Tuesday, 15 July 2014

Physical activity and disability

Exercise is the old chestnut on MS forums: how do we get MSers to exercise? #MSBlog #MSResearch

"The following study suggests, and only suggests, that physical activity is associated with better outcomes in MS. We have no idea based on the trial design if this is cause or association; i.e. does exercise improve MS outcomes or are MSers with better outcomes likely to partake in exercise? This is why we need randomised double-blind placebo-controlled trials to answer the question whether any health intervention is effective, or not. Exercise is also likely to be associated with many confounding variables that may affect the results. For example, people who exercise are less likely to smoke. Smoking has been shown to be associated with a poor outcome in MS. People who exercise are less likely to be obese; obesity is a risk factor for MS and may be linked to hormonal changes that affect disease outcome. Exercise is a natural anti-depressant; if you are less depressed you may respond to the questionnaires of these sorts of studies differently. MSers who exercise are less likely to have comorbidities of diabetes and hypertension and therefore less likely to suffer from small vessel, or cardiovascular, disease, which have been linked to a poorer MS outcome."

"Taking my cynical hat off; it is quite clear that MSers have an enormous amount to gain from being physically active and I recommend to all my patients regardless of levels of disability that they need to exercise. However, I am fully aware that clinical advice is not often taken and we need better systems to get MSers exercising. Some MSers benefit from a formal training programme designed by a physiotherapist and other not."

"Exercise is the old chestnut; how do you change population behaviour for the good. Is  there something we can use to nudge people in the right direction? Would mass exercise monitoring with rewards for those adhering to their exercise programme work? Any ideas? Crack this problem and we will solve a lot of the health problems of the general population."

Exercise is the old chestnut! How do we crack  it?

Epub: Marck et al. Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey. BMC Neurol. 2014 Jul;14(1):143.

BACKGROUND: MS is a common neurodegenerative disease, which often has a devastating effect on physical and emotional wellbeing of MSers. Several studies have shown positive effects of physical activity (PA) on disability, health related quality of life (HRQOL), and other outcomes. However, many studies include only MSers with mild disability making it difficult to generalize findings to those with moderate or severe disability. This study investigated the associations between PA and HRQOL, relapse rate (RR), disability, and demographic variables in MSers with varying disability.


METHODS: Through online platforms this large international survey recruited 2232 MSers who completed items regarding PA, MS and other health characteristics.

RESULTS: MSers who were younger (p < .001), male (p = 0.006), and with lower body mass index (BMI) (p < .001) undertook more PA, which was associated with decreased disability (p < 0.001) and increased HRQOL measures (all p < 0.001). For the subsample of RRMSers, PA was associated with a decreased RR (p = 0.009). Regression analyses showed that increased PA predicted clinically significant improvements in HRQOL while controlling for level of disability, age and gender. More specifically, increasing from low to moderate and to high PA increased estimated mean physical health composite from 47.7 to 56.0 to 59.9 respectively (25.6% change), mental health composite from 60.6 to 67.0 to 68.8 (13.5% change), energy subscale from 35.9 to 44.5 to 49.8 (38.7% change), social function subscale from 57.8 to 66.1 to 68.4 (18.3% change), and overall QOL subscale from 58.5 to 64.5 to 67.7 (15.7% change).

CONCLUSIONS: For MSers, regardless of disability level, increased PA is related to better HRQOL in terms of energy, social functioning, mental and physical health. These are important findings that should be taken into consideration by clinicians treating MSers.

8 comments:

  1. I think practical solutions and ideas need to be put forward to make it easier for MSers to exercise. sometimes it is a relatively small hindrance that will prevent someone taking exercise. For my part, I go swimming, but have some difficulty walking back from the pool as my legs are tired. but this is something that takes only a few minutes and I don't need a huge system put in place to help. Interesting post, good to keep it in the forefront.

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  2. I'm sure it's only exercise that keeps me going. The physio agrees that without it I'd have lost function by now. It's tough, though, if you didn't exercise pre-MS - being asked to make a big lifestyle change WHILE YOU'RE FEELING ILL! . I researched the benefits myself and have worked closely with the physios .. but I can't recall ever being asked much about it by the neuro team. My view is that it should be CENTRAL to any neuro MS consultation and that it should be one of the monitoring tools of MS nurses... and I don't mean just vague questions about 'level of activity'. You need to get the message across that lack of exercise is likely to make your MS worse than it needs to be. I also think that the co-morbidity information needs to be in there at consultations. Perhaps it's just too much to communicate, but unless you're a self-motivator, how else are MSers going to know the facts?

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  3. I have little doubt that physio/exercise can improve mobility and is good for general health too, so well worth the effort. Do you refer MSers to the Ability Bow gym in Tower Hamlets? It has MS specific classes that caters for all levels and is an excellent local resource.
    http://www.abilitybow.co.uk/ms-gym-class

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  4. I never smoked and was a runner. Medium build / weight. I got MS (I'm male). Would love to run / play sport again, but need treatments to repair damage (lesions in spine). Telling me I should exercise is a bit galling (15 years doing 10Ks!). This is a bit like the yesterday's news that elderly should do crosswords to keep alzeimers at bay. It's a disease like MS - you get it or don't get it - just bad luck. I never smoked and got it, I know 40 a day smokers (in their 50s) who didn't get MS. If it was that simple -smoking, obesity etc. you would have cracked the puzzle years ago!

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  5. Are you aware of the study of social marketing? It's a discipline that uses commercial marketing techniques (advertising, focus groups, etc.) for social good--often health campaigns. I occasionally work for a (US) professor in this field who tests programs in reducing obesity, smoking, drug use, and such in communities. She actually works out of the Business School at her university. As in your field, there's a lot of guessing, snake oil sales, and just plain bad information out there when it comes to behavior change. So social marketers, as well as health communication researchers in general, use scientific methods, like double blind studies, to figure out which interventions really work.

    I'm on the peripheral, here, but I think issues of identity are often involved in behavior change. "I'm the kind of person who exercises."
    http://en.wikipedia.org/wiki/Social_marketing

    Over in good old social sciences (where I got my degree), we all learn Bandura's Self-Efficacy model right along with Roger's Diffusion of Innovation (which I think you cited in this blog a while ago) in our first semester of grad school. Whether someone will take on a new behavior (like exercise) often takes more than convincing them that it's good for them. Have they had similar success in this area before? Have they seen other people accomplish the goal? And so on...
    http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.315.4567

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  6. More effort is needed to persuade certain PCTs to fund things like FES for use with treadmills and exercise bikes - "its even possible that some of the symptoms that appear to be the signs of MS progression may be the result of deconditioning and the lack of physical activity." a US Therapist suggested recently.

    It seems that physical therapy and physiatry are the 'way to go', while we (PMSers) wait for pharmaceuticals to be successfully trailed, and NICE'd.

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  7. The study you cite is the exact reason I started www.ActiveMSers.org when I was diagnosed 8 years ago: to inspire others with this disease, regardless of disability, to stay active physically, intellectually and socially. While I try to motivate through stories on the website, e-mail, and social media, it's the other members who truly drive one another in our shared fight against this disease.

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  8. Just had a quick look at your website, Dave - it looks really useful - thanks for mentioning it in this post. Kind regards Bouncy

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