyakit.
Indeks
Secara keseluruhan, peserta tanpa MS dalam penelitian ini
olahraga telah menunjukkan sikap yang lebih positif terhadap kualitas
Kesehatan 2.34 .72 5.508 114 .000 hidup mereka karena hal ini diungkapkan melalui persepsi yang
MS 1.55 .30 lebih optimis mengenai kesehatan dan vitalitas umum mereka,
Total PA tingkat fungsi, fungsi sosial, kesejahteraan psikologis dan peran
Kesehatan 7.67 1.54
mereka dalam semua aspek kehidupan sehari-hari mereka.
7.011 114 .000 Studi sebelumnya juga melaporkan orang dengan MS
memiliki kualitas hidup yang dipersepsikan lebih rendah
dibandingkan dengan populasi sehat [38, 39] dengan banyak
faktor yang berkontribusi terhadap hasil ini. Sebagai contoh,
tingkat pendidikan yang lebih rendah dari orang dengan MS
dibandingkan dengan orang tanpa MS yang dilaporkan dalam
penelitian ini, sebelumnya telah ditemukan sebagai faktor
yang mempengaruhi kualitas hidup yang dirasakan, karena
orang dengan tingkat pendidikan yang lebih tinggi cenderung
menunjukkan kemampuan persepsi yang lebih kuat. untuk
mengatasi penyakit dan tantangannya [8, 40, 41] sebanyak
kurangnya minat dalam hidup yang disebabkan oleh penyakit
[11].
Dalam upaya penelitian untuk memahami dan
mencatat faktor perilaku, psikologis, dan sosial, latihan telah
ditemukan secara tidak langsung dan positif mempengaruhi
kualitas hidup pasien MS, melalui pengurangan depresi,
kecemasan, rasa sakit dan kelelahan [42, 43] dan peningkatan
efikasi diri yang dirasakan dan pengendalian penyakit [16].
Fakta bahwa pasien MS dalam penelitian ini cenderung
memilih tingkat aktivitas fisik yang ringan dibandingkan
dengan intensitas olahraga moderat yang dipilih oleh peserta
tanpa MS, mungkin secara tidak langsung terkait dengan
persepsi kualitas hidup terendah yang juga dilaporkan oleh
sampel pasien MS ini.
Tujuan dari penelitian ini adalah, bagaimanapun, untuk
menguraikan profil keseluruhan orang dengan MS dan tidak
untuk menguji sejauh mana partisipasi dalam latihan
mempengaruhi persepsi kualitas hidup mereka. Namun, hasil
penelitian lebih lanjut menyoroti perlunya studi doktoral yang
akan datang untuk memeriksa efek dari program latihan
intervensi pada parameter psikologis peserta MS.
Kecemasan, depresi dan kelelahan adalah fitur umum
pada MS dengan kecenderungan untuk saling mengganggu
[44]. Latihan dapat menjadi metode yang menjanjikan baik
untuk mencegah depresi di masa depan atau untuk secara
andal mengurangi gejala depresi dan kecemasan yang sudah
ada yang sering dialami pasien MS [45], meskipun penelitian
lebih lanjut di masa depan diperlukan untuk kesimpulan yang
pasti [46]. Dalam sampel ini, perbedaan yang diamati antara
tingkat depresi dan kecemasan di antara orang dengan dan
tanpa MS adalah karena perbedaan yang signifikan secara
statistik yang terdeteksi hanya antara pria dengan dan tanpa
MS, dan bukan antara wanita dengan dan tanpa MS. Temuan
ini sesuai dengan studi Casetta [47] yang meneliti perbedaan
gender dalam kualitas hidup terkait kesehatan dalam multiple
sclerosis. Hasil penelitian menunjukkan bahwa dampak
kecacatan lebih tinggi untuk pria daripada wanita terutama
dalam kaitannya dengan parameter yang mencerminkan
kesehatan mental dan kesejahteraan emosional.
Selain itu, tidak ada perbedaan yang diamati antara
peserta dengan dan tanpa MS dalam penelitian ini, mengenai
kebiasaan merokok dan niat mereka untuk mengadopsi diet
yang lebih sehat di masa depan mungkin karena kurangnya
informasi tentang nutrisi dan masalah merokok dan
dampaknya terhadap penyakit, masalah yang secara
internasional kurang memiliki integrasi ilmiah, baik dalam hal
pencatatan kebiasaan pasien dan saran nutrisi lengkap [48].
Baru-baru ini, peneliti [49] menunjukkan bahwa
perkembangan MS secara konsisten terkait dengan diet
rendah vitamin D sementara merokok dikaitkan dengan
peningkatan cepat dalam tingkat kecacatan, bahkan kematian,
yang disebabkan oleh penyakit [50]
Hasil penelitian menyoroti kebutuhan penting untuk
penelitian di masa depan menggunakan sampel yang lebih
besar untuk memeriksa dan membandingkan efek keseluruhan
faktor seperti olahraga, nutrisi dan penghentian merokok pada
peningkatan parameter kesehatan fisik dan psikologis dan
kualitas hidup pasien yang dirasakan MS.
5. Kesimpulan
Pemeriksaan dan perbandingan pasien MS dengan individu
sehat sehubungan dengan keterlibatan aktivitas fisik, adopsi
perilaku kesehatan, dan tingkat depresi dan kegelisahan
merupakan kebutuhan dalam kualitas penentuan hidup dan
penciptaan gambaran yang komprehensif tentang kebiasaan
mengenai diet dan olahraga. program untuk kedua populasi,
terutama ketika menguraikan profil keseluruhan individu
Yunani dengan dan tanpa MS untuk pertama kalinya.
Perbedaan hasil yang diilustrasikan dalam penelitian ini,
menunjukkan pasien MS memilih tingkat aktivitas fisik ringan
dibandingkan dengan peserta sehat yang memilih PA tingkat
sedang dan individu sehat yang mencapai skor lebih tinggi
dalam waktu luang, olahraga dan total aktivitas fisik dengan
tingkat kecemasan dan depresi yang lebih rendah dan lebih baik
persepsi kualitas hidup dibandingkan dengan pasien dengan
MS, menunjukkan kebutuhan untuk memeriksa aplikasi masa
depan dari program latihan yang dimodifikasi yang disesuaikan
dengan kebutuhan pasien MS. Bentuk latihan yang terorganisir,
sistematis dan tepat sasaran akan membantu pasien MS untuk
meningkatkan persepsi kualitas hidup, suasana hati dan tingkat
fungsionalitas.
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