Improving Fatigue and Depression in Individuals with Multiple Sclerosis Using Telephone-Administered Physical Activity Counseling

Background: Fatigue and Depression are common and often persistent symptoms for individuals with MS.  There is considerable need for easily implemented and broadly disseminable psychosocial treatments that address these issues. Objectives: To evaluate the impact of a physical activity intervention consisting of telephone counseling with home-based monitoring to improve fatigue and depression in individuals with Multiple Sclerosis (MS).  Methods: Randomized controlled trial.  Sixty-four Veterans with multiple sclerosis received either telephone counseling (TC; N = 31), or self-directed physical activity education (EC; N = 33).  TC included mailed graphic feedback, 6 telephone counseling sessions using principles of motivational interviewing, and telehealth home monitoring to track progress on exercise goals.  Booster sessions were provided when indicated.  EC consisted of advice to exercise and a DVD with examples of in home exercises for multiple physical ability levels.  Assessment was conducted at baseline, 3 month and 6 month follow-up.  Results: TC participants reported significantly increased physical activity (d = .98), reduced fatigue (d = -.37) and reduced depression (d = -.50) relative to EC participants.  33.3% of individuals receiving TC experienced clinically significant improvement in fatigue and 53.3% experienced clinically significant improvement in depression.  Improvements in physical activity partially mediated improvements in fatigue with a similar trend for depression.  TC was highly feasible (participants completed 99.5% of schedule telephone sessions) and well tolerated (100% rated it highly successful).  Conclusions: Telephone-based counseling with home monitoring is a promising modality to improve physical activity and treat fatigue and depression.