General Exercise Research

Exercise is good for the brains of patients with multiple sclerosis, a new study has found.

In the new study, researchers found that highly fit multiple sclerosis patients performed significantly better on tests of cognitive function than similar less-fit patients.

In addition, MRI scans of the patients showed that the fitter MS patients showed less damage in parts of the brain that show deterioration as a result of MS, as well as a greater volume of vital gray matter.

“We found that aerobic fitness has a protective effect on parts of the brain that are most affected by multiple sclerosis,” said Ruchika Shaurya Prakash, lead author of the study and assistant professor of psychology at Ohio State University.

“As a result, these fitter patients actually show better performance on tasks that measure processing speed.”

The study, done with colleagues Robert Motl and Arthur Kramer of the University of Illinois and Erin Snook of the University of Massachusetts, Amherst, appears online in the journal Brain Research and will be published in a future print edition.

The study involved 21 women diagnosed with relapsing-remitting MS. They were compared with 15 age- and education-matched healthy female controls. The study assessed fitness, cognitive function, and structural changes in all participants.

Source: Health News Copyright© 2010 Taragana (19/02/10)

Sheffield Hallam University has been awarded a new £200,000 research grant to investigate the effects of exercise intervention on sufferers of multiple sclerosis (MS). The MS Society has awarded the grant to the University's Centre for Sport and Exercise Science, which will study the effects of exercise therapy on physical activity and health outcomes in people living with MS. Led by Dr John Saxton, a Reader in Clinical Exercise Physiology, the grant becomes the third received from the Society by Sheffield Hallam University.

"Living with multiple sclerosis is a difficult experience both physically and mentally," said Dr Saxton. "This has created a need for clinicians and researchers to address issues that are related to the long-term health-related quality of life for people with the condition. Our study will tackle some important questions, the answers to which we hope will not only help people with MS but also the organisations which must budget for their treatment."

MS research has previously demonstrated that exercise is an effective intervention which improves function, mobility and health-related quality of life in people living with the disease, but it is not known what type of intervention or what dose of exercise might be most effective. Dr Saxton's study will seek not only to develop knowledge in this area, but also to examine the cost-effectiveness of a practical exercise intervention. This aspect will play a vital role in decisions by health policy makers over the implementation of such treatments.

The project will measure physical activity, aerobic function, physical function and health related quality of life before and after a 12-week exercise plan. Participants will be followed for three months after the interventions to provide an indication of whether any benefits have been sustained.

"The award of this grant is a real endorsement by the MS Society," says Dr Saxton. "Together we hope to provide valuable and vital insights to help alleviate the difficulties for people living with MS."

Ed Holloway, Social and Economic Research Manager, said: "The MS Society is delighted to fund further research in this important area of symptom relief.

"For many people with MS, remaining active through exercise is hugely beneficial and it is important to understand what exercise is most helpful and what health benefits it brings."

The study will be partnered with Sheffield Teaching Hospitals NHS Trust and the University of Birmingham. About the study

The effects of a pragmatic exercise therapy intervention on physical activity and important health outcomes influencing maintenance in people with multiple sclerosis

The programme is predominantly home-based, but uses a tapered programme of supervised sessions to provide support and guidance. The programme will be tailored for each individual, taking into account the views and expertise of a physiotherapist, exercise specialist and the participant.

As many individuals do not succeed in their efforts to establish and maintain lifestyle changes, the programme will include practical strategies, tools and skills to help individuals sustain their exercise behaviour and thus experience positive health gains from their participation. These strategies will incorporate some principles from Cognitive Behavioural Therapy (CBT).

120 people with MS will be recruited to the study, who will then be randomized to either receive the 12 week exercise programme or usual care.

A range of outcome measures will be assessed in order to evaluate the effectiveness of the exercise programme. These include physical activity levels of the participants, neurological assessments including EDSS, and a range of quality of life measures including measures of fatigue.

Source: Medical News Today © 2008 MediLexicon International Ltd (17/11/08)

"We devised a physical activity program for MS patients with fatigue and present the results from our first use of this program, on nine patients from our region. The program consisted of a 20-week series of gradual stretching, resistance and aerobic exercises, adapted to the individual clinical condition of each patient. The results showed significant improvement in cardio-circulatory parameters, as well as a significant decrease in scores on the fatigue scale," wrote Y.D. Fragoso and colleagues, University Metropolitana of Santos, Department of Neurology.

The researchers concluded: "The success of this program led patients to ask to continue with it after the trial was finished, and more patients are enrolling in the program, motivated by the good results reported by fellow patients."

Source: Neurorehabilitation (The positive effects of a physical activity program for multiple sclerosis patients with fatigue. Neurorehabilitation, 2008;23(2):153-7). (02/07/08)

A team led by nurse researcher Dr Jane Neill from Flinders University in Adelaide, examined 162 research studies published between 1987 and 2006, analysing 36 in detail.

They discovered that there was evidence that people with conditions like multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus could benefit from exercise that gradually increased in intensity, duration and frequency.

“Fatigue is a major symptom in all three conditions and can cause a range of physical, psychological and social problems” says Dr Neill.

“Our review showed that aerobic exercise can significantly reduce fatigue and that some behavioural, nutritional and physiological interventions are also very effective.”

Studies reviewed by the team tested 38 interventions on more than 1,700 patients. 24 resulted in statistically reduced fatigue or increased vitality levels.

The effective aerobic exercise programmes lasted an average of 12 weeks, with participants exercising for 30 to 60 minutes, three times a week.

Group interventions involved supervised exercise classes, including warm up, low impact aerobic activity and strengthening or stretching exercises before cool down.

Home-based programmes made use of exercise bicycles, walking, cycling, jogging or swimming.

“There is good evidence that people experiencing fatigue from chronic auto-immune conditions can benefit from a range of non-medicinal interventions” concludes Dr Neill.

“Other effective strategies, apart from aerobic exercise, include health education and cognitive behavioural therapy.

“Cooling techniques and nutritional supplements such as acetyl-L-carnitine and fish oil showed a number of benefits, but need to be looked at in more detail.”

The authors suggest electro-magnetic field devices also warrant further investigation, due to promising results.

But they add that low-cost, low technology interventions that promote self-management of fatigue are probably more appropriate and feasible than those requiring specialised equipment or professional expertise.

They stress that any exercise programmes must be suitable for each individual and take account of issues that affect how people manage their conditions, like reduced mobility, pain, nausea and stress.

“Healthcare professionals should ask people about their fatigue and assess each person’s symptoms” adds Dr Neill. “People with fatigue should be encouraged to design their own exercise routines based on awareness of their individual fatigue patterns and daily priorities, while group activities must take account of the changing nature of fatigue over time.”

Previous research suggests that 70 per cent of people with multiple sclerosis suffer daily fatigue, 57 per cent of people with rheumatoid arthritis experience fatigue and 81 per cent of those with system lupus erythematosus find fatigue moderately to severely disabling.

“Any measures that can reduce people’s fatigue and improve their quality of life are to be welcomed. Our review shows that some interventions have great potential, particularly in the short term, but that more research is needed to measure their long-term effectiveness” says Dr Neill.

Notes

Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis or systemic lupus erythematosus: a systematic review. Neill J, Belan I and Ried K. Journal of Advanced Nursing. Volume 56.6, pages 617-635.

Journal of Advanced Nursing, which is celebrating its 30th anniversary in 2006, is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.journalofadvancednursing.com

Source: Blackwell Publishing Ltd.

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