The Effect of Eight Weeks of Home-Based Resistance Training on Melatonin, Serotonin Levels, Sleep Quality, and Quality of Life in Women with Multiple Sclerosis

Background and Purpose
Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system that causes neurological disability in adults. Around 50% of MS patients experience sleep disorders such as insomnia and restless legs syndrome, which negatively affect their Quality of Life (QoL). Melatonin, a hormone involved in regulating the sleep/wake cycle, is found to be reduced in MS patients. Studies suggest that melatonin supplementation can improve sleep quality and exert antioxidant effects. Additionally, serotonin (5-HT), which is associated with depression and MS, is also reduced in patients. Some antidepressant medications targeting the serotonergic system may help alleviate MS symptoms.
Physical activity, such as aerobic and resistance exercises, can help reduce MS symptoms and improve QoL. However, due to limitations such as fatigue and depression, home-based exercise training (HBET) has been proposed as a practical solution. Studies have shown that HBET has positive effects on physical health and QoL in chronic conditions such as Parkinson's disease and type 2 diabetes. However, its effectiveness in MS patients requires further investigation. The present study aims to evaluate the impact of HBET on melatonin and serotonin levels, sleep quality, and QoL in women with MS.
 
Materials and Methods
This study was a practical and semi-experimental comparative investigation involving 700 patients with multiple sclerosis (MS) from Gilan University of Medical Sciences' neurology clinic. The sample, determined using G*Power software, included 27 female volunteers aged 25–50, with an expanded disability status scale (EDSS) score between 5–5.5, who met criteria such as no smoking, alcohol use, or comorbid conditions, and a relapsing-remitting MS diagnosis. Participants were randomized into resistance and control groups. Exclusion criteria included inconsistent training attendance or worsening symptoms. Seven participants were excluded due to personal reasons or study protocol non-compliance.
The resistance group underwent online training on proper exercise techniques, Borg scale monitoring, and heart rate measurement. They received weighted vests and instructional videos for home-based resistance training (HBRT). The program included 3 weeks of educational sessions followed by an 8-week periodized HBRT protocol divided into hypertrophy (4 weeks) and strength (4 weeks) phases. Training intensity was tailored individually using weights, fatigue levels, heart rate, and clinical conditions under physician supervision. Each session included warm-ups, 25–30 minutes of resistance exercises, and cool-downs, with rest intervals of 2–4 minutes.
The control group did not engage in any specific activity. Blood samples were collected pre- and post-intervention after overnight fasting. Physical assessments (e.g., height, weight, WHR, body fat, blood pressure) were conducted at participants' homes. Sleep quality and QoL were measured using validated questionnaires. Sleep metrics included subjective sleep quality, sleep duration, disturbances, medication use, and daytime dysfunction. QoL evaluation encompassed physical function, emotional role, energy, social function, pain, and general health.
Data were analyzed using descriptive and inferential statistics (Shapiro-Wilk test, ANCOVA, paired t-test) in SPSS 26, with significance set at P≤0.05. Serum melatonin and serotonin levels were measured via ELISA using Elabscience kits. Feedback was collected after each session for protocol adherence, and weights were adjusted biweekly during home visits to ensure progression. The results were intended to evaluate the effects of HBRT on sleep, QoL, and biomarkers in MS patients.
 
Findings
The results of the ANCOVA test showed no significant differences in serotonin levels (F=0.05, P=0.827) and melatonin levels (F=0.132, P=0.722) between the two groups. A significant difference was observed only in the subscale of sleep medication use, while no significant differences were found in other sleep quality subscales (P>0.05). The results related to the QoL subscales, indicate that there were no significant differences between the resistance and control groups in any of the QoL subscales (P>0.05).
 
Conclusion
This study examined the effects of eight weeks of home-based resistance training on serum levels of melatonin and serotonin, sleep quality, and QoL in women with MS. The results showed no significant effects of the training on these parameters, which contrasts with previous studies such as those by Deichmann et al. (2021) and Shobeiri et al. (2022). The difference in intervention type may explain this discrepancy, as previous research mainly focused on aerobic exercise, which has been shown to increase serotonin and brain-derived neurotrophic factor (BDNF) levels. Serotonin plays a crucial role in regulating inflammation and providing neuroprotective effects in MS. Exercise may help reduce inflammation by decreasing fat mass and increasing regulatory T cells. However, in the present study, no significant changes in melatonin levels were observed. Limited research exists on the impact of resistance training on melatonin in MS patients, but some studies have shown that melatonin supplementation can improve sleep quality. The lack of improvement in sleep quality in this study may be due to methodological limitations, such as self-reporting. More objective tools, such as actigraphy, may provide better insights. Additionally, factors like patients' disability levels, fatigue, and the use of immunomodulatory drugs may influence the effects of exercise on melatonin levels. Home-based training has limitations such as fear of health deterioration, lack of motivation, and safety concerns, whereas supervised group training may overcome these barriers. Overall, the findings suggest that home-based resistance training does not significantly improve hormonal levels, sleep quality, or QoL in MS patients.
 Article Message
It seems that performing exercises without direct supervision for at least 8 weeks in MS patients will lack the spectator effect and motivation necessary for their effectiveness.
 Funding
This study received no funding from public, commercial, or nonprofit organizations.
 Authors’ Contributions
Contribution to writing and editing: Payam Saidie, Ashkan Golabi; Patient selection and assessment: Alia Saberi, Payam Saidie, Ashkan Golabi; Monitoring and collection of data: Ashkan Golabi, Payam Saidie, Alia Saberi; Statistical analysis: Payam Saidie; Supervision: Payam Saidie, data interpretation: payam saidie, Alia Saberi, Ashkan Golabi.
 Ethical Considerations
The present study has been reviewed and approved by the Institute of Physical Education and Sport Sciences under the ethics code SSRI.REC-2106-1085 (R2).
 Conflicts of Interest
The authors declared no conflict of interest.
 Acknowledgement
The authors would like to express their gratitude to the director of the Besat Neurology Clinic of Rasht University of Medical Sciences and all the participants.