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Objectives: This study investigated the effects of a pragmatic exercise intervention, incorporating cognitive-behavioural techniques to facilitate sustained behaviour change, on physical activity (PA) behaviour and key health outcomes in PwMS up to 9 months of follow-up.
Methods: A total of 120 PwMS (Expanded Disability Status Score: 1.0-6.5) were randomized (1:1) to a 12-week exercise intervention or standard care control group. The intervention comprised a tapered program of individually-tailored supervised aerobic exercise, strength and balance training, with 2 supervised plus 1 home exercise session during weeks 1-6 and 1 supervised plus 2 home exercise sessions during weeks 7-12. Supervised exercise incorporated cognitive-behavioural techniques (e.g. goal setting, finding social support, understanding the costs/benefits of exercise, etc.) to promote long-term changes in PA behaviour. Outcome measures were blindly assessed before and after the intervention and six months later. Outcomes included self-reported PA (Godin Leisure-Time Exercise Questionnaire), objectively measured average daily step-count (Actigraph, USA), subjective fatigue (MFIS) and health-related QoL (MSQoL-54).
Results: An increase in self-reported PA (P=0.01) and average daily step count (adjusted mean difference of 688 [95% CI: 173-1204] steps; P=0.009) was observed in the intervention group versus controls after 12 weeks, and a sustained increase in self-reported PA, of border-line statistical significance (P=0.08), was also observed at 9 months. Reductions in physical (-4.3 [95% CI: -6.2 to -2.5]), cognitive (-3.6 [95% CI: -5.5 to -1.8]), psychosocial (-1.2 [95% CI: -1.7 to -0.7]) and total fatigue (-9.2 [95% CI: -12.8 to -5.7]) in favour of the exercise group were also observed after 12 weeks (all P<0.0001). There were non-significant reductions favouring the intervention group in all fatigue dimensions, particularly total fatigue (P=0.12), after 9 months. Many MSQoL-54 domains showed improvements in favour of the exercise group after 12 weeks (P≤0.03), with improvements in emotional wellbeing (P=0.01), social function (P=0.004) and overall quality of life (P=0.001) being sustained for 9 months.
Conclusions: Our results suggest that this pragmatic approach to implementing exercise therapy results in a meaningful improvement in PA behaviour and a sustained enhancement of health-related QoL in PwMS.