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Moderate Exercise Helps MS Patients

Discussion in 'Other Health News and Research' started by Marco, Jan 15, 2014.

  1. Marco

    Marco Grrrrrrr!

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    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 :

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

    I wonder how many of them 'recovered'? :)
     
  2. Firestormm

    Firestormm

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  3. Marco

    Marco Grrrrrrr!

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    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'.
     
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  4. Esther12

    Esther12 Senior Member

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    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
     
    Last edited: Jan 15, 2014
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  5. Firestormm

    Firestormm

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    Inclusion criteria:

    Exclusion criteria:

    Thanks Esther. A useful source :)
     
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  6. Valentijn

    Valentijn Senior Member

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    Do they say how "Physical activity levels" are measured? Actometers or questionnaire?
     
  7. Esther12

    Esther12 Senior Member

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    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):

    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).
     
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  8. biophile

    biophile Places I'd rather be.

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    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."
     
    Last edited: Jan 15, 2014
  9. Esther12

    Esther12 Senior Member

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    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:

    @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:

    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:

     
    Last edited: Jan 15, 2014
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