The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial

Abstract

BackgroundDespite the commonly known benefits of exercise and physical activity evidence shows that persons Multiple Sclerosis (MS) are relatively inactive yet physical activity may be even more important in a population facing functional deterioration. No exercise is effective if it is not done and people with MS face unique barriers to exercise engagement which need to be overcome. We have developed and pilot tested a Multiple Sclerosis Tailored Exercise Program (MSTEP) and it is ready to be tested against general guidelines for superiority and ultimately for its impact on MS relevant outcomes. The primary research question is to what extent does an MS Tailored Exercise Program (MSTEP) result in greater improvements in exercise capacity and related outcomes over a one year period in comparison to a program based on general guidelines for exercise among people with MS who are sedentary and wish to engage in exercise as part of MS self-management.Methods/DesignThe proposed study is an assessor-blind, parallel-group, randomized controlled trial (RCT). The duration of the intervention will be one year with follow-up to year two. The targeted outcomes are exercise capacity, functional ambulation, strength, and components of quality of life including frequency and intensity of fatigue symptoms, mood, global physical function, health perception, and objective measures of activity level. Logistic regression will be used to test the main hypothesis related to the superiority of the MSTEP program based on a greater proportion of people making a clinically relevant gain in exercise capacity at 1 year and at 2 years, using an intention-to-treat approach. Sample size will be 240 (120 per group).DiscussionThe MS community is clearly looking for interventions to help alleviate the disabling sequelae of MS and promote health. Exercise is a well-known intervention which has known benefits to all, yet few exercise regularly. For people with MS, the role of exercise in MS management needs to be rigorously assessed to inform people as to how best to use exercise to reduce disability and promote health.Trial registrationClinical Trials.gov: NCT01611987

Quality improvement in neurology: Multiple sclerosis quality measures

“…17 Despite the known benefits of exercise and physical activity, many persons with MS remain inactive, offering an opportunity for improvement. 18,19 Fatigue occurs in about 80% of persons with MS and has an impact on physical activity and daily functioning. 20 Behavioral strategies and medications can improve fatigue, offering an opportunity for improvement.…”

Physical and Immunological Aspects of Exercise in Chronic Diseases

“…Further, improvements to physical and psychological functioning, fatigue and quality of life are noted [105,106], in addition to, improved ambulatory function and mood status [107], in MS patients taking part in exercise activity. A 2 year blind, parallel-group, randomized controlled trial is currently being assessed in 240 multiple sclerosis patients, to determine the effects of exercise to reduce disability and to promote health [108].…”

Benefits of an intensive task-oriented circuit training in Multiple Sclerosis patients with mild disability

“…A recent update (Asano, 2009) of a 2004 Cochrane Review summarized the results of 11 randomized trials on exercise with a combined total of 502 persons with MS and the conclusion was that, due to the broad range of exercise interventions, it is not possible to make unified exercise recommendation as to what type of exercise is safe and effective for persons with MS. Mayo et al (2013) conducted a randomized controlled trial in order to test the role of a MS Tailored Exercise Program (MSTEP) in comparison to a program based on general guidelines for exercise among people with MS in altering MS outcomes over time; nevertheless, the study enrolled patients with different degree of disability and the research mainly focused on the deleterious role of physical inactivity in these patients.…”