It seems counterintuitive, but exercise has long been advocated as a means of managing fatigue in pain disorders like fibromyalgia and chronic fatigue syndrome. Results of a major research study in the U.K. now show that short sessions of moderate intensity exercise such as walking or cycling can significantly help relieve symptoms and improve quality of life for Multiple Sclerosis (MS) patients as well.
The U.K. Multiple Sclerosis Society notes that exercise is increasingly being accepted as a component of symptom management in people with multiple sclerosis, and high quality research now exists to support the benefits of exercise on physical function, muscle power, exercise tolerance, quality of life and mobility-related activities in people with MS. Previous research already suggests that exercise intervention has the potential to improve the mental wellbeing of people with MS.
In 2008, Sheffield Hallam University was awarded a £200,000 research grant to investigate the effects of exercise intervention on sufferers of multiple sclerosis (MS). The U.K. MS Society also awarded the grant to the University’s Centre for Sport and Exercise Science to study the effects of exercise therapy on physical activity and health outcomes in 120 participants from the south Yorkshire (England) area living with MS. The research, known as EXIMS (pragmatic Exercise Intervention for people with MS), was led by Dr. John Saxton, then a Reader in Clinical Exercise Physiology at SHU. “Living with multiple sclerosis is a difficult experience both physically and mentally,” said Dr. Saxton at the time. “This has created a need for clinicians and researchers to address issues that are related to the long-term health-related quality of life for people with the condition. Our study will tackle some important questions, the answers to which we hope will not only help people with MS but also the organizations which must budget for their treatment.”
MS research had previously demonstrated that exercise is an effective intervention that improves function, mobility and health-related quality of life in people living with the disease, but it was not known what type of intervention or what dose of exercise might be most effective. The SHU study’s aim was to investigate whether a practically designed exercise program is effective for providing improvements in physical activity and health outcomes which are likely to have a positive impact on physical function and quality of life in people with MS. The study would also attempt to determine what amounts of exercise are most effective and whether exercise is more or less beneficial for people with MS with different disability levels, and if the addition of a pragmatic exercise therapy intervention in people with multiple sclerosis is a more cost-effective treatment than current medical care alone, and also examine the cost-effectiveness of a practical exercise intervention — an aspect that would play a vital role in decisions by health policy makers over the implementation of such treatments.
The study, which started in February 2009, ending in January 2012, entitled “The effects of a pragmatic exercise therapy intervention on physical activity and important health outcomes influencing maintenance in people with multiple sclerosis,” hypothesized:
1) that people with multiple sclerosis (PWMS) randomized to pragmatic exercise therapy would have improved functional and health outcomes in comparison to usual care only controls at three-months and six-months of follow-up.
2) People with multiple sclerosis (PWMS) randomized to pragmatic exercise therapy would have improved functional and health outcomes in comparison to usual care only controls at three-months and six-months of follow-up.
3) Inclusion of a pragmatic exercise therapy intervention in the patient care pathway is a more cost-effective treatment strategy than current medical care alone in PWMS.
The MS Society reported results of the study on January 15, noting that the researchers had placed 60 participants on a 12 week exercise program that included supervised sessions of short bursts of aerobic exercise, as well as self-directed exercise in the home. For comparison, a control group of 60 remaining participants received usual care from the U.K. National Health Service (NHS).
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Multiple Sclerosis Fatigue levels reduced
At the end of the study, participants in the exercise program reported significantly reduced fatigue levels, as well as improvements in emotional wellbeing, social function and overall quality of life, and importantly, these benefits were sustained for nine months, demonstrating that exercising can bring long-term benefits for people with MS.
The researchers also assessed the cost effectiveness of the exercise program, discovering that it is highly likely to be cost effective when compared to usual NHS care.
“It seems illogical to turn to exercise as a way of managing fatigue but the results showed that a pragmatic program based on short bouts of moderate intensity exercise can really help improve symptoms and quality of life”, Professor Saxton, who in March 2010 was appointed to the position of Professor of Clinical Exercise Physiology at the University of East Anglia in Norwich, commented to The Guardian health correspondent Denis Campbell.
The EXIMS study findings will now be used as the basis for developing an exercise program that can be delivered to people with MS from all over the UK.
The MS Society notes that while many people benefit from regular exercise, but keeping motivated and sticking to an exercise routine can be extremely difficult. The Sheffield study researchers designed a pragmatic exercise program specifically for people with MS, using the principles of cognitive behavioral therapy and including practical strategies and tools to help people with MS to stick to their exercise routine.
What’s Next For MS Exercise Research?
The MS Society is currently funding three exercise research projects that they hope will help to make exercise more practical for people living with MS.
Aquatic (water-based) physiotherapy could offer an alternative and fun way for people to exercise. A new project will look at the long term effects of aquatic physiotherapy on balance, fatigue and quality of life in people with MS
Aquatic physiotherapy can be particularly beneficial when physical symptoms progress or you are recovering from a relapse.
Exercise Using A Wii
Could a Wii video game console help keep you fit? This project aims to help people find a way to get active at home. It will develop and test an intervention package (Mii-vitaliSe) to support people with MS to use the Wii at home.
If the researchers can demonstrate that using the Wii is beneficial and safe then this system could be developed within a larger study, and ultimately the Mii-vitaliSe package made more widely available to people with MS.
Finding Ways To Reduce Fatigue
Researchers will test a resistance exercise program as a potential treatment for fatigue. The study will also compare people with MS who have high levels of fatigue with those who do not, using a range of tests of how the nervous system functions. This will help improve our understanding of fatigue in MS.
The MS Society is the largest source of MS research in the UK., currently funding some 70 world-class research projects that cost over £19 million. The society has funded research related to exercise since 2002, aiming to break barriers and make exercise practical for everybody living with MS.
U.K. MS Society
Sheffield Hallam University
University of East Anglia