Innovations In Clinical Neuroscience

Hot Topics in Mulitple Sclerosis NOV 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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15 Hot Topics in Multiple Sclerosis [November 2017] O R I G I N A L R E S E A R C H BACKGROUND Multiple sclerosis (MS) is a chronic and often progressive condition affecting the central nervous system. MS has many consequences, including impaired strength, fitness, mood, fatigue, and cognition, along with limitations of activities such as walking that impact on quality of life. Available evidence supports the beneficial effects of exercise on fatigue, 1,2 depression, 3 fitness, 4 walking mobility, 5,6 in addition to quality of life. 7 Indeed, this evidence has led to the development of the MS Exercise guideline, 8,9 which recommends moderate intensity aerobic exercise for 30 minutes and resistance training involving major muscle groups twice per week. We are not aware of a single trial that has actually documented the benefits of the exercise guidelines in MS. Of further concern, there are few studies in the MS exercise literature that have evaluated the long-term benefits of exercise interventions, and the results are mixed. For example, we reported positive improvements from a combined aerobic and resistance exercise program in the community; 10 however, the improvements generally were not maintained 12 weeks post-intervention, 11 suggesting that additional measures are required to enable sustained increases in physical activity behaviour among people with MS (PwMS). This need to foster long-term exercise participation is not unique to PwMS, and authors have highlighted the need to include theory-based behaviour change interventions. 12 Social cognitive theory has been extensively investigated among PwMS, and exercise self-efficacy and goal A B S T R A C T Background: Recent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education. Methods: Physically inactive people with MS, scoring 0–3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up. Results: One hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(−9.87, −0.21), p = 0.04, Control −7.68(−12.13, −3.23), p = 0.00), strength (SCT -1.51(−2.41, −0.60), p < 0.01, Control −1.55(−2.30, −0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(−4.45(−8.68, −0.22), −4.12(−8.25, 0.01), anxiety(−1.76(−3.20, −0.31), −1.99(−3.28, −0.71), depression(−1.51(−2.89, −0.13), −1.02(−2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges' g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up. Conclusion: There were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program. KEYWORDS: Multiple sclerosis, exercise, fatigue, cognition, behavior change techniques, social cognitive theory, randomized controlled trial Effect of Exercising at Minimum Recommendations of the Multiple Sclerosis Exercise Guideline Combined with Structured Education or Attention Control Education—Secondary Results of the Step It Up Randomized Controlled Trial by SUSAN COOTE, MARCIN USZYNSKI, MATTHEW P. HERRING, SARA HAYES, CAROL SCARROTT, JOHN NEWELL, STEPHEN GALLAGHER, AIDAN LARKIN, and ROBERT W. MOTL Ms. Coote and Ms. Hayes are with the Department of Clinical Therapies and the Health Research Institute, University of Limerick, in Limerick, Ireland. Mr. Uszynski is with the Department of Clinical Therapies, University of Limerick, in Limerick, Ireland, and the Multiple Sclerosis Society of Ireland, Western office, Galway, Ireland. Mr. Herring is with the Health Research Institute and the Department of Physical Education and Sports Science, University of Limerick, in Limerick, Ireland. Mr. Scarrott is with the HRB Clinical Research Facility, National University of Ireland, Galway, Ireland, and the School of Mathematics and Statistics, University of Canterbury, in Christchurch, New Zealand. Mr. Gallagher is with the Health Research Institute and Department of Psychology, University of Limerick, in Limerick, Ireland. Mr. Larkin is with the Multiple Sclerosis Society of Ireland, Western office, in Galway, Ireland. Mr. Motl is with the Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, in Birmingham, Alabama. BMC Neurol. 2017;17:17:119 FUNDING: This work is supported by the Irish Health Research Board Health Research Award, grant number: HRA_ PHR/2013–264. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. DISCLOSURES: The authors declare that they have no competing interests. CORRESONDENCE: Susan Coote; E-mail:

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