Feasibility
cognitive exertion
RECRUITMENT
Advantages of inpatient rehabilitation include the high frequency of exercise sessions and high retentions rates, as patients are on-site. However, pwMS are also embedded in a multidisciplinary setting, with study-unrelated appointments possibly interfering with study-related sessions. Adherence rates were lower than the ones described by Zimmer et al. [Another option would be to cut the pool-based sessions to (I) allow for more time to recover, (II) increase recruitment (as eligibility for pool-based sessions was low), (III) avoid the mix-up of effects from gym- and pool-based MAT, and (IV) lower the barrier for replication, without the need for a pool.Even though both groups performed the minimum number of sessions, the SET-group attended substantially more sessions (228 [MAT] vs. 308 [SET]), as appointments were much more flexible due to individual scheduling. Consequently, MAT had considerably lower ‘dosing’. This is interesting, as one hypothesis of the MAT framework is that it might be more time-efficient [Only about 1.8 participants were randomized per month instead of the intended four. There are examples of other trials conducted in similar settings, reporting equally low eligibility [Interestingly, gym-based MAT elicited the highest ratings of session-based perceived exertion, which on average approached the rating of ‘hard’ - despite the fact, that average heart rate values were low. This warrants several considerations. First, the present heart rate values only give a very broad impression regarding intensity as they do not take maximum heart rate into account. As age differed between groups, heart rates indicating relative intensity would also be different. Furthermore, it is important to consider that even ‘high physical strain’ gym-based MAT sessions have many standing breaks, e.g., while the therapist gives demonstration and instructions, which profoundly reduces average heart rate for a complete session and leads to a more interval-like training stimulus. Values of average maximum heart rate might also be misleading, as ‘low physical strain’ MAT sessions blunted maximum values from the ‘high physical strain’ sessions. For example, four MAT-participants had individual gym-sessions with maximum heart rates above 150 bpm. Lastly, what we can only describe anecdotally is that MAT-participants repeatedly differentiated their session-based perceived exertion between physical and cognitive exertion (but were then prompted to give an overall score). Supposedly, this could reflect the unique content of MAT, and cognitive elements might increase session-RPE scores.