A pilot study of an exercise-based patient education program in people with multiple sclerosis.
Kersten S, Mahli M, Drosselmeyer J, Lutz C, Liebherr M, Schubert P, Haas CT. Mult Scler Int. 2014;2014:306878. doi: 10.1155/2014/306878. Epub 2014 Dec 21.
is increasing evidence that physical exercise leads to numerous
positive effects in PwMS. However, long-term effects of exercise may
only be achievable if training is implemented in daily routine. Enabling
patients to exercise regularly, we developed a patient education
program focused on evidence-based information of training. PwMS were
educated in neurophysiological effects of physical exercise,
exercise-induced benefits for PwMS, and risk factors (e.g., weather).
Fifteen PwMS were analyzed before (T 0) and after (T 1) a 12-week
patient education. Afterwards, participants performed their exercises
autonomously for 32 weeks and were tested in sustainability tests (T 2).
Guided interviews were carried out, additionally. Significant
improvements from T 0 to T 1 were found in 6MWT, gait velocity, TUG,
fatigue, and quality of life. Significant results of TUG and gait
velocity from T 1 to T 2 demonstrated that participants kept few effects
after the 32-week training phase. Qualitative analyses showed improved
self-confidence and identified training strategies and barriers. This
pilot study provides evidence that PwMS are able to acquire good
knowledge about physical exercise and apply this knowledge successfully
in training management. One might conclude that this exercise-based
patient education seems to be a feasible option to maintain or improve
patients' integral constitution concerning physical and mental health.
Phase I: an instructed training phase (six weeks) and
an assistive training phase (six weeks).
The first 6 weeks was essentially the theory and then practical education program covering coordination/balance
(e.g., highly reflex-based movements, balance training, active games),
endurance (e.g., dancing, aerobics, walking on different surfaces like
in the forest or at sand), and strength training (e.g.,
device-independent body weight training, elastic band).
Phase II: after the 12-week patient education program, participants did the exercises on their own for 32 weeks.
People participating were scored before the intervention (T0), straight after the intervention (T1), and after 32 weeks of self-regulated training (T2).
Those who participated: 3 men, 12 women; average age=48; average time since diagnosis=11years; sub-type=8 RRMS (relapsing), 4 SPMS (secondary progressive), 3 PPMS (primary progressive); average EDSS = 4 (able to walk without aid/rest for 500m).
And the results are:
0–T1 (α) P value||T
0–T1 effect size d||T
0–T2 (α) P value||T
0–T2 effect size d|
|TUG [s]||9.8 ± 2.7||7.5 ± 2.3||8.1 ± 1.9||<0.001||3.38||<0.05||<0.001||2.6|
|6MWT [m]||419.2 ± 126.3||483.7 ± 140.2||432.9 ± 123.3||<0.001||−3.3||ns||ns||−0.73|
|Treadmill [min]||12.1 ± 5.5||15 ± 5||14.6 ± 5.5||<0.001||−1.91||<0.01||<0.05||−1.12|
|Treadmill [km/h]||3.5 ± 0.8||4 ± 0.7||4 ± 0.9||<0.001||−2.39||<0.001||<0.05||−1.23|
|Fatigue [score]||5 ± 1.6||4.5 ± 1.7||4.7 ± 1.5||<0.05||0.86||ns||ns||0.14|
|SSA [score]||4.9 ± 1.4||5.4 ± 0.8||5.2 ± 0.7||ns||−0.6||—||ns||−0.5|
|General health||58.9 ± 18.6||66.7 ± 18.1||61.3 ± 19.6||<0.01||−1.49||ns||ns||−0.15|
|Physical functioning||51.7 ± 19.3||56.3 ± 25.7||51.9 ± 25||ns||−0.57||—||ns||0.15|
|Vitality||44.3 ± 19.6||55 ± 18.6||52.7 ± 16.2||<0.001||−2||ns||=0.05||−0.91|
|Mental health||73.3 ± 13.2||77.3 ± 14.6||73.5 ± 13.1||<0.05||−0.97||ns||ns||0.22|
Most of us find regular exercise a difficult task outside of having a personal trainer. But what these results show is that persistence and dedication pays - check out the highlighted significant outcomes in treadmill scores after 32 weeks of training alone compared to pre-training) and it also improves vitality.
Labels: Exercise, training, treadmill, vitality