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MS research update - Could computer games help with MS symptoms? - 6 October 2017

Summary

People with MS are increasingly advised to stay physically active, but for some of us getting to the gym isn’t always possible. Exergaming could offer a fun way to exercise at home, but previous studies found that the use of the Nintendo Wii or similar devices dropped off over time. To encourage regular use, UK researchers developed an exercise programme, Mii-vitaliSe, which uses the Nintendo Wii and incorporates one-to-one support. This aim of this study was to assess the acceptability and suitability of Mii-vitaliSe.

30 participants were split into two groups. One group received training and began using the Nintendo Wii for 12 months, while the other group waited 6 months before starting. Participants kept a daily log of Wii use and completed questionnaires on their physical and mental health. Balance, walking style, mobility and hand dexterity were assessed at the start and at 6 and 12 months.

Use of the Wii lead to an increase in exercise. Average use of the Wii for the first 6 months was twice a week for 27 min/day. No serious side effects were reported during the study.

Participants reported a wide range of benefits related to both physical and mental health, for example physical activity, improved mood, better sleep, improved balance, strength and posture and relief of symptoms such as pain and fatigue. For some, use of the Wii acted as a "gateway" to other physical activities and to greater self-confidence.

The researchers conclude that the results of the study are promising and support further testing in a larger trial.


Background

We all recognise that physical activity is good for our health and well-being, but taking regular exercise is not always feasible. Having MS can make it harder, with the unpredictability of MS symptoms such as pain and fatigue making it difficult to plan regular activities, psychological barriers such as lack of confidence making it harder to get started, or practical issues such as the difficulty of balancing other commitments or arranging transport.

Exergaming could overcome some of these barriers by offering a relatively inexpensive, convenient, involving and fun way to exercise at home. To test this, the Dorset MS Service has developed an exercise package, Mii-vitaliSe, which uses the Nintendo Wii and incorporates training, installation and one-to-one support from physiotherapists to encourage regular use. This aim of this study was to assess the acceptability and suitability of Mii-vitaliSe and help to design a larger study involving more MS specialist centres.

How this study was carried out

30 participants were split into two groups. One group received training and began using the Nintendo Wii for 12 months, while the other group waited 6 months before starting. Physiotherapists provided two training sessions to give background information on exercising and using the Wii, installed the equipment and agreed a personal exercise programme with each participant. They provided continued support and encouragement at regular intervals either by telephone or home visits. Participants kept a daily log of Wii use and completed questionnaires on their physical and mental health. Balance, walking style, mobility and hand dexterity were assessed at the start and at 6 and 12 months.

What was found

Use of the Wii lead to an increase in exercise. Average use of the Wii for the first 6 months was twice a week for 27 min/day. No serious adverse events were reported during the study.

Participants reported a wide range of benefits related to both physical and mental health, for example physical activity, improved mood, better sleep, improved balance, strength and posture and relief of symptoms such as pain and fatigue. For some people, use of the Wii acted as a gateway to other physical activities and to greater self-confidence.

Several participants said they would have liked to have been able to contact others in order to provide mutual encouragement and share tips.

What does it mean?

The findings suggest that the programme was well received by the majority of the participants with very few people dropping out. Use of the Wii was good and approached activity guideline levels recommended for MS.

The current study used the Nintendo Wii, but technology moves at a fast pace and the Wii has since been superseded by the Wii U, which itself recently ceased production and has been replaced by the Wii Switch. Building a resource around a commercial game console and software reduces development time and cost but risks becoming obsolete within a few years; however, expertise gained can quickly be applied to developing an updated version.

The researchers conclude that the results of the study are promising and support proceeding to a full-scale trial of effectiveness and cost-effectiveness.

Thomas S, et al.
Mii-vitalise: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis.
BMJ Open 2017; 7(9): e016966.
Read the full text of this paper 

More about exercising with MS

In the past, people with multiple sclerosis were advised to avoid exercise especially activities that might be tiring. But recently studies have shown that regular moderate exercise is a good thing as long as it is enjoyable and fits within your 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 you have to be more aware of your limits. If you have concerns about doing certain activities, talk to a health professional (eg your neurologist, GP, MS 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  watch our exercise videos online or order the free DVD . There is also a relaxation session.

Research by topic areas...

Causes of MS

Palacios N, Munger KL, Fitzgerald KC, et al.
Exposure to particulate matter air pollution and risk of multiple sclerosis in two large cohorts of US nurses.
Environ Int. 2017 Sep 19;109:64-72. [Epub ahead of print]
abstract

Montgomery S, Hiyoshi A, Burkill S, et al.
Concussion in adolescence and risk of multiple sclerosis.
Ann Neurol. 2017 Sep 4. [Epub ahead of print]
abstract

Diagnosis

Thormann A, Sørensen PS, Koch-Henriksen N, et al.
Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality.
Neurology. 2017 Sep 20. pii: 10.1212/WNL.0000000000004508. [Epub ahead of print]
abstract

Disease modifying drugs

Uphaus T, Oberwittler C, Groppa S, et al.
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J Neurol. 2017 Oct 3. [Epub ahead of print]
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Ho PR, Koendgen H, Campbell N, et al.
Risk of natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: a retrospective analysis of data from four clinical studies.
Lancet Neurol. 2017 Sep 29. pii: S1474-4422(17)30282-X. [Epub ahead of print]
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Ziemssen T, Thomas K.
Alemtuzumab in the long-term treatment of relapsing-remitting multiple sclerosis: an update on the clinical trial evidence and data from the real world.
Ther Adv Neurol Disord. 2017 Oct;10(10):343-359.
abstract
Read the full text of this paper

Zhang T, Kingwell E, Zhu F, et al.
Effect of adherence to the first-generation injectable immunomodulatory drugs on disability accumulation in multiple sclerosis: a longitudinal cohort study.
BMJ Open. 2017 Sep 29;7(9):e018612.
abstract
Read the full text of this paper

Grebenciucova E, Pruitt A.
Infections in Patients Receiving Multiple Sclerosis Disease-Modifying Therapies.
Curr Neurol Neurosci Rep. 2017 Sep 22;17(11):88.
abstract

Melendez-Torres GJ, Auguste P, Armoiry X, et al.
Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation.
Health Technol Assess. 2017 Sep;21(52):1-352.
abstract
Read the full text of this paper

Williamson EML, Berger JR.
Diagnosis and Treatment of Progressive Multifocal Leukoencephalopathy Associated with Multiple Sclerosis Therapies.
Neurotherapeutics. 2017 Sep 14. [Epub ahead of print]
abstract

Ernst FR, Barr P, Elmor R, et al.
Relapse outcomes, safety, and treatment patterns in patients diagnosed with relapsing-remitting multiple sclerosis and initiated on subcutaneous interferon β-1a or dimethyl fumarate: a real-world study.
Curr Med Res Opin. 2017 Sep 28:1-8. [Epub ahead of print]
abstract

Rorsman I, Petersen C, Nilsson PC.
Cognitive functioning following one-year natalizumab treatment: A non-randomized clinical trial.
Acta Neurol Scand. 2017 Sep 13. [Epub ahead of print]
abstract

Hersh CM, Love TE, Bandyopadhyay A, et al.
Comparative efficacy and discontinuation of dimethyl fumarate and fingolimod in clinical practice at 24-month follow-up.
Mult Scler J Exp Transl Clin. 2017 Aug 24;3(3):2055217317715485.
abstract
Read the full text of this paper

Pardo G, Jones DE.
The sequence of disease-modifying therapies in relapsing multiple sclerosis: safety and immunologic considerations.
J Neurol. 2017 Sep 6. [Epub ahead of print]
abstract
Read the full text of this paper

Havrdova E, Arnold DL, Cohen JA, et al.
Alemtuzumab CARE-MS I 5-year follow-up: Durable efficacy in the absence of continuous MS therapy.
Neurology. 2017 Sep 12;89(11):1107-1116.
abstract
Read the full text of this paper

Alsop J, Medin J, Cornelissen C, et al.
Two studies in one: A propensity-score-matched comparison of fingolimod versus interferons and glatiramer acetate using real-world data from the independent German studies, PANGAEA and PEARL.
PLoS One. 2017 May 5;12(5):e0173353.
abstract
Read the full text of this paper

Meca-Lallana J, Hernández L, Caminero AB, et al.
Fatigue Improvement after Switching Multiple Sclerosis Treatment from Interferon-β to Glatiramer Acetate in Clinical Practice.
Eur Neurol. 2016;76(1-2):40-7.
abstract

Drugs in development

Bove RM, Green AJ.
Remyelinating Pharmacotherapies in Multiple Sclerosis.
Neurotherapeutics. 2017 Sep 25. [Epub ahead of print]
abstract

Kappos L, Arnold DL, Bar-Or A, et al.
Two-year results from a phase 2 extension study of oral amiselimod in relapsing multiple sclerosis.
Mult Scler. 2017 Sep 1:1352458517728343. [Epub ahead of print]
abstract
Read the full text of this paper

Comi G, Hartung HP, Bakshi R, et al.
Benefit-Risk Profile of Sphingosine-1-Phosphate Receptor Modulators in Relapsing and Secondary Progressive Multiple Sclerosis.
Drugs. 2017 Sep 13. [Epub ahead of print]
abstract
Read the full text of this paper

Ruggieri S, Tortorella C, Gasperini C.
Anti lingo 1 (opicinumab) a new monoclonal antibody tested in relapsing remitting multiple sclerosis.
Expert Rev Neurother. 2017 Nov;17(11):1081-1089.
abstract

Giovannoni G, Soelberg Sorensen P, Cook S, et al.
Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study.
Mult Scler. 2017 Aug 1:1352458517727603. [Epub ahead of print]
abstract
Read the full text of this paper

Epidemiology

Harris EC, Palmer KT, Cox V, et al.
Mortality from multiple sclerosis in British military personnel.
Occup Med (Lond). 2017 Aug 1;67(6):448-452.
abstract
Read the full text of this paper

Bezzini D, Battaglia MA.
Multiple Sclerosis Epidemiology in Europe.
Adv Exp Med Biol. 2017;958:141-159.
abstract

Families

Moberg JY.
Life course of children with parental multiple sclerosis.
Dan Med J. 2017 Aug;64(8). pii: B5399.
abstract
Read the full text of this paper

Other treatments

Charvet LE, Dobbs B, Shaw MT, et al.
Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial.
Mult Scler. 2017 Sep 1:1352458517732842. [Epub ahead of print]
abstract

da Rovare VP, Magalhães GPA, Jardini GDA, et al.
Cannabinoids for spasticity due to multiple sclerosis or paraplegia: A systematic review and meta-analysis of randomized clinical trials.
Complement Ther Med. 2017 Oct;34:170-185.
abstract

Herzog S, Shanahan M, Grimison P, et al.
Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis.
Pharmacoeconomics. 2017 Sep 2. [Epub ahead of print]
abstract

Vermersch P, Trojano M.
Tetrahydrocannabinol:Cannabidiol Oromucosal Spray for Multiple Sclerosis-Related Resistant Spasticity in Daily Practice.
Eur Neurol. 2016;76(5-6):216-226. Epub 2016 Oct 13.
abstract

Paediatric MS

Tremlett H, Waubant E.
The Gut Microbiota and Pediatric Multiple Sclerosis: Recent Findings.
Neurotherapeutics. 2017 Sep 22. [Epub ahead of print]
abstract

Huppke P, Huppke B, Ellenberger D, et al.
Therapy of highly active pediatric multiple sclerosis.
Mult Scler. 2017 Sep 1:1352458517732843. [Epub ahead of print]
abstract

McGinley M, Rossman IT.
Bringing the HEET: The Argument for High-Efficacy Early Treatment for Pediatric-Onset Multiple Sclerosis.
Neurotherapeutics. 2017 Sep 11. [Epub ahead of print]
abstract

Pregnancy and childbirth

Meinl I, Havla J, Hohlfeld R, et al.
Recurrence of disease activity during pregnancy after cessation of fingolimod in multiple sclerosis.
Mult Scler. 2017 Sep 1:1352458517731913. [Epub ahead of print]
abstract

Provision of care

Strupp J, Groebe B, Knies A, et al.
Evaluation of a palliative and hospice care telephone hotline for patients severely affected by multiple sclerosis and their caregivers.
Eur J Neurol. 2017 Sep 19. [Epub ahead of print]
abstract

Psychological aspects

Calandri E, Graziano F, Borghi M, et al.
Coping strategies and adjustment to multiple sclerosis among recently diagnosed patients: the mediating role of sense of coherence.
Clin Rehabil. 2017 Oct;31(10):1386-1395.
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Neuhaus M, Bagutti S, Yaldizli Ö, et al.
Characterization of social cognition impairment in multiple sclerosis.
Eur J Neurol. 2017 Sep 12. [Epub ahead of print]
abstract

Broersma F, Oeseburg B, Dijkstra J, et al.
The impact of self-perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients: results of a cross-sectional study.
Clin Rehabil. 2017 Sep 1:269215517730670. [Epub ahead of print]
abstract
Read the full text of this paper

Heldner MR, Kaufmann-Ezra S, Gutbrod K, et al.
Behavioral Changes in Patients with Multiple Sclerosis.
Front Neurol. 2017 Aug 28;8:437.
abstract
Read the full text of this paper

Meca-Lallana J, Mendibe M, Hernández-Clares R, et al.
Predictors of burden and depression among caregivers of relapsing-remitting MS patients in Spain: MS Feeling study.
Neurodegener Dis Manag. 2016 Aug;6(4):277-87.
abstract

Rehabilitation

Bulguroglu I, Guclu-Gunduz A, Yazici G, et al.
The effects of Mat Pilates and Reformer Pilates in Patients with Multiple Sclerosis: A randomized controlled study.
NeuroRehabilitation. 2017 Sep 16. [Epub ahead of print]
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Aidar FJ, Carneiro AL, Costa Moreira O, et al.
Effects of resistance training on the physical condition of people with multiple sclerosis.
J Sports Med Phys Fitness. 2017 Sep 22. [Epub ahead of print]
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Butchard-MacDonald E, Paul L, Evans JJ.
Balancing the Demands of Two Tasks: An Investigation of Cognitive-Motor Dual-Tasking in Relapsing Remitting Multiple Sclerosis.
J Int Neuropsychol Soc. 2017 Sep 22:1-12. [Epub ahead of print]
abstract

Bisson EJ, Fakolade A, Pétrin J, et al.
Exercise interventions in multiple sclerosis rehabilitation need better reporting on comorbidities: a systematic scoping review.
Clin Rehabil. 2017 Oct;31(10):1305-1312.
abstract

Motl RW, Sandroff BM, Kwakkel G, et al.
Exercise in patients with multiple sclerosis.
Lancet Neurol. 2017 Oct;16(10):848-856.
abstract

Learmonth YC, Adamson BC, Balto JM, et al.
Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers.
Health Expect. 2017 Oct;20(5):1001-1010.
abstract
Read the full text of this paper

Lutz C, Kersten S, Haas CT.
Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study.
Mult Scler Int. 2017;2017:2826532.
abstract
Read the full text of this paper

Kasser SL, Goldstein A, Wood PK, et al.
Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships.
Disabil Health J. 2017 Apr;10(2):207-213.
abstract

Self-management

Winberg C, Kylberg M, Pettersson C, et al.
The Use of Apps for Health in Persons with Multiple Sclerosis, Parkinson's Disease and Stroke - Barriers and Facilitators.
Stud Health Technol Inform. 2017;242:638-641.
abstract

Stem cells

Dahbour S, Jamali F, Alhattab D, et al.
Mesenchymal stem cells and conditioned media in the treatment of multiple sclerosis patients: Clinical, ophthalmological and radiological assessments of safety and efficacy.
CNS Neurosci Ther. 2017 Nov;23(11):866-874.
abstract
Read the full text of this paper

Sarkar P, Redondo J, Kemp K, et al.
Reduced neuroprotective potential of the mesenchymal stromal cell secretome with ex vivo expansion, age and progressive multiple sclerosis.
Cytotherapy. 2017 Sep 13. pii: S1465-3249(17)30666-7. [Epub ahead of print]
abstract
Read the full text of this paper

Symptoms and symptom management

Hameau S, Bensmail D, Roche N, et al.
Adaptations of fatigue and fatigability after a short intensive, combined rehabilitation program in patients with multiple sclerosis.
J Rehabil Med. 2017 Oct 5. [Epub ahead of print]
abstract
Read the full text of this paper

Holland MT, Teferi N, Noeller J, et al.
Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience.
Clin Neurol Neurosurg. 2017 Sep 7;162:80-84. [Epub ahead of print]
abstract

Goverover Y, Chiaravalloti ND, O'Brien A, et al.
Evidenced Based Cognitive Rehabilitation for Persons with Multiple Sclerosis: An Updated Review of the Literature from 2007-2016.
Arch Phys Med Rehabil. 2017 Sep 25. pii: S0003-9993(17)31117-6. [Epub ahead of print]
abstract

Marck CH, De Livera AM, Weiland TJ, et al.
Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life.
Front Neurol. 2017 Sep 5;8:461.
abstract
Read the full text of this paper

Comber L, Quinn G, McGuigan C, et al.
Medication usage and falls in people with multiple sclerosis.
Mult Scler. 2017 Sep 1:1352458517731912. [Epub ahead of print]
abstract

Till C, Kuni B, De Somma E, et al.
A feasibility study of working memory training for individuals with paediatric-onset multiple sclerosis.
Neuropsychol Rehabil. 2017 Sep 18:1-16. [Epub ahead of print]
abstract

Migliore S, Ghazaryan A, Simonelli I, et al.
Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability.
Behav Neurol. 2017;2017:7404289.
abstract
Read the full text of this paper

Green R, Cutter G, Friendly M, et al.
Which symptoms contribute the most to patients' perception of health in multiple sclerosis?
Mult Scler J Exp Transl Clin. 2017 Sep 5;3(3):2055217317728301.
abstract
Read the full text of this paper

Carling A, Forsberg A, Nilsagård Y.
Falls in people with multiple sclerosis: experiences of 115 fall situations.
Clin Rehabil. 2017 Sep 1:269215517730597. [Epub ahead of print]
abstract
Read the full text of this paper

Alexander M, Bashir K, Alexander C, et al.
A randomized trial of clitoral vacuum suction versus vibratory stimulation in neurogenic female orgasmic dysfunction.
Arch Phys Med Rehabil. 2017 Sep 9. pii: S0003-9993(17)31075-4. [Epub ahead of print]
abstract

Johnen A, Landmeyer NC, Bürkner PC, et al.
Distinct cognitive impairments in different disease courses of multiple sclerosis-A systematic review and meta-analysis.
Neurosci Biobehav Rev. 2017 Sep 8. pii: S0149-7634(17)30367-6. [Epub ahead of print]
abstract

Yang TT, Wang L, Deng XY, et al.
Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.
J Neurol Sci. 2017 Sep 15;380:256-261.
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Greeke EE, Chua AS, Healy BC, et al.
Depression and fatigue in patients with multiple sclerosis.
J Neurol Sci. 2017 Sep 15;380:236-241.
abstract

van den Akker LE, Beckerman H, Collette EH, et al.
Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.
J Psychosom Res. 2016 Nov;90:33-42.
abstract

Vitamin D

Vitamin D supplementation.
Pract Neurol. 2017 Sep 25. pii: practneurol-2017-001720. [Epub ahead of print]
abstract

Munger KL, Hongell K, Åivo J, et al.
25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort.
Neurology. 2017 Oct 10;89(15):1578-1583.
abstract

Work

Dorstyn D, Roberts R, Murphy G, et al.
An online resource to promote vocational interests among job-seekers with multiple sclerosis: a randomized controlled trial in Australia.
Arch Phys Med Rehabil. 2017 Sep 16. pii: S0003-9993(17)31084-5. [Epub ahead of print]
abstract

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