Exercise
Dodd KJ, Taylor NF, Shields N, et al. Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial. Mult Scler. 2011; 17(11):1362-74.
Progressive resistance training is a relatively safe intervention that can have short-term effects on reducing physical fatigue, increasing muscle endurance and can lead to small improvements in muscle strength and quality of life in people with relapsing-remitting MS. However, no improvements in walking performance were observed and benefits do not appear to persist if training is completely stopped.
Motl RW, Gappmaier E, Nelson K, et al. Physical activity and cognitive function in multiple sclerosis. J Sport Exerc Psychol. 2011; 33(5):734-41.
This cross-sectional study examined the associations among physical activity, cognitive processing speed, and learning and memory in 33 persons with MS who underwent neuropsychological assessments and wore a physical activity monitor for seven days.
Cameron MH, Wagner JM. Gait abnormalities in multiple sclerosis: pathogenesis, evaluation, and advances in treatment. Curr Neurol Neurosci Rep. 2011; 11(5):507-15.
Gait dysfunction in MS is distinguished by decreased gait speed, walking endurance, step length, cadence and joint motion, as well as increased metabolic cost of walking and increased variability of gait. This study reviews the field.
Motl RW, Sandroff BM, Benedict RH. Cognitive dysfunction and multiple sclerosis: developing a rationale for considering the efficacy of exercise training. Mult Scler. 2011; 17(9):1034-40.
The consideration of exercise training is warranted based on evidence summarized in literature reviews and meta-analyses that (1) aerobic fitness, physical activity, and exercise training are associated with better cognitive function in older adults; and (2) exercise training has comparable effects on mobility and quality of life outcomes in older adults and persons with MS.
Andreasen AK, Stenager E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Mult Scler. 2011; 17(9):1041-54.
This paper aimed to determine the effect of exercise therapy on MS fatigue by systematically reviewing the literature.
Rietberg MB, van Wegen EE, Uitdehaag BM, et al. The association between perceived fatigue and actual level of physical activity in multiple sclerosis. Mult Scler. 2011; 17(10):1231-7.
The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS. It concluded that there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.
McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurological disorders: a systematic review. Arch Phys Med Rehabil. 2011;92(7):1044-52.
This study aimed to evaluate whether aerobic exercise improves cognition in adults diagnosed with neurologic disorders. Of the 67 studies retrieved, less than half included cognition as an outcome, and few studies continued the aerobic exercise program long enough to be considered effective
Sabapathy NM, Minahan CL, Turner GT, et al. Comparing endurance- and resistance-exercise training in people with multiple sclerosis: a randomized pilot study. Clin Rehabil 2011; 25(1):14-24.
The purpose of this study was to compare adaptations in functional and quality of life measures following endurance- and resistance-exercise training in people with multiple sclerosis. Both endurance- and resistance-exercise training were well tolerated and appear to provide similar effects
Motl RW. Physical activity and irreversible disability in multiple sclerosis. Exerc Sport Sci Rev 2010; 38(4):186-91.
Physical activity has been identified as a behavioural correlate of disability in MS. This review highlights that previous research has generally included samples with minimal disability and provides a rationale for considering physical activity as an influence of disability in the second stage of MS.
Kuspinar A, Andersen RE, Teng SY, et al. Predicting exercise capacity through submaximal fitness tests in persons with multiple sclerosis. Arch Phys Med Rehabil 2010; 91(9):1410-17.
People with MS with a mild degree of disability exhibit marked reductions in exercise capacity. Submaximal tests are good predictors of exercise capacity and these measures may be used in clinical settings to help assess and monitor maximum oxygen consumption and in research to evaluate the effect of exercise-related interventions.
McAuley E, Motl RW, White SM, et al. Validation of the Multidimensional Outcome Expectations for Exercise Scale in Ambulatory, Symptom-Free Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2010; 91(1):100-105.
Study aimed to determine the psychometric properties of the 3-factor Multidimensional Outcome Expectations for Exercise Scale in a sample of ambulatory, symptom-free persons with multiple sclerosis (MS). The Multidimensional Outcome Expectations for Exercise Scale appears to be a reliable and valid measure of outcome expectations for exercise in this limited sample of community-dwelling adults with MS. Further validation in clinical samples is warranted.
Smith C, Hale L, Olson K, et al. How does exercise influence fatigue in people with multiple sclerosis. Disabil Rehabil 2009; 31(9):685-692.
Explored the influence of an 8-week exercise programme on fatigue perceptions in people with multiple sclerosis MS. Method. Eight women and two men with a confirmed diagnosis of MS participated three times a week in an 8-week exercise programme at a physiotherapy gymnasium. Study details the positive and negative influences of exercise on fatigue perceptions in people with MS.
Stroud N, Minahan C, Sabapathy, S. The perceived benefits and barriers to exercise participation in persons with multiple sclerosis. Disabil Rehabil 2009; 31(26):2216-2222.
Examined the perceived benefits and barriers to exercise participation in people with MS. A cross-sectional postal survey comprised of 93 adults with MS was conducted. When compared with previous studies conducted in the general population, the participants in the present study reported different perceived barriers to exercise participation. Furthermore, awareness of the benefits of physical activity is not sufficient to promote exercise participation in persons with MS. Perceived exercise self-efficacy is shown to play an important role in promoting exercise participation in persons with MS.
Rietberg MB, Brooks D, Uitdehaag BMJ et al. Exercise therapy for multiple sclerosis. Cochrane Database Syst Review 2009; (4) art no. CD003980.
Systematic review suggests that exercise therapy can be beneficial for patients with MS not experiencing an exacerbation. There is an urgent need for consensus on a core set of outcome measures to be used in exercise trials. In addition, these studies should experimentally control for 'dose' of treatment, type of MS and should include sufficient contrast between experimental and control groups.
Barrett CL, Mann GE, Taylor PN, et al. A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis. Multiple Sclerosis 2009; 15(4): 493-504.
Two-group randomized trial assessed the effects of single channel common peroneal nerve stimulation on objective aspects of gait relative to exercise therapy for people with secondary progressive multiple sclerosis (SPMS). Concludes that exercise may provide a greater training effect on walking speed and endurance than FES for people with SPMS. FES may provide an orthotic benefit when outcome is measured using the same parameters.
Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. Arch Phys Med Rehabil 2009; 90 (3): 420-428
Study investigated the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. Study concludes that the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain
Mutluay FK, Tekeoǧlu A, Saip S, et al. Group exercise training approach to multiple sclerosis rehabilitation. Nobel Medicus 2008; 4 (3):20-26.
22 people with MS partook in the programme. Baseline and posttraining measures of Barthel index, fatigue severity scale, perceived exertion level (Borg), muscle strength, 10m and 20m walking times were recorded; the quality of life was assessed with MSQOL-54 survey. Group exercise training was shown to reduce motor impairments, increase mobility and improve the quality of life of MS patients of various disability levels
Motl RW, Gosney JL. Effect of exercise training on quality of life in multiple sclerosis: A meta-analysis. Mult Scler 2008; 14 (1): 129-135.
Using meta-analytic procedures, this study examined the overall effect of exercise training interventions on quality of life (QOL) among individuals with MS. The cumulative evidence supports that exercise training is associated with a small improvement in QOL among individuals with MS
Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: Recommendations for the application of resistance-, endurance- and combined training. Mult Scler 2008; 14 (1): 35-53
This review summarizes the existing knowledge regarding the effects of physical exercise in people with MS. Furthermore, recommendations are given regarding exercise prescription for MS patients and for future study directions.
Bjarnadottir OH, Konradsdottir AD, Reynisdotir K, et al. Multiple sclerosis and brief moderate exercise: A randomised study. Mult Scler 2007; 13 (6): 776-782
Randomised control study to determine the effect of aerobic and strength exercise on physical fitness and quality of life in people with mild multiple sclerosis (MS). Sixteen outpatients with definitive MS, aged 18-50, with an Expanded Disability Status Scale (EDSS) < 4, completed the study. Study confirms that brief, moderate, aerobic exercise improves physical fitness in individuals with mild MS.
Mutluay FK, Demir R, Ozyilmaz S, et al. Breathing-enhanced upper extremity exercises for patients with multiple sclerosis. Clin Rehabil 2007; 21 (7): 595-602
Study explored the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. The programme improved most pulmonary performance measures and had clinical significance
Rampello A, Franceschini M, Piepoli M et al. Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients With Multiple Sclerosis: A Randomized Crossover Controlled Study. Phys Ther. 2007 Apr 3; [Epub ahead of print]
Compared 8 week aerobic training programme with neurological rehabilitation on 19 people with MS with mild to moderate disability. 11 completed the study. Aerobic training improved walking distances and speeds, but not in walking capacity compared with neurological rehabilitation. More disabled people benefited more from aerobic training. Suggests aerobic training is more effective than neurological rehabilitation in improving walking speed and distance in people with moderate disability and MS.
Taylor NF, Dodd KJ, Shields N, et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother. 2007; 53(1): 7-16.
This review of reviews found that therapeutic exercise in a range of conditions is more beneficial if intense, targeted, and ideally individualised. No findings about one type of exercise over another were identified.
Newman MA, Dawes H, van den Berg M, et al. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler 2007; 13(1): 113-9.
16 adults with MS undertook 12 sessions of up to 30 minutes, training on a treadmill at 55-85% of age-predicted maximum heart rate. Primary outcome was walking effort, measured by oxygen consumption, with associated changes in gait parameters and the Fatigue Severity Scale. Over time, all subjects improved their comfortable walking speed, oxygen consumption decreased, time spent in stance on the weaker leg fell. Reported fatigue remained constant. Aerobic treadmill training potentially reduces effort and fatigue for some people with MS
Motl RW, Snook EM, McAuley E, et al. Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis. Res Nurs Health. 2006; 29(6): 597-606
196 people with MS completed symptoms, self-efficacy and physical activity measures for one week. Analysis of results showed that symptoms had a direct negative effect on self-efficacy and physical activity. It provides continued support for the need of regular physical exercise by people with MS.
Taylor NF, Dodd KJ, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil 2006;28(18):1119-26.
A small qualitative study of 9 people to determine whether participation in a progressive resistance exercise programme would increase muscle force and endurance and functional activity. Completed over a 14 week period (4 weeks of familiarization followed by 10 weeks of twice-weekly gym attendance), this study found a progressive programme of resistance exercise brought significant improvements in arm strength, leg endurance and fast walking speed, without adverse events.
Karpatkin HI. Multiple sclerosis and exercise: a review of the evidence. Int J MS Care 2005;7(2):36-41.
Reviews trials into exercise as an intervention for people with MS, including strength training, aerobic exercise and respiratory training. Suggests that more research could be focused on the specific types of exercise appropriate for people who have MS.
Heesen C, Romberg A, Gold S et al. Physical exercise in multiple sclerosis: supportive care of a putative disease modifying treatment. Expert Rev. Neurotherapeutics 2006; 6(3):347-55
Reviews clinical trials that examine use of exercise in people with MS. Concludes that exercise training studies demonstrate a consistent beneficial physical effect in people with modest disability and positive effects on psychological well being. Suggests exercise training should be considered for everyone with MS with use of feedback strategies to enhance adherence.
Smith RM, Adeney-Steel M, Fulcher G et al. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil 2006;87(5):723-7.
Pilot study of 34 people with MS referred to physiotherapy and exercise program. Individually prescribed exercise sessions include strengthening, stretches and fitness exercises. Whilst 40% of people experienced temporary increase in sensory symptoms and 44% increase in intensity of sensory symptoms, study concluded that exericse is unlikely to produce negative changes in fatigue and function.
Van den Berg M, Dawes H, Wade DT et al. Treadmill training for individuals with multiple sclerosis: a pilot randomised trial. J Neurol Neurosurg Psychiatry 2006; 77(4):531-3.
Pilot study of 19 people wtih MS, showed that aerobic treadmill training is feasible and well-tolerated. Walking speed and endurance increased following training with no increase in reported fatigue. Detraining occurred in the period following, these findings suggest the need for a larger randomised trial.
Stuifbergen AK, Blozis SA, Harrison TC, Becker HA. Exercise, functional limitations and quality of life: a longitudinal study of persons with multiple sclerosis. Arch Phys Med Rehabil 2006; 87(7): 935-43.
A sample of 611 people with MS studied over 5 years to examine the interrelations between functional limitations, exercise and quality of life. Results suggest that people who exercise regularly experience fewer functional limitations over time, with correlating positive effects for quality of life.
Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Catellano V, White LJ. Resistance training improves gait kinematics in persons with multiple sclerosis. Arch Phys Med Rehabil 2005;86(9): 1824-9.
Evaluation study of an 8 week lower-body resistance-training programme on people with MS’s walking. At end point, there were significant improvements in step length, stride length, food angle, and percentage of stride time in the swing phase. Fatigue and self-reported disability also improved.
Kileff J, Ashburn A.A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis. Clin Rehabil 2005;19(2):165-9.
Intervention was bi-weekly 30 minute sessions of cycling on a static bicycle, in 6 people with MS, over 12 weeks. Results showed significant improvement on the Guys Neurological Disability Scale and the 6-minute walk.
Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M et al. Randomised controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004;62(11):2058-64.
69 people with MS were randomised into 3 groups: yoga group, exercise using a static bicycle, or no treatment group, over a 6-month period. Both active interventions produced improvements in fatigue compared with the no treatment group. No effect was seen on other outcome measures of mood and cognitive ability.
Petajan JH, White AT. Recommendations for physical activity in patients with multiple sclerosis. Sports Medicine 1999; 27(3): 179-81.
Known leading expert discusses assessment of people with MS, types of exercise, and incorporating exercise into activities of daily living.
Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996;39(4): 432-41.
54 people with MS randomised into aerobic exercise or no exercise groups. The treatment group showed improvements in fatigue, depression and anger, compared with the non-treatment group.
Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database Sytem Rev 2005. 25(1): CD003980.
Comprehensive literature review. Exercise therapy improves muscle power function, exercise tolerance functions and mobility-related activities, with some evidence for enhancing mood. Does not find more evidence in favour of one type of exercise therapy over another.
Romberg A, Virtanen A, Ruutiainen J, Aunola S, Karppi SL, Vaara M et al. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomised study. Neurology 2004; 63(11): 2034-8.
A 6 month exercise programme group was compared with a group receiving no treatment. Change in the treatment group was significant in tests of walking and increased upper extremity endurance. No other noteworthy changes were observed.
Surakka A, Romberg A, Ruutiainen J, Aunola S, VirtanenA, Karppi SL, Maentaka K. Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis:a randomised, controlled trial. Clin Rehabil 2004; 18(7): 737-46.
Study investigated effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in people with MS. The intervention group received 6 months’ exercise programme compared with no treatment. Findings were that motor fatigue lessened in women but not men in the treatment group.