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MS research update - Exercise programmes for the longer term: what works? - 20 January 2014

Summary

120 people with MS in the Sheffield area, aged 18 to 65, were recruited. Participants were randomly divided into two groups and each group received their usual level of care but one group also undertook the EXIMS (EXercise Intervention for people with MS) programme.

In weeks one to six on the EXIMS programme, the participants attended two supervised sessions each week for up to one hour at a university exercise facility and also did one session at home. Sessions were typically three minutes long, repeated five times with two minute rests in between each three minute session. The programme was tailored to fit each person's capability by a physiotherapist.

In weeks, seven to 12, the participants attended the centre once a week and did two sessions at home. Participants were encouraged to find opportunities to exercise in the local community such as healthy living centres, health walks, fitness centres, swimming pools, gardening etc. based on their own personal preferences.

The supervised sessions included teaching techniques, such as goal setting, finding social support and understanding the costs/benefits of exercise, to help with confidence and encourage exercising in the longer term.

Those who undertook the EXIMS programme reported that they exercised more, had less fatigue and that their quality of life was improved after three months. The majority preferred to exercise by walking, use home exercise equipment, public facilities (including swimming) and/or gardening.

After nine months, improvements in emotional well-being, social function and overall quality of life were maintained although improvements in fatigue were not.

Background

Exercise is good for most of the general population but finding a kind of exercise that you like, and are able to stick at, can be quite difficult. The same principles apply to people with MS. One option is to attend supervised exercise classes or a gym but this can be hard to keep up in the long term because of finding the time, the costs, perhaps travelling a long distance or issues like fatigue.

Another option could be to undertake exercise at home or at local community facilities especially if support could be provided to encourage someone to become self-motivated.

How this study was carried out

The participants

120 people with MS in the Sheffield area, aged 18 to 65, were recruited to the trial. All the participants had an EDSS score (a commonly used measure of disability) between 1.0 and 6.5 and could walk at least 10m with or without one or two walking aids such as sticks or crutches. In all cases, their MS had been stable for at least a month and they were physically able to exercise three times a week. People were not included in the trial if they were already doing structured exercise or brisk walking for at least 30 minutes, at least three times a week and had kept up this regime for at least six months.

The trial

Participants were randomly divided into two groups while still ensuring that the groups were evenly balanced for gender and low versus high EDSS scores. Each group received their usual level of care but one group also undertook the EXIMS (EXercise Intervention for people with MS) programme.

In weeks one to six on the EXIMS programme, the participants attended two supervised sessions each week for up to one hour at a university exercise facility and also did one session at home. Sessions were typically three minutes long, repeated five times with two minute rests in between each three minute session. The programme was tailored to fit each person's capability by a physiotherapist and could include stepping up and down, treadmill walking, wall press ups, knee extensions, balance exercises, work with an exercise ball and stretching exercises, amongst other possibilities. Over time, participants were encouraged to do longer sessions (e.g. four minute bouts) or to take shorter rests in between bouts.

In weeks, seven to 12, the participants attended the centre once a week and did two sessions at home. Participants were encouraged to find opportunities to exercise in the local community such as healthy living centres, health walks, fitness centres, swimming pools, gardening etc. based on their own personal preferences. They recorded their activities in a diary.

The supervised sessions included teaching techniques, such as goal setting, finding social support and understanding the costs/benefits of exercise, to help with confidence and encourage exercising in the longer term.

What was found

Those who undertook the EXIMS programme reported that they exercised more, had less fatigue and that their quality of life was improved after three months. The majority preferred to exercise by walking, use home exercise equipment, public facilities (including swimming) and/or gardening.

After nine months, improvements in emotional well-being, social function and overall quality of life were maintained although improvements in fatigue were not.

What does it mean?

The authors concluded that this very practical approach to encouraging people to direct themselves to exercise worked well. It improved the level of exercise undertaken, decreased fatigue and lead to a long lasting improvement in various aspects of quality of life.

It allowed the physiotherapist to tailor the programme to the person's capabilities and allowed the person to choose the type of home-based exercise that they preferred. However, it may be even more helpful to continue contact between the participant and the health professional, for example by posting literature, sending text messages or by posting on social media, to encourage exercise in the longer term.

Carter A, Daley A, Humphreys L, et al.
Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial.
Mult Scler. 2014 Jan 13. [Epub ahead of print]
abstract

More about exercising with MS

In the past, people with multiple sclerosis were advised to avoid exercise especially activities that might be tiring. A number of studies, including the one summarised above, have shown that regular moderate exercise is a good thing although the exercise should be something that is enjoyable and fits within someone's capabilities.

Exercise can be something energetic or something more leisurely.There is no right or wrong exercise. However, the nature of MS may mean that someone has to be more aware of what they can achieve than someone who doesn't have MS. If you have concerns about undertaking certain activities, talk to a relevant health professional (eg a neurologist, GP, MS specialist nurse, physiotherapist or occupational therapist) beforehand. You have to learn to listen to your own body and to be honest with what it is telling you. As recovery time can be longer for someone with MS, be prepared to stop before your body tells you that you've reached your limit.

You can view or download some exercises for people with MS, including core stability exercises, watch our exercise videos online or order the free DVD. There is also a relaxation exercise with an MS specialist nurse which you can either watch or download as an MP3 file for your MP3 player.

If you are concerned about fatigue, you might like to read Living with fatigue which gives tips on managing fatigue and maximising energy.

Research by topic areas...

Diagnosis

Milo R, Miller A.
Revised diagnostic criteria of multiple sclerosis.
Autoimmun Rev. 2014 Jan 12. pii: S1568-9972(14)00024-X. [Epub ahead of print]
abstract

Giordano A, Lugaresi A, Confalonieri P, et al.
Implementation of the 'Sapere Migliora' information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial.
Mult Scler. 2014 Jan 13. [Epub ahead of print]
abstract

Symptoms and symptom management

Coggrave M, Norton C, Cody JD
Management of faecal incontinence and constipation in adults with central neurological diseases.
Cochrane Database Syst Rev. 2014 Jan 13;1:CD002115. [Epub ahead of print]
abstract
Read the full text of this paper

Razazian N, Shokrian N, Bostani A, et al.
Study of fatigue frequency and its association with sociodemographic and clinical variables in patients with multiple sclerosis.
Neurosciences (Riyadh). 2014 Jan;19(1):38-42.
abstract

Disease modifying treatments

Olberg HK, Cox RJ, Nostbakken JK, et al.
Immunotherapies influence the influenza vaccination response in multiple sclerosis patients: an explorative study.
Mult Scler. 2014 Jan 16. [Epub ahead of print]
abstract

Patti F, Pappalardo A, Montanari E, et al.
Interferon-beta-1a treatment has a positive effect on quality of life of relapsing-remitting multiple sclerosis: Results from a longitudinal study.
J Neurol Sci. 2013 Dec 26. pii: S0022-510X(13)03077-3. [Epub ahead of print]
abstract

Oleen-Burkey M, Cyhaniuk A, Swallow E.
Retrospective US database analysis of persistence with glatiramer acetate vs. available disease-modifying therapies for multiple sclerosis: 2001-2010.
BMC Neurol. 2014 Jan 14;14(1):11. [Epub ahead of print]
abstract
Read the full text of this paper

Continuing education case study quiz.[teriflunomide]
Hosp Pharm. 2013 Mar;48(3):241-2.
abstract
Read the full text of this paper

Fragoso YD, Arruda NM, Arruda WO, et al.
We know how to prescribe natalizumab for multiple sclerosis, but do we know how to withdraw it?
Expert Rev Neurother. 2014 Jan 13. [Epub ahead of print]
abstract

Freedman MS, De Stefano N, Barkhof F, et al.
Patient subgroup analyses of the treatment effect of subcutaneous interferon β-1a on development of multiple sclerosis in the randomized controlled REFLEX study.
J Neurol. 2014 Jan 12. [Epub ahead of print]
abstract

Other treatments

Finch P, Bessonnette S.
A pragmatic investigation into the effects of massage therapy on the self efficacy of multiple sclerosis clients.
J Bodyw Mov Ther. 2014 Jan;18(1):11-6.
abstract

Epidemiology

Bjørnevik K, Riise T, Casetta I, et al.
Sun exposure and multiple sclerosis risk in Norway and Italy: The EnvIMS study.
Mult Scler. 2014 Jan 10. [Epub ahead of print]
abstract

Guimond C, Lee JD, Ramagopalan SV, et al.
Multiple sclerosis in the Iranian immigrant population of BC, Canada: prevalence and risk factors.
Mult Scler. 2014 Jan 10. [Epub ahead of print]
abstract

Fiddes B, Wason J, Sawcer S.
Confounding in association studies: month of birth and multiple sclerosis.
2014 Jan 12. [Epub ahead of print]
abstract

Assessment tools

Solari A, Grzeda M, Giordano A, et al.
Use of Rasch analysis to refine a patient-reported questionnaire on satisfaction with communication of the multiple sclerosis diagnosis.
Mult Scler. 2014 Jan 16. [Epub ahead of print]
abstract

Kieseier BC.
The challenges of measuring disability accumulation in relapsing-remitting multiple sclerosis: evidence from interferon beta treatments.
Expert Rev Neurother. 2014 Jan;14(1):105-20.
abstract

Beckmann YY, Çiftçi Y, Ertekin C.
The detection of sensitivity of proprioception by a new clinical test: the dual joint position test.
Clin Neurol Neurosurg. 2013 Jul;115(7):1023-7.
abstract

Carers

Ertekin O, Ozakbaş S, Idiman E.
Caregiver burden, quality of life and walking ability in different disability levels of multiple sclerosis.
NeuroRehabilitation. 2014 Jan 13. [Epub ahead of print]
abstract

Psychological aspects

Madan S, Pakenham KI.
The stress-buffering effects of hope on adjustment to multiple sclerosis.
Int J Behav Med. 2014 Jan 17. [Epub ahead of print]
abstract

Rosti-Otajärvi E, Mäntynen A, Koivisto K, et al.
Predictors and impact of the working alliance in the neuropsychological rehabilitation of patients with multiple sclerosis.
J Neurol Sci. 2014 Jan 3. pii: S0022-510X(13)03110-9.[Epub ahead of print]
abstract

Physical activity

Swinnen E, Baeyens JP, Pintens S, et al.
Trunk muscle activity during walking in persons with multiple sclerosis: The influence of body weight support.
NeuroRehabilitation. 2014 Jan 13. [Epub ahead of print]
abstract

Economics

Tosh J, Dixon S, Carter A, et al.
Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial.
Mult Scler. 2014 Jan 13. [Epub ahead of print]
abstract

Pathophysiology

Anhoque CF, Biccas-Neto L, Domingues SC, et al.
Cognitive impairment and optic nerve axonal loss in patients with clinically isolated syndrome.
Clin Neurol Neurosurg. 2013 Jul;115(7):1032-5.
abstract

Self-management

Beier M, D'Orio V, Spat J, et al.
Alcohol and substance use in multiple sclerosis.
J Neurol Sci. 2013 Dec 27. pii: S0022-510X(13)03100-6.
abstract

Review

Olsson T.
The new era of multiple sclerosis therapy.
J Intern Med. 2014 Jan 16.[Epub ahead of print]
abstract

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