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Randomized Controlled Trial
. 2017 Oct;23(11):1517-1526.
doi: 10.1177/1352458517696596. Epub 2017 May 22.

Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

Martin Heine  1 , Olaf Verschuren  2 , Erwin Lj Hoogervorst  3 , Erik van Munster  4 , Hub Ga Hacking  3 , Anne Visser-Meily  2 , Jos Wr Twisk  5 , Heleen Beckerman  6 , Vincent de Groot  6 , Gert Kwakkel  7 ; TREFAMS-ACE study group
Affiliations
Randomized Controlled Trial

Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

Martin Heine et al. Mult Scler. 2017 Oct.

Abstract

Background: Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking.

Objective: To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue.

Methods: Patients ( N = 90) with severe MS-related fatigue were allocated to 16-week aerobic training or control intervention. Primary outcomes were perceived fatigue (Checklist Individual Strength (CIS20r) fatigue subscale) and societal participation. An improvement of ⩾8 points on the CIS20r fatigue subscale was considered clinically relevant. Outcomes were assessed by a blinded observer at baseline, 2, 4, 6 and 12 months.

Results: Of the 89 patients that started treatment (median Expanded Disability Status Scale (interquartile range), 3.0 (2.0-3.6); mean CIS20r fatigue subscale (standard deviation (SD)), 42.6 (8.0)), 43 received aerobic training and 46 received the control intervention. A significant post-intervention between-group mean difference (MD) on the CIS20r fatigue subscale of 4.708 (95% confidence interval (CI) = 1.003-8.412; p = 0.014) points was found in favour of aerobic training that, however, was not sustained during follow-up. No effect was found on societal participation.

Conclusion: Aerobic training in MS patients with severe fatigue does not lead to a clinically meaningful reduction in fatigue or societal participation when compared to a low-intensity control intervention.

Keywords: Multiple sclerosis; exercise therapy; fatigue; randomized controlled trial; rehabilitation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CONSORT diagram for TREFAMS-AT trial. The light grey area marks the treatment phase. aDue to use of a website and local advertisement, the exact number of potential participants reached cannot be determined. b90 patients with MS were included; one withdrew prior to randomization due to transport issues.
Figure 2.
Figure 2.
Change in perceived fatigue according to the CIS20r fatigue subscale in the aerobic training group (blue line) and control group (orange line). The horizontal reference line at 35 points indicates the value above which participants had to score in order to be included (i.e. severe fatigue). Asterisk (*) indicates a significant (p = 0.014) mean difference of 4.7 points between the aerobic training group and control group based on the mixed-model analysis.
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Comment in

References

    1. Compston A, Coles A. Multiple sclerosis. Lancet 2008; 372: 1502–1517. - PubMed
    1. Browne P, Chandraratna D, Angood C, et al. Atlas of multiple sclerosis 2013: A growing global problem with widespread inequity. Neurology 2014; 83: 1022–1024. - PMC - PubMed
    1. De Groot V, Beckerman H, Twisk JW, et al. Vitality, perceived social support and disease activity determine the performance of social roles in recently diagnosed multiple sclerosis: A longitudinal analysis. J Rehabil Med 2008; 40: 151–157. - PubMed
    1. Multiple Sclerosis Council for Clinical Practice Guidelines. Fatigue and multiple sclerosis: Evidence-based management strategies for fatigue in multiple sclerosis. Washington, DC: Paralyzed Veterans of America, 1998, http://www.pva.org/atf/cf/{CA2A0FFB-6859–4BC1BC96–6B57F57F0391}/fa...
    1. Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet 2004; 363: 978–988. - PubMed

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