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MS research update - Exercise rehabilitation programmes for people with MS: is it possible to predict who will benefit? - 15 September 2014

Summary

Previous research studies into exercise based rehabilitation for people with MS, have shown that exercise can produce small but significant improvements in quality of life, fatigue and walking. However not all participants in these studies responded in the same way and not all benefited from the programmes, but it is not known why this is the case. This study assessed people with MS before and after exercise based rehabilitation programmes to see if they could identify anything that could be used to predict how participants would respond to the exercise interventions.

314 people with MS were randomly allocated to take part in a yoga class, a physiotherapy led exercise class, a fitness instructor led exercise class or to be in a control group who didn't change their exercise habits. Each group took part in one hour of class per week over 10 weeks. All participants took part in a series of tests before and after the 10 week exercise period.

The researchers then took all of the information and data that they had collected to make a series of models to see if they could find anything that would predict how participants would respond to the exercise interventions.

The study found that several things could be used to predict the scores on each of the tests used after a programme of exercise, these included levels of fatigue, upper body coordination and the gender of the participant.

This study shows that different forms of exercise rehabilitation may have different effects, depending on the gender of the person and their abilities and difficulties prior to starting rehabilitation. The authors conclude that as exercise has been shown to help improve several symptoms of MS, the results of this study suggest that healthcare professionals should take into account the characteristics of the person with MS and what they want to achieve through the rehabilitation, when deciding on a rehabilitation programme to prescribe.

Background

Previous research studies into exercise based rehabilitation for people with MS, have shown that exercise can produce small but significant improvements in quality of life, fatigue and walking. However not all participants in these studies responded in the same way and not all benefited from the programmes, but it is not known why this is the case. It has been suggested that differences in the physical, cognitive or emotional characteristics of the people with MS involved in these studies may have an impact on the progress they are able to make. Knowing what characteristics can be used to identify the people with MS who will best respond to an exercise based rehabilitation programme, will mean that health professionals can identify those people who would be better helped with an different type of programme. This study assessed people with MS before and after exercise based rehabilitation programmes to see if they could identify anything that could be used to predict how participants would respond to the exercise interventions.

How this study was carried out

314 people with MS, who walked with at most one walking stick when outdoors, were randomly allocated to one of four groups to receive an exercise based rehabilitation intervention. The groups took part in a yoga class, a physiotherapy led exercise class, a fitness instructor led exercise class or were in a control group who don't change their exercise habits. Each group took part in one hour of class per week over 10 weeks. 242 participants completed the study.

All participants took part in a series of tests before and after the exercise class period. These tests included:

  • Modified Fatigue Impact Score (MFIS), which measures the impact of fatigue on daily life, including assessing the physical and cognitive effects;
  • Multiple Sclerosis Impact Scale-29 version 2 (MSIS-29), which is a questionnaire that measures the impact of MS on the participants daily life
  • Six Minute Walk Test (6MWT), which measures walking ability, by seeing how far the participant can walk in a six minute period.

The researchers then took all of the information and data that they had collected to make a series of models to see if they could find anything that would predict how participants would respond to the exercise interventions.

What was found

The MSIS-29 is a questionnaire that measures how the participant themselves feels the impact of MS is on them, whereas the 6MWT measures the physical distance the participant is able to walk. The study found that several things could be used to predict the scores on each of these tests after a programme of exercise. Participants who were female, took part in any of the exercise classes or who were less affected by their MS at the start of the study, had better scores on the MSIS-29 at the end of the 12 week study period. Whereas participants who were male, took part in a physiotherapy led exercise class or had normal upper body coordination had better scores on the 6MWT. All three types of exercise class significantly improved fatigue.

What does it mean?

This study shows that different forms of exercise rehabilitation may have different effects, depending on the gender of the person and their abilities and difficulties prior to starting rehabilitation. The authors conclude that as exercise has been shown to help improve several symptoms of MS, the results of this study suggest that healthcare professionals should take into account the characteristics of the person with MS and what they want to achieve through the rehabilitation, when deciding on a rehabilitation programme to prescribe.

Kehoe M, Saunders J, Jakeman P , et al.
Predictors of the physical impact of Multiple Sclerosis following community-based, exercise trial.
Mult Scler. 2014 Sep 10. pii: 1352458514549395. [Epub ahead of print]
abstract

More about rehabilitation

Rehabilitation involves helping an individual achieve their personal goals. Rehabilitation professionals, including nurses, rehabilitation consultants, physiotherapists and occupational therapists can help someone work out ways of dealing with some of the common problems MS can cause and support them to draw up practical goals for living the way they want to. This might mean finding solutions to difficulties at home or work, such as walking difficulties, memory problems, fatigue or pain. However as rehabilitation services, often shorted to 'rehab', involve several different types of health professional, there are many more things that rehab can help with.

A programme of rehabilitation may take place in a hospital, a specialist centre, or in the person's home, and it should be tailored to meet the individual's health needs and goals. This study looked at exercise programmes, but there are many other group programmes available, such as fatigue management, as well as individual programmes such as nutritional and diet advice from a dietitian to help with fatigue or bowel problems.

You can read more about rehabilitation in MS in the May 2014 issue of our newsletter Open Door which had a special feature on the subject, talking to professionals working in the area explaining how the can help and also people with MS describing their experiences of rehab. You can read a pdf of the full issue or read the rehab section online to learn more.

MS rehab services do vary depending on where you live. If you have an MS nurse, they are often the best people to ask what's available locally. If you have an MS therapy centre near you they might also be able to help you find a physiotherapist or other rehab professionals. You might need a referral from your GP to access some of these services.

You can use our online map to find MS health professionals and services near you.

Research by topic areas...

Assessment tools

Goretti B, Niccolai C, Hakiki B, et al.
The brief international cognitive assessment for multiple sclerosis (BICAMS): normative values with gender, age and education corrections in the Italian population.
BMC Neurol. 2014 Sep 10;14(1):171. [Epub ahead of print]
abstract
Read the full text of this paper (PDF)

Gabelić T, Krbot Skorić M, Adamec I, et al.
The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis.
Eur J Neurol. 2014 Sep 8. [Epub ahead of print]
abstract

Breiner A, Barnett C, Bril V.
INCAT disability score: a critical analysis of its measurement properties.
Muscle Nerve. 2014 Aug;50(2):164-9.
abstract

Co-existing conditions

Lund C, Nakken KO, Edland A, et al.
Multiple sclerosis and seizures: incidence and prevalence over 40 years.
Acta Neurol Scand. 2014 Sep 10. [Epub ahead of print]
abstract

Diagnosis

Assouad R, Louapre C, Tourbah A, et al.
Clinical and MRI characterization of MS patients with a pure and severe cognitive onset.
Clin Neurol Neurosurg. 2014 Aug 20;126C:55-63. [Epub ahead of print]
abstract

Disease modifying treatments

Magyari M, Koch-Henriksen N, Laursen B, et al.
Gender effects on treatment response to interferon-beta in multiple sclerosis.
Acta Neurol Scand. 2014 Sep 10. [Epub ahead of print]
abstract

Other treatments

Rekand T.
THC:CBD spray and MS spasticity symptoms: data from latest studies.
Eur Neurol. 2014;71 Suppl 1:4-9.
abstract
Read the full text of this paper

Paediatric MS

Amato MP, Goretti B, Ghezzi A, et al.
Neuropsychological features in childhood and juvenile multiple sclerosis: five-year follow-up.
Neurology. 2014 Sep 12. [Epub ahead of print]
abstract

Prognosis

Lucenti A, Galimberti S, Barizzone N, et al.
Multiple sclerosis progression is not associated with birth timing in Italy.
J Neurol Sci. 2014 Aug 23. [Epub ahead of print]
abstract

Psychological aspects

Blundell Jones J, Walsh S, Isaac C.
"Putting one foot in front of the other": A qualitative study of emotional experiences and help-seeking in women with multiple sclerosis.
J Clin Psychol Med Settings. 2014 Sep 14. [Epub ahead of print]
abstract

Stepleman LM, Penwell-Waines LM, Rollock M, et al.
Routine depression screening in an MS clinic and its association with provider treatment recommendations and related treatment outcome.
J Clin Psychol Med Settings. 2014 Sep 7. [Epub ahead of print]
abstract

Rehabilitation

Hendrie WA, Watson MJ, McArthur MA.
A pilot mixed methods investigation of the use of Oswestry standing frames in the homes of nine people with severe multiple sclerosis.
Disabil Rehabil. 2014 Sep 10:1-8. [Epub ahead of print]
abstract

Vitamin D

Jalkanen A, Kauko T, Turpeinen U, et al.
Multiple sclerosis and vitamin D during pregnancy and lactation.
Acta Neurol Scand. 2014 Sep 12. [Epub ahead of print]
abstract

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