Friday, 6 March 2015

ClinicSpeak: impact of exercise on walking

Can we afford to continue to ignore the positive effect exercise has on MS? #ClinicSpeak #MSBlog #MSResearch

"The meta-analysis below shows that exercise improves walking speed and endurance in MSers. This is another piece of evidence that supports exercise as such an important part of the management of MS. In addition to physical performance exercise also boosts cognitive outcomes and boosts cognitive reserve. I can't think of any reason why MSers should not exercise, even MSers with disability. There is an exercise programme for everyone."

"Yesterday, thanks to you I won a debate making the case for pelvic floor exercises in all MSers. My case was based on the argument that pelvic floor exercises are simply part of a general exercise programme and supported by evidence that it improves bladder function and possibly sexual dysfunction. Why wouldn't you do pelvic floor exercises? As with all lifestyle interventions is how do you get people to do exercise and adhere to a long-term exercise programme? All ideas and suggestions welcome."


"If you have not sure how to start an exercise programme please ask your MS team to refer you to the physiotherapists."

Epub: Pearson et al. Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: A meta-analysis. Arch Phys Med Rehabil. 2015 Feb 21.

OBJECTIVE: To quantify improvements in walking performance commonly observed in patients with Multiple Sclerosis (pwMS). A systematic literature search and meta-analysis was conducted quantifying the expected benefits of exercise on walking ability in pwMS.


DATA SOURCES: Potential studies were identified by systematic search using PubMed (1966 to 31st March, 2014), EMBASE (1974 to 31st March, 2014), CINAHL (1998 to 31st March, 2014), SPORTSDiscus (1991-31st March, 2014) and the Cochrane Central Register of Controlled Trials (1966 to 31st March, 2014). The search used key concepts of "Multiple Sclerosis" AND "exercise".

STUDY SELECTION: Randomised controlled trials of exercise training in adult patients with MS.

DATA EXTRACTION: Data on patient and study characteristics; walking ability; 10metre walk test (10mWT); Timed 25-foot walk test (T25FW); 2 minute walk test (2MWT); 6 minute walk test (6MWT); Timed up and go (TUG) were extracted and archived.

DATA SYNTHESIS: Data from 13 studies were included. Exercise produced significant improvements in walking speed, measured by 10mWT, mean difference (MD) reduction in walking time of -1.76 seconds (95%CI -2.47 to -1.06, p<0.001), but no change in the T25FW MD = -0.59s (95%CI -2.55 to 1.36, p=0.55). Exercise produced significant improvements in walking endurance as measured by 6MWT and 2MWT, with increased walking distance of MD=36.46 metres (95%CI 15.14 to 57.79, P<0.001) and MD=12.51 metres (95%CI 4.79 to 20.23, p=0.001), respectively. No improvement was found for TUG MD = -1.05s (95% CI -2.19 to 0.09, p=0.07).

CONCLUSIONS: Our meta-analysis suggests exercise improves walking speed and endurance in pwMS.

15 comments:

  1. I think it's because it's not made an explicit part of the management of MS. From what I've read, it should be up there along with starting meds. But do GPs and neurologists see it a) as part of the MS treatment package and b) make it their business to monitor it? I'm remembering the lengthy questionnaire on mental health I've had to fill in when presenting at the relapse clinic.... shouldn't there be the equivalent for recording physical exercise? Until the medical staff really drive home the message with all their patients, it's only going to be the self-starters who take it to heart.

    ReplyDelete
    Replies
    1. I agree. Exercise should be presented as part of our treatment plan, right along with meds, by our doctors and by the MS societies.

      Delete
    2. Totally agree :-). After 9 years with MS (and 4 DMTs) my GP ( not neuro!) finally referred me to physiotherapy :-)

      Delete
  2. Further to my previous comment, I think the introduction of an 'exercise log' would be helpful. I keep one, because I aim for at least 2 hours of aerobic exercise a week. It's surprising how useful a written prompt is. You see patterns - e.g. after a holiday it always takes me a couple of weeks to get back into shape, so the log helps me to work out how many times and for how long I can afford to be away without affecting the MS. It would have been massively encouraging to think that the medical team had an interest in this, or had indeed initiated the log. You also don't mention how useful exercise is to build awareness of what's going on in your musculo-skeletal structure and hence to notice when changes occur. You've posted often about the importance of reporting relapses - I would imagine that an MSer who exercises regularly is much better at recognising them.

    ReplyDelete
  3. When I was diagnosed, nobody could tell me if walking was a use-it-or-lose-it function in the context of the disease.

    They still can't but 7 years ago I got a dog to keep myself active and walking and I've still not needed a wheelchair, which makes it statistically unlikely that I will need one full-time for MS-related reasons before I die. I now use FES for a spot of drop-foot but like to clock up a couple of miles a day.

    ReplyDelete
  4. This blog ought to have embedded the American MS Society's panel discussion in the field of progressive MS (http://edge.media-server.com/m/p/95gdq3j6). At least the U.S. is doing more than you guys. They're also more committed to PPMSers.

    ReplyDelete
    Replies
    1. You might not be aware that the American MS Society funded us for work on progressive MS, which is now bearing fruit. More news on this soon.
      All the best MD2

      Delete
    2. You guys keep hinting that there's something you're busting a gut to tell us. Even as an RRMSer, I know at some level we are all progressives and I'm eager to hear your news.

      Delete
    3. Keep waiting, Bennie. The British scientists have lost the will to flag up progressive MS.

      Delete
  5. I think people with disabilities need to view exercise in a different light. When we think of exercise we see professional athletes or relatively healthy people jogging and running. Exercise comes in all shapes and sizes depending on your level of ability. It should be part of a healthy lifestyle. We are physical animals (how much time can we spend at the pub anyway).

    ReplyDelete
  6. Diagnosed very young I've always exercised. My SPMS has got worse and having really bad falls. I contacted my MS nurse as I felt I was struggling., still on the waiting list for weeks later. Never asked for help for 35 years, did my own regime, now I'm in the queue,

    ReplyDelete
    Replies
    1. Reading your comment tells us how ignorant Team G is about how badly progressive MSers are doing. They just focus on those they can help. We get little coverage on living with progressive MS.

      Delete
  7. I have SPMS, got foot drop, leg drop and balance issues. My idea of exercise varies from one day to the next. I am active, by that I mean I cook the meals, load and empty the dishwasher + go shopping on my mobility scooter. Taking athletic exercise is out of the question but I lead a very active life. Does that count as exercise?

    ReplyDelete
  8. I think there needs to be some caution here. Whilst I am very self motivated and do as much as I possibly can for my PPMS (Pilates, exercise outdoors, good diet etc.), I would not take kindly to some overbearing medical person setting out what I had to do. Thankfully I am on the same wavelength as my excellent neurophysiotherapist, who is remarkably talented not only in providing advice, but also not reminding me of my twisted PE teacher at high school. At the end of the day, people have to want to do something for themselves. It is about providing opportunity and information to allow them to do that. And a lot of the symptoms of MS need to be experienced to be properly understood. The last thing many people with MS would welcome is some prescriptive exercise programme that they are expected to undertake without personalised consultation with them about their specific wants and needs.

    ReplyDelete
  9. This isn't about MS, but it's very persuasive about exercise
    well.blogs.nytimes.com/2015/03/04/one-twin-exercises-the-other-doesnt

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.