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Effects of internet-based exercise (e-training) on fatigue and other patient reported behavioural outcomes (PRO) in patients with relapsing-remitting multiple sclerosis (RRMS)
N. Jäckel1, A. Tallner2, Ö. Virsevci3, N. Denkinger3, K. Sebald3, M. Mäurer4, M. Lang3,5, H. Schreiber3,5
1Pediatrics, Ortenau Klinikum Offenburg, Offenburg, 2Institute of Sports Science and Sport, Friedrich Alexander University, Erlangen, 3Neurological Practice and Neuropoint Academy, Ulm, 4Department of Neurology, Caritas Krankenhaus, Bad Mergentheim, 5NeuroTransData (NTD) Study Group on Multiple Sclerosis, Neuburg, Germany
Objective: To evaluate the impact of structured, internet-guided exercise (e-training) on profile/expression of fatigue and other behavioural PROs, i.e. depression, cognition, self-perception, disease coping and quality of life (QoL), in MS patients.
Methods: Prospective, multicenter study of 12 months with assessments at baseline/BL and after 3, 6, 9 and 12 months (T3/T6/T9/T12). 83 RRMS patients (aged 18-60 yr, mean: 36.6) cared at ambulant MS centers (Mc Donald, EDSS 0-3.5, FSMC total scale > 43, stable on INFbeta-1b at study onset) were randomized to an instant training group (TG1) that trained for 3 months (BL-T3), and a delayed training group (TG2) that, after a 3 month waiting period, trained for 6 months (T3-T9).
Outcomes: Primary: fatigue (FSMC total, motor and cognitive subscores). Secondary: MS-specific QoL/FAMS, clinical outcomes (neurostatus, relapses, EDSS), depression/ADS, daytime sleepiness/ESS, self-assessment of attent. Deficits/FEDA, disease coping/FKV, BICAMS cognition battery (SDMT/AVLT/BVMT), and mobility (two-minute walk test/TMWT, timed up and go test/TUG). E-training included Internet-guided strength and endurance training at home, 2-3 times/week, for 10-60 min.
Results: After 3 months of exercise (BL-T3) TG1 had highly significant less fatigue (FSMCtot decreasing by -5.98 pts.; p=0,001, effect size/ES -0,56). This effect was observed in motor fatigue (FSMCmot: -3.46 pts.; p< 0.01, ES -0.61), and, albeit to a lesser extent, in cognitive fatigue (FSMCcog p< 0.01, ES-0.42). In TG2, the exercise effect was only significant for motor fatigue after 3 months; global fatigue insignificantly decreased both after 3 and 6 months exercise. Irrespective of duration of exercise, improved fatigue was not stable in TG1 and TG2 , but reversed to higher scores after termination of exercise. Comparing TG1 to TG2, the magnitude of the exercise effect on fatigue was insignificantly different. However, the benefit of exercise on fatigue was smaller in the clinically more affected TG2 group. In TG1, significantly more exercise-related improvements were seen in FAMS (p< 0,05) and FEDA (p< 0,04) compared to TG2, and depression tended to improve more in TG1
(ADS, p< 0.1).
Conclusion:
(1) The findings indicate that e-Training significantly improves MS patients` fatigue.
(2) The exercise effect (EE) is essentially realized after 3 months and only persists with training.
(3) The size of the EE on fatigue and other behavioral PROs might depend on disease severity.
N. Jäckel1, A. Tallner2, Ö. Virsevci3, N. Denkinger3, K. Sebald3, M. Mäurer4, M. Lang3,5, H. Schreiber3,5
1Pediatrics, Ortenau Klinikum Offenburg, Offenburg, 2Institute of Sports Science and Sport, Friedrich Alexander University, Erlangen, 3Neurological Practice and Neuropoint Academy, Ulm, 4Department of Neurology, Caritas Krankenhaus, Bad Mergentheim, 5NeuroTransData (NTD) Study Group on Multiple Sclerosis, Neuburg, Germany
Objective: To evaluate the impact of structured, internet-guided exercise (e-training) on profile/expression of fatigue and other behavioural PROs, i.e. depression, cognition, self-perception, disease coping and quality of life (QoL), in MS patients.
Methods: Prospective, multicenter study of 12 months with assessments at baseline/BL and after 3, 6, 9 and 12 months (T3/T6/T9/T12). 83 RRMS patients (aged 18-60 yr, mean: 36.6) cared at ambulant MS centers (Mc Donald, EDSS 0-3.5, FSMC total scale > 43, stable on INFbeta-1b at study onset) were randomized to an instant training group (TG1) that trained for 3 months (BL-T3), and a delayed training group (TG2) that, after a 3 month waiting period, trained for 6 months (T3-T9).
Outcomes: Primary: fatigue (FSMC total, motor and cognitive subscores). Secondary: MS-specific QoL/FAMS, clinical outcomes (neurostatus, relapses, EDSS), depression/ADS, daytime sleepiness/ESS, self-assessment of attent. Deficits/FEDA, disease coping/FKV, BICAMS cognition battery (SDMT/AVLT/BVMT), and mobility (two-minute walk test/TMWT, timed up and go test/TUG). E-training included Internet-guided strength and endurance training at home, 2-3 times/week, for 10-60 min.
Results: After 3 months of exercise (BL-T3) TG1 had highly significant less fatigue (FSMCtot decreasing by -5.98 pts.; p=0,001, effect size/ES -0,56). This effect was observed in motor fatigue (FSMCmot: -3.46 pts.; p< 0.01, ES -0.61), and, albeit to a lesser extent, in cognitive fatigue (FSMCcog p< 0.01, ES-0.42). In TG2, the exercise effect was only significant for motor fatigue after 3 months; global fatigue insignificantly decreased both after 3 and 6 months exercise. Irrespective of duration of exercise, improved fatigue was not stable in TG1 and TG2 , but reversed to higher scores after termination of exercise. Comparing TG1 to TG2, the magnitude of the exercise effect on fatigue was insignificantly different. However, the benefit of exercise on fatigue was smaller in the clinically more affected TG2 group. In TG1, significantly more exercise-related improvements were seen in FAMS (p< 0,05) and FEDA (p< 0,04) compared to TG2, and depression tended to improve more in TG1
(ADS, p< 0.1).
Conclusion:
(1) The findings indicate that e-Training significantly improves MS patients` fatigue.
(2) The exercise effect (EE) is essentially realized after 3 months and only persists with training.
(3) The size of the EE on fatigue and other behavioral PROs might depend on disease severity.
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