Exercise is GOOD! Fatigue is improved.

Carter A, Daley A, Humphreys L, Snowdon N, Woodroofe N, Petty J, Roalfe A, Tosh J, Sharrack B, Saxton J. Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial. Mult Scler. 2014 Jan 13. [Epub ahead of print]

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.

So following from yesterdays post of another fatigue trial there is some movement in this area at last. ProfG talked about deconditioning and the thought that if you are unfit then things make you tired. Get fitter and have more energy. This study shows that if you can exercise and keep at it then there can be improvements. But is it worth it?…..Is it a load of Tosh?

Will Dr Dre approve of this?

The only Tosh is the author

Tosh J, Dixon S, Carter A, Daley A, Petty J, Roalfe A, Sharrack B, Saxton JM. Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial. Mult Scler. 2014 Jan 13.

Background: Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost effective

approaches to implementing exercise within health care settings are needed.

Objective: The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis.

Methods: A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire.
Results: The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold.
Conclusion: The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds,
and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.
Well every trial needs to assess whether there is cost effectiveness from the treatment, this study ticks that box. What and where next?

About the author



  • I'm a great believer of the effectiveness of exercise, but it needs to be designed for each patient. We are all totally different. I fell out of an ambulance yesterday following the advice of physios of how to walk down steps. Thankfully the driver caught me, no harm done.

  • My name is Dr. Dre and I approve this message.

    (May I remind anyone with a health issue that could clinically benefit from exercise that a GP referral can gain you significant discounts at gyms across Britain.)

  • Thank you for the positive comments regarding our research!

    Just a couple of points (and these are in no way representative of the research team, just personal):

    Anonymous – The exercise intervention we trialled is tailored to each person. After the group sessions they then received a personalised home plan and undertook self-directed exercise. We checked to see if there was an issue with participants undertaking exercise and then having falls/accidents and ending up in A&E (in the Tosh et al paper). We did not find a statistically significant effect (although the study was obviously not powered to detect these rare events).

    Bouncy and Dr Dre – absolutely right. ask your GP about exercise referral schemes if you want to access gym facilities. Also, don't forget that there's plenty of ways to exercise in and around your own home, without the need for significant personal expense.

    Marija – yes the mechanisms are absolutely fundamental to designing of appropriate exercise interventions – well beyond my area of expertise however.

    The 'What and Where Next?' question is key. The fast moving world of academic research inevitably results in a rush to the next project, and once the paper has been accepted we tend to file it and move on! I hope that's not the case with this research. I know the other members of the research team are pursuing routes to implementation, and the funder (MS Society) are as well. It looks like a new NICE MS clinical guideline is due to be published later in 2014. Let's hope that the evidence regarding exercise has been suitable considered.

    Dr Dre – thank's for the approval. I'm more of a Nas fan personally 😉

    Thanks again,

    Jon Tosh (Health Economist at University of Sheffield)

    P.S. Drop me an email if you want a personal copy of the full papers.

  • Enough already with the exercise studies enlightening humanity to the obvious. Everyone get off your ass and MOVE! It is tragic that MS diminishes and robs many of motor function but there are alternatives to running a 10K. I agree with the post above that a person who is unable or unsure of an appropriate exercise regimen should consult with a professional. With regard to mechanisms for the benefits of exercise. Really? But I wonder if the chronically ill are no different from the "healthy" component – sometimes people need to take an initiative.

  • These posts have been helpful to me. In November, you put up a study that suggested that exercise might be neuroprotective, among its other benefits. I thought, "If that's the case, I'm going to make exercise as important as my DMT." I have always exercised some, but now a 30-minute hike/bike ride/treadmill is no longer optional every day. And you guys are right–fatigue is much improved. Hopefully it's doing something for my brain too.

  • Seeing this late but wanted to add my experience. I have been athletic all my life. Dxd with "benign MS" in 1993. Now using cane, have mild-moderate cognitive dysfunction (severity depends on specific function as assessed by complete neuropsych testing in 2008; primarily executive functions) and experiencing overwhelming lassitude & MS fatigue. Fatigue forced me away from my athletic lifestyle. I have tried numerous times to make exercise part of my life again but end up overdoing or injuring myself because of unnoticed impacts of MS. I know I am deconditioned and exercise would help. What I don't know is how to find a trainer who knows how to work with MS. Would like to see study about what exercises are safe and effective for PwMS.

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