Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education – secondary results of the step it up randomised controlled trial

Abstract

BackgroundRecent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education.MethodsPhysically inactive people with MS, scoring 0–3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up.ResultsOne hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(−9.87, −0.21), p = 0.04, Control −7.68(−12.13, −3.23), p = 0.00), strength (SCT -1.51(−2.41, −0.60), p < 0.01, Control −1.55(−2.30, −0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(−4.45(−8.68, −0.22), −4.12(−8.25, 0.01), anxiety(−1.76(−3.20, −0.31), −1.99(−3.28, −0.71), depression(−1.51(−2.89, −0.13), −1.02(−2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges’ g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up.ConclusionsThere were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program.Trial registrationClinicalTrials.gov, NCT02301442, retrospectively registered on November 13th 2014.

Changing Physical Activity Behavior in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

“…Fourteen RCTs were included for review and are detailed in Table 2. Four of these studies delivered the behavioural interventions using the internet as a medium and included the same core website intervention, albeit observing different outcomes, adding elements to the programme and using varying cohorts of people with MS. [29][30][31][32] Group exercise or group educational interventions were used in five studies, [33][34][35][36][37] newsletters/pamphlets used in 2 studies, 38,39 telephone only in 1 study, 40 home-based exercise sessions only in 1 study 41 and a DVD in 1 study. 42 Three studies had active control groups that included exercise with non-theory based education, 35 a healthy ageing DVD with telephone calls and 'healthy tips of the day' 42 Table 2 here>>…”

“…The sample were predominately female (n=792, 86%) with mean age ranging between 39.5 and 59.62 years. Disability was measured using the Patient Determined Disease Steps (PDDS) in five studies, [29][30][31][32]38 the Expanded Disability Scale Score (EDSS) in four studies [33][34][35][36] and device use in one study. 42 Four studies did not report disability.…”

“…PA was measured subjectively using the Physical Activity and Disability Survey (PADS), 39 the Godin Leisure Time Exercise Questionnaire (GLTEQ), [29][30][31][33][34][35]38,39,42 the International Physical Activity Questionnaire (IPAQ), 32,35 the Health Promoting Lifestyle Profile II (HPLP II) 36,37 and the 7-Day Physical Activity Recall (7-Day PAR). 40 In four studies PA was measured objectively using the Acti-graph Accelerometer to obtain 7-day activity counts (raw, non-transformable counts from the accelerometer) and minutes of moderate-vigorous PA (MVPA) 31,33,41 and the SenseWear armband to obtain energy expenditure and steps per day.…”

“…40 In four studies PA was measured objectively using the Acti-graph Accelerometer to obtain 7-day activity counts (raw, non-transformable counts from the accelerometer) and minutes of moderate-vigorous PA (MVPA) 31,33,41 and the SenseWear armband to obtain energy expenditure and steps per day. 35…”

Safety, feasibility, acceptability and effects of a behaviour-change intervention to change physical activity behaviour among people with multiple sclerosis: Results from the iStep-MS randomised controlled trial

“…Although the intervention was less intensive than other behaviour-change interventions in the literature, 31 it was delivered face-to-face, on a one-to-one basis, unlike previous interventions that delivered group sessions, 32,33 or delivered telephone 20,34 or internet interventions. [17][18][19] Participants emphasised the strong therapeutic relationship was key to developing confidence and competence for PA enactment.…”