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Latest MS research update - Can exercise improve mood in people with MS? - 21 October 2014

The MS Trust runs a weekly search for interesting and relevant research articles relating to multiple sclerosis using Medline, a specialised search engine for medical journals. The original abstracts to each of the articles can be accessed via the links provided.

For further information on any topic please contact the information team at info@mstrust.org.uk.


This week's highlighted research...

Can exercise improve mood in people with MS?

Research by topic areas...

Assessment tools
Causes of MS
CCSVI
Disease modifying treatments
Other treatments
Physical activity
Prognosis
Provision of care
Psychological aspects
Quality of life
Rehabilitation
Symptoms and symptom management
Vitamin D


Can exercise improve mood in people with MS?

Summary

This study pools the previous research in order to assess the evidence and evaluate the effect of exercise on mood in people with MS.

The study found that exercise has the potential to improve mood in people with MS, by reducing depressive symptoms. Results from a very small number of the studies examined, suggested that exercise seemed to improve mood in people with a higher EDSS score, which suggested it had a greater impact on people more severely affected by MS. The analysis did not identify which particular type of exercise or how often and intense exercise should be done to improve mood.

The authors point out that the effect seen is small and the number and size of studies done to date has been limited. They suggest further well designed studies that specifically look at the effects that exercise can have on mood in people with MS are needed.


Background

About half of people with MS experience depression at some time and many others can experience periods of low mood and depressive symptoms. This can be the result of living with MS but can also be a symptom caused directly by MS if there is a lesion in an area of the brain involved in mood.

Treatment of depression and other mood disorders usually involves drugs and talking therapies such as counselling. Previous research has shown that exercise could be an alternative to these traditional treatments for some people, as it has been found to improve mood in people with major depressive disorder and in people with other conditions such as stroke. This study pools the previous research in order to assess the evidence and evaluate the effect of exercise on mood in people with MS.


How this study was carried out

This study was a review of the previous research into the effects of exercise treatments on depressive symptoms in people with MS. To be included in the review the studies needed to be randomised controlled trials, compared exercise with a control, such as no exercise and assessed the participants mood using one of the standard questionnaires used for mood evaluation.

Depressive symptoms include altered sleep patterns, feelings of hopelessness, guilt and low self-esteem, thoughts of death, reduced energy and the inability to concentrate and to take pleasure in anything.

15 studies met the criteria and were included in the analysis. These included a total of 331 exercising participants and 260 control participants. The studies were further classified into groups based on the type of exercise involved: resistance training, endurance training, combined training (resistance and endurance) or another exercise type.


What was found

The study found that exercise appeared to have a small effect on reducing depressive symptoms in people with MS. Results from a very small number of the studies examined suggested that exercise seemed to improve mood in people with a higher EDSS score, which suggested it had a greater impact on people more severely affected by MS.

The analysis did not identify which particular type of exercise or how often and intense exercise should be done to improve mood.


What does it mean?

The authors comment that the results of their review of previous research suggests that exercise has the potential to improve mood in people with MS, by reducing depressive symptoms. However they point out that the effect seen is small and the number and size of studies done to date has been limited. They suggest further well designed studies that look at the effects that exercise can have on mood in people with MS are needed.


Dalgas U, Stenager E, Sloth M, et al.
The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature..
Eur J Neurol. 2014 Oct 18. [Epub ahead of print]
abstract

More about mood changes in MS

Living with MS can be challenging and long lasting changes in mood could be due to managing these challenges or directly as a result of MS and its effect on the central nervous system. Many people can find it difficult to talk about mood changes and to seek appropriate support.

Treatment usually works well. This could be antidepressant medication or talking therapies or both. In addition, there are self-help groups run by a number of charities who support people with depression, whatever its cause. You can find your local group here:

This study looks at using exercise to improve mood. Physical activity is thought to cause chemical changes in the brain, which can help to change mood. Being active can also help improve wellbeing through taking back control of your body, increasing self-esteem and self-control.

You can read more about exercise for depression and exercise to relieve stress on the NHS Choices website.

You don't need to spend hours down the gym, there is no right or wrong way to stay active. Do something you enjoy and fits into your life. The StayingActive section of our web site has an A to Z of suggestions from angling to yoga. There is also some advice on exercising with MS including general fitness advice.

Depression

It is estimated that about half of all people with multiple sclerosis will experience an episode of depression at some stage. Depression involves persistent sadness lasting more than two weeks, accompanied by other symptoms such as an altered sleep pattern, feelings of hopelessness, guilt and low self esteem, thoughts of death, reduced energy and the inability to concentrate and to take pleasure in anything.

It is important to distinguish clinical depression, which is persistent, from episodes of low mood, which tend to resolve after a period of time. You can read more about depression in the A to Z of MS or order our factsheet about managing depression. An article in our newsletter, Open Door, describes depression, the treatment options and where to seek help if you feel depressed.

Inappropriate laughing or crying

Some people with multiple sclerosis find that they laugh or cry with little reason or at inappropriate times. This is because MS lesions have occurred in an area of the brain that is involved in controlling the emotional pathways. These symptoms are called pseudobulbar affect.

This is a physical disorder which occurs, not because someone truly feels happy or sad but because their ability to control the expression of their feelings is disrupted by MS.

You can read more about pseudobulbar affect in the A to Z of MS and in an earlier edition of Research Update.

Getting help with mood changes

If you are concerned about changes in mood, your MS nurse or GP should be able to refer you to specialist support or may be able to prescribe treatment directly.

Keep up to date

You can sign up to receive an email alert for the MS Trust research update. The email provides links to this page so that you can see the latest published research in MS. You can read our blog on how we choose research to include in this update.

You can also sign up for our News alerts which cover reports about MS on our news page and in the media.

Open Door, the MS Trust's free quarterly newsletter is available both by post and by email. It contains information on all the publications and support that the MS Trust provides, articles on a wide range of topics written by health professionals and people with MS as well as news about MS and recent research. Sign up for Open Door here or call us on 0800 032 38 39 or 01462 476700

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Assessment tools

Uysal U, Idiman F, Idiman E, et al.
Contingent negative variation is associated with cognitive dysfunction and secondary progressive disease course in multiple sclerosis.
J Clin Neurol. 2014 Oct;10(4):296-303.
abstract

Read the full text of this paper

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Causes of MS

Langer-Gould A, Qian L, Tartof SY, et al.
Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases.
JAMA Neurol. 2014 Oct 20. [Epub ahead of print]
abstract

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CCSVI

Sethi SK, Utriainen DT, Daugherty AM, et al.
Jugular venous flow abnormalities in multiple sclerosis patients compared to normal controls.
J Neuroimaging. 2014 Oct 15. [Epub ahead of print]
abstract

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Disease modifying treatments

Fleischer V, Salmen A, Kollar S, et al.
Cardiotoxicity of mitoxantrone treatment in a German cohort of 639 multiple sclerosis patients.
J Clin Neurol. 2014 Oct;10(4):289-95.
abstract

Read the full text of this paper

Savale L, Sattler C, Günther S, et al.
Pulmonary arterial hypertension in patients treated with interferon.
Eur Respir J. 2014 Oct 16. [Epub ahead of print]
abstract

Kita M, Fox RJ, Gold R, et al.
Effects of delayed-release dimethyl fumarate (DMF) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: an integrated analysis of the phase 3 define and confirm studies.
Clin Ther. 2014 Oct 11. [Epub ahead of print]
abstract

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Other treatments

Wright S, Yadav V, Bever C Jr, et al.
Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology.
Neurology. 2014 Oct 14;83(16):1484-6.
abstract

Muñoz García D, Midaglia L, Martinez Vilela J, et al.
Associated inosine to interferon: results of a clinical trial in multiple sclerosis.
Acta Neurol Scand. 2014 Oct 14. [Epub ahead of print]
abstract

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Physical activity

Eijnde BO, Keytsman C, Wens I, et al.
Whole-body cooling does not compromise muscle oxidative capacity in subjects with multiple sclerosis.
NeuroRehabilitation. 2014 Oct 15. [Epub ahead of print]
abstract

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Prognosis

Alroughani RA, Akhtar S, Ahmed SF, et al.
Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort.
Int J Neurosci. 2014 Oct 20:1-17. [Epub ahead of print]
abstract

Brown MG, Asbridge M, Hicks V, et al.
Estimating typical multiple sclerosis disability progression speed from clinical observations.
PLoS One. 2014;9(10):e105123.
abstract

Read the full text of this paper

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Provision of care

Jones-Berry S.
Clinical nurse specialist - a serious shortfall in numbers.
Nurs Stand. 2014 Oct 15;29(7):64-5.
abstract

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Psychological aspects

Kawahara Y, Ikeda M, Deguchi K, et al.
Cognitive and affective assessments of multiple sclerosis (MS) and neuromyelitis optica (NMO) patients utilizing computerized touch panel-type screening tests.
Intern Med. 2014;53(20):2281-90. Epub 2014 Oct 15.
abstract

Read the full text of this paper (PDF)

Bonavita S, Sacco R, Della Corte M, et al.
Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study.
J Neurol. 2014 Oct 12. [Epub ahead of print]
abstract

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Quality of life

Williams AE, Vietri JT, Isherwood G, et al.
Symptoms and association with health outcomes in relapsing-remitting multiple sclerosis: results of a US patient survey.
Mult Scler Int. 2014;2014:203183.
abstract

Read the full text of this paper

Khalaf KM, Coyne KS, Globe DR, et al.
The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis.
Neurourol Urodyn. 2014 Oct 18. [Epub ahead of print]
abstract

Read the full text of this paper

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Rehabilitation

Rasova K, Prochazkova M, Tintera J, et al.
Motor programme activating therapy influences adaptive brain functions in multiple sclerosis: clinical and mri study.
Int J Rehabil Res. 2014 Oct 16. [Epub ahead of print]
abstract

Coote S, Hughes L, Rainsford G, et al.
A pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with multiple sclerosis who use walking aids.
Arch Phys Med Rehabil. 2014 Oct 9. [Epub ahead of print]
abstract

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Symptoms and symptom management

Khan F, Amatya B, Galea M.
Management of fatigue in persons with multiple sclerosis.
Front Neurol. 2014;5:177.
abstract

Read the full text of this paper

Ferrucci R, Vergari M, Cogiamanian F, et al.
Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis.
NeuroRehabilitation. 2014;34(1):121-7.
abstract

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Vitamin D

Bhargava P, Cassard S, Steele SU, et al.
The vitamin D to ameliorate multiple sclerosis (VIDAMS) trial: study design for a multicenter, randomized, double-blind controlled trial of vitamin D in multiple sclerosis.
Contemp Clin Trials. 2014 Oct 10. [Epub ahead of print]
abstract