Efficacy of high-intensity aerobic exercise on fatigue, walking, and quality of life in people with multiple sclerosis: A randomized controlled trial

Winner Young Investigator Award
Young Investigator
Martin Langeskov-Christensen
Aarhus University
26
Aarhus, Denmark

Abstract

Objectives:
Fatigue and walking impairment are two of the most common and disabling symptoms of multiple sclerosis (MS). We aimed to investigate the effects of a 24-week progressive aerobic exercise (PAE) intervention on fatigue impact and severity, walking ability and capacity, and quality of life in people with MS.

Methods:
This was a randomized controlled trial (1:1 ratio, stratified by sex) with a 24-week crossover follow-up, including an exercise (24 weeks of supervised PAE followed by self-guided physical activity) and a waitlist (24 weeks of habitual lifestyle followed by supervised PAE) group. PAE consisted of two supervised sessions per week; session duration = 30-60min, intensity = 65%-95% of maximum heart rate. Fatigue impact (Modified Fatigue Impact Scale; MFIS) and severity (Fatigue Severity Scale; FSS), walking ability (12-item MS Walking Scale; MSWS-12) and capacity (6-Minute Walk Test; 6MWT, Six Spot Step Test; SSST), quality of life (Short Form (36) health survey; SF-36), and cardiorespiratory fitness (VO2max) were measured at 0, 24, and 48 weeks. Data were analyzed using intention-to-treat linear mixed effects models.

Results:
A total of 86 mildly to severely impaired people with MS were enrolled. Following 24 weeks of PAE, between group differences showed reductions in MFIStotal score (-5.3 [95% CI: -10.9;0.4]; mean value > clinical relevance), MFISphysical subscore (-2.8 [-5.6;-0.1]), MFISpsychosocial subscore (-0.9 [-1.6;-0.2]), and MSWS-12 (-5.9 [-11.9; 0.2]), and increases in VO2max (+3.5 mL O2/min/kg [2.0;5.1]) and 6MWT (+14 m [-5;33]). These improvements were maintained at follow-up after 48 weeks. No changes were observed in FSS, SSST, SF-36Physical subscore, or SF-36Mental subscore.

Conclusions:
In a representative sample of people with MS, 24 weeks of PAE induced a clinically relevant and long-lasting reduction in fatigue impact along with small improvements in walking. These findings justify recommending long-term PAE as a possible treatment for MS fatigue impact

Efficacy of high-intensity aerobic exercise on fatigue, walking, and quality of life in people with multiple sclerosis: A randomized controlled trial

Martin Langeskov-Christensen, PhD1 (main author), Lars Gr√łndahl Hvid, PhD1, Henrik Boye Jensen, PhD2,7, Helle Hvilsted Nielsen, PhD3-5, Thor Petersen, DMSc6, Egon Stenager, PhD7, and Ulrik Dalgas, PhD1.
1 Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark.
2 Brain and Nerve Diseases, Lillebaelt Hospital, Kolding, Denmark.
3 Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
4 Department of Neurology, Odense University Hospital, Odense, Denmark
5 BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
6 The multiple sclerosis clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
7 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark