Moderate Exercise Helps MS Patients

[Marco]

A 'pragmatic' combination of short duration medium intensity aerobic exercise and CBT can improve fatigue and quality of life in multiple sclerosis patients its claimed :

Funded by the MS Society, the research was published in the Multiple Sclerosis Journal.

Prof Saxton said: "It seems illogical to turn to exercise as a way of managing fatigue, but the results showed that a pragmatic programme based on short bouts of moderate-intensity exercise can really help people improve symptoms and quality of life.

"Exercise can also offer social interaction - walking with friends, bike riding with the family - there's a lot to gain."

Ed Holloway, head of care and services research at the MS Society, said: "We're delighted that this study has shown how a well-designed exercise programme can be a cost-effective way to help manage some of the symptoms of MS.

"Fatigue in MS is an incredibly common but troubling symptom that can hugely affect an individual's quality of life. For many people with MS this programme could be a cost effective treatment option."

http://news.uk.msn.com/uk/moderate-exercise-helps-ms-patients

I wonder how many of them 'recovered'?

 

[Firestormm]

Also, in the Daily Wail: http://www.dailymail.co.uk/health/a...ergy-levels-short-bursts-walking-cycling.html Same story. Have you found the paper perchance, Marco?

Perhaps this represents but one significant difference between ME and MS. I know some are keen to see similarities - but (and I ain't seen the paper) - this could be a major difference.

 

[Marco]

Also, in the Daily Wail: http://www.dailymail.co.uk/health/a...ergy-levels-short-bursts-walking-cycling.html Same story. Have you found the paper perchance, Marco?

Perhaps this represents but one significant difference between ME and MS. I know some are keen to see similarities - but (and I ain't seen the paper) - this could be a major difference.

Can't track the paper down at the mo' I'm afraid.

I found the fact that the MS Society provided funding for this and the Society's spokesman's comments were an interesting contrast.

Although they do have the luxury of legitimacy and not being offered this as a monotherapy.

I"d still be interested to see the paper though in respect of the rationale and whether the trial may have been 'insprired by'.

 

[Esther12]

Also, in the Daily Wail: http://www.dailymail.co.uk/health/a...ergy-levels-short-bursts-walking-cycling.html Same story. Have you found the paper perchance, Marco?

Perhaps this represents but one significant difference between ME and MS. I know some are keen to see similarities - but (and I ain't seen the paper) - this could be a major difference.

Hard to say... based only on news reports, this seems like the sort of results one would expect for CFS too. No active control intervention, subjective outcome measures... no controlling for response bias, which could easily explain positive results.

However, the trial's primary outcomes were supposed to be the 6 minute walking test and physical activity.

http://www.controlled-trials.com/ISRCTN41541516

 

[Firestormm]

Hard to say... based only on news reports, this seems like the sort of results one would expect for CFS too. No active control intervention, subjective outcome measures... no controlling for response bias, which could easily explain positive results.

However, the trial's primary outcomes were 6 minute walking test and physical activity.

http://www.controlled-trials.com/ISRCTN41541516

Inclusion criteria:

5. Physically able to participate in some form of exercise three times per week

Exclusion criteria:

4. Living more than 20 miles from the trial centre
5. Already engaged in purposeful structured exercise or brisk walking exercise for equal to or greater than three times per week for equal to or greater than 30 minutes per session and have been so on a consistent basis during the previous six months

Primary outcome measure(s)

1. Physical activity levels
2. Six-minute walking test

All outcome measures will be taken at baseline, 12-weeks and at 6-months follow-up.

Secondary outcome measure(s) 1. Neurological impairment and clinical functional mobility
2. Quality of life
3. Fatigue
4. Focus groups and interviews
5. Immunological analysis

All outcome measures will be taken at baseline, 12-weeks and at 6-months follow-up.

Thanks Esther. A useful source

 

[Valentijn]

Do they say how "Physical activity levels" are measured? Actometers or questionnaire?

 

[Esther12]

Here's the paper: http://msj.sagepub.com/content/early/2014/01/07/1352458513519354.full

Looks like the primary measure of physical activity they used was self-report (GLTEQ questionnaire):

An increase in GLTEQ was observed in the exercise group versus usual care at the primary time point of three months (p = 0.01) and a non-significant increase was still apparent after nine months (p = 0.08; Figure 3). The improvement in self-reported exercise behaviour was accompanied by increases in objectively measured daily step counts at three months (p = 0.009) in the exercise group versus usual care, but at nine months daily step counts were similar to baseline levels (Figure 3). All dimensions of fatigue were significantly improved in the exercise group in comparison with usual care at three months (p <0.0001), with the change in total fatigue scores being positively correlated with baseline levels (Table 3). Interestingly, volume of supervised aerobic exercise achieved was negatively correlated with the change in total fatigue scores at the three-month follow-up (Table 3). The improvements in fatigue were not maintained at nine months (Table 4).

The exercise intervention had no effect on functional ability or neurological impairment (Table 4).

Looks like no statistical difference in 6 mwt results, and they didn't mention that this was a primary outcome measure.

So some increase in physical activity when people were in the trial, but they chose not to continue with it afterwards. They did fill in some questionnaires more positively for the people who'd been providing them with 'care' though.

To me, this looks like some dodgy 'empowering' spin in the press. MS patients aren't going to be dumped upon in the way CFS patients are, so I don't think that this should be too harmful for them, but I still think it's a bad thing.

(I only read the results section of the paper - maybe they fess up in the discussion. Presentation to the press still dodgy though).

 

[biophile]

It looks like both self-report questionnaire (GLTEQ) and accelerometer step counts were used for physical activity levels, so I guess both are counted as primary measures in this study?

At 3 months there was a significant increase in self-reported physical activity and a 15% increase in accelerometer step counts. At 9 months the self-reported physical activity had decreased somewhat compared to 3 months, and the remaining difference above baseline scores became non-significant. The accelerometer results returned to baseline levels by 9 months too. The authors concede the possibility that self-reporting bias could explain the discrepancy between GLTEQ scores and accelerometer step counts at 9 months, but also note that the accelerometers may not be detecting all exercises.

There were improvements to fatigue at 3 months but these were not sustained at 9 months. There were no changes on the 6MWT or measures of neurological impairment (EDSS and MSFC).

"Improvements in emotional well-being, social function and overall HRQoL were maintained to nine months in the exercise group (versus controls), whereas the difference between groups in other HRQoL domains and fatigue was diminished at the final follow-up. The lack of a sustained improvement in other HRQoL domains and fatigue might be explained by a reduction in self-directed exercise over the follow-up period."

 

[Esther12]

Just got drawn back...

Actually, though they chose to use self-reported activity levels as their primary outcome in their paper, rather than their objective measure, it's not clear to me that they decided to do this in advance:

Primary outcome measure(s)

1. Physical activity levels
2. Six-minute walking test

All outcome measures will be taken at baseline, 12-weeks and at 6-months follow-up.

Secondary outcome measure(s) 1. Neurological impairment and clinical functional mobility
2. Quality of life
3. Fatigue
4. Focus groups and interviews
5. Immunological analysis

All outcome measures will be taken at baseline, 12-weeks and at 6-months follow-up.

@biophile got in there while I was typing. Ta B. (I'm really trying to avoid looking into this... need to focus on CFS dodginess!)

The full protocol is paywalled here:

The abstract says:

In addition, the cost effectiveness of the intervention will be evaluated and dose–response relationships between physical activity and the primary/secondary outcomes in those with mild and more severe disease will be explored.

It would be interesting to see that data, and it might give some clue as to the role of response bias, but I couldn't see it in their cost effectiveness paper:

http://msj.sagepub.com/content/early/2013/12/13/1352458513515958.full.pdf html

Also, the intervention included a CBT component, so if patients were being encouraged to believe that thinking in a certain way is what they're meant to do, then this increases the danger of biasing self-report outcomes.

Okay... really done now.


Hard to justify the spin of this paper:

Study finds short bouts of moderately intense activity can have big impact on tiredness levels of people with MS