Exercise Underutilized Treating Multiple Sclerosis Symptoms

An international team of experts found that exercise is underutilized in patients with multiple sclerosis (MS) — despite its potential to improve symptoms, restore function and increase quality of life — and recommended that clinicians promote exercise as a therapeutic intervention.

Robert Motl, PhD, Professor, Department of Physical Therapy, University of Alabama at Birmingham, and lead author of the review and recommendations, described the value of exercise for patients with MS in comments to MD Magazine.

"Exercise is quickly being recognized as one of the most important approaches for self-managing the consequences of MS,” Motl said. “Persons with MS who exercise can experience a range of benefits from improving symptoms such as fatigue and depression through optimizing quality of life.”

Motl and colleagues in the US, UK, Canada, and Europe examined the evidence of therapeutic benefit from exercise, the disparity between that evidence and levels of participation, and considered how to mitigate factors which may have constrained clinicians from directing their patients with MS to exercise activities.

They attribute the relatively low prescribing and promotion of exercise as a therapeutic strategy to an inadequate quality and scope of existing evidence, insufficient research into possible mechanisms underlying beneficial effects in MS, and an absence of a conceptual framework and "toolkit" for translating the available evidence into clinical practice.

"Overcoming these limitations and narrowing the gap between research and clinical practice are both timely and important given the deleterious effect of low-level participation in exercise and physical activity in people with multiple sclerosis," Motl and colleagues wrote.

In examining evidence of beneficial effects of exercise, the reviewers found several studies that demonstrated clinically meaningful improvement in aerobic capacity and in balance, but that many of the study designs were underpowered and without adequate controls. There were also good results with exercises to improve walking-mobility, but they suggest that the heterogeneity of these exercise protocols could discourage clinicians from specifying a particular program for that outcome.

There has been moderate reductions in fatigue demonstrated with exercise programs, although many of these studies were also deemed to be underpowered, and some found to be selective in reporting outcomes. Small, but consistent beneficial effects on depressive symptoms have been demonstrated, and a meta-analysis determined that the effects of exercise on depressive outcomes were larger when the level of exercise activity met guideline thresholds.

The limited research into possible mechanisms for the benefit of exercise is a factor in the low utilization, according to Motl and colleagues.

"Investigation of the biological factors involved in exercise-training effects in this population is crucial to increase the confidence of health-care providers in prescribing exercise to patients," researchers wrote.

Despite inconsistent quality of evidence and unclear underlying mechanisms, Motl and colleagues argued that beneficial effects have been sufficiently demonstrated to warrant clinicians recommend these approaches to patients with MS.

People with MS do seek information about behavioral approaches such as exercise and diet for managing their symptoms, they indicate, and in one study, 34-50% sought this information within the context of health-care services.

"We believe that all persons with MS should engage in some type of physical activity, and this can be initiated by a conversation with a healthcare provider," Motl said.

The study, "Exercise in patients with multiple sclerosis," was published online in The Lancet Neurology last month.