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Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial
A Carter1
A Daley2
L Humphreys1
N Snowdon3
N Woodroofe4
J Petty5
A Roalfe2
J Tosh6
B Sharrack7
JM Saxton8
1Centre for Sport and Exercise Science, Sheffield Hallam University, UK
2Primary Care Clinical Sciences, University of Birmingham, UK
3Centre for Health and Social Care Research, Sheffield Hallam University, UK
4Biomedical Research Centre, Sheffield Hallam University, UK
5Multiple Sclerosis Society, UK
6School of Health and Related Research, University of Sheffield, UK
7Neurology Department, Sheffield Teaching Hospitals Foundation Trust, UK
8School of Rehabilitation Sciences, University of East Anglia, UK
•John M Saxton, School of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
Abstract
Background: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (PwMS).
Objective: The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up.
Methods: We conducted a parallel-arm, randomised controlled trial: 120 PwMS (Expanded Disability Status Scale (EDSS) 1.0–6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1–6) were followed by one supervised and two home-exercise sessions (weeks 7–12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL).
Results: The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue (p < 0.0001) and many HRQoL domains (p ≤ 0.03) at three months. The improvements in emotional well-being (p = 0.01), social function (p = 0.004) and overall quality of life (p = 0.001) were sustained for nine months.
Conclusion: This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS.
A Carter1
A Daley2
L Humphreys1
N Snowdon3
N Woodroofe4
J Petty5
A Roalfe2
J Tosh6
B Sharrack7
JM Saxton8
1Centre for Sport and Exercise Science, Sheffield Hallam University, UK
2Primary Care Clinical Sciences, University of Birmingham, UK
3Centre for Health and Social Care Research, Sheffield Hallam University, UK
4Biomedical Research Centre, Sheffield Hallam University, UK
5Multiple Sclerosis Society, UK
6School of Health and Related Research, University of Sheffield, UK
7Neurology Department, Sheffield Teaching Hospitals Foundation Trust, UK
8School of Rehabilitation Sciences, University of East Anglia, UK
•John M Saxton, School of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
Abstract
Background: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (PwMS).
Objective: The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up.
Methods: We conducted a parallel-arm, randomised controlled trial: 120 PwMS (Expanded Disability Status Scale (EDSS) 1.0–6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1–6) were followed by one supervised and two home-exercise sessions (weeks 7–12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL).
Results: The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue (p < 0.0001) and many HRQoL domains (p ≤ 0.03) at three months. The improvements in emotional well-being (p = 0.01), social function (p = 0.004) and overall quality of life (p = 0.001) were sustained for nine months.
Conclusion: This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS.