For people with MS, homebased aerobic exercise combined with regular remote coaching improves cardiovascular and respiratory health, results of a randomized controlled trial suggest.
The aerobic exercise “group had modest, yet significant, increases in aerobic capacity over the 12- week period, coupled with improvements in T25FW [timed 25-foot walk] speed and vasodilatory reactivity,” Tracy Baynard, PhD, of the University of Illinois Chicago, and her coauthors report in Multiple Sclerosis and Related Disorders. “Reactive hyperemia was improved during follow-up in the exercise group, showing that the exercise intervention had a positive effect on arterial health.”
Thus, they write: “It is possible that a home-based exercise intervention can improve outcomes of a subclinical marker of atherosclerosis.”
Dr. Baynard and her colleagues randomly assigned people who had MS with minimal disability (Expanded Disability Status Scale [EDSS] 0–4) to 12 weeks of either aerobic exercise (N=26; 19 women; mean age 49 years; mean body mass index (BMI) 28.8 kg/m2) or to a stretching protocol (n=22; 16 women; mean age 44 years; mean BMI 29.2 kg/m2). Both groups were asked to refrain from changing their diets or engaging in any outside structured exercise activities during the study.
Participants in the aerobic exercise group exercised 3 days per week, 10 minutes per day for the first week, adding 5 minutes per day until they reached 30 minutes per day. Intensity for the first week began at 40% of peak aerobic capacity (VO2peak) and increased by 5% each week, until participants reached 60% to 65% of VO2peak.
By contrast, participants in the stretch group were provided with a stretching manual based on recommendations from the National Multiple Sclerosis Society and performed standardized stretches and sets 3 days per week that were progressively increased over the 12 weeks, for the same duration per session as those in the exercise group.
All participants received one-on-one social cognitive theory behavioral coaching through written materials and weekly phone or video chats lasting around 5-10 minutes that covered topics appropriate to their assigned group.
The researchers assessed aerobic capacity using a graded cycle ergometer test with indirect calorimetry. They measured pre- and post-intervention subclinical atherosclerosis by ultrasound of the right common carotid intima-media thickness, reactive hyperemia and strain-gauge plethysmography to assess forearm vasodilatory reactivity, and ultrasound to determine right common carotid arterial stiffness. They also tested mobility using a timed 25-foot walk test (T25FW) and a 6-minute walk test.
After 12 weeks, the exercise group had increased aerobic capacity (7%), vasodilatory reactivity (16%) and T25FW speed (13%), (P<0.05). By contrast, the corresponding results for the stretch group did not change. Both groups improved in the 6-minute walk test (P<0.05).
“Quite Convincing” Study Results
“MS affects millions of people worldwide, and the scientific evidence that exercise can improve mobility, cardiovascular health, and overall wellbeing is compelling,” says Brad Willingham, PhD, a clinical research scientist at the Multiple Sclerosis Research Program at the Shepherd Center, who independently reviewed the findings of this study.
“People with MS may have physical, social, environmental, and economic barriers to participating in exercise and greatly need more accessible exercise programs,” Dr. Willingham says. “Home-based exercise programs promote sustained engagement in exercise in the time and place people choose.”
However, these programs c a n lack clinical oversight and p a – tient support, he adds. This study addressed these critical issues by integrating a home-based exercise program with scheduled, virtual coaching sessions to provide guidance and support. The fact that nearly 90% of participants completed the exercise program suggests that this approach is well tolerated.
“The coaching sessions are a critical feature. It is important for patients to know they are supported and held accountable, even when participating in exercises remotely and independently,” Dr. Willingham advises. “The authors based their coaching interactions on principles of social cognitive theory, which further empowered the participants by equipping them with evidence-based knowledge related to self-efficacy, expectations, “impediments, and goal setting.”
The results are “quite convincing,” he says. “They represent tangible improvements in the lives of people with MS. Improved cardiovascular health and enhanced mobility can translate to reduced risk of secondary health complications associated with MS and potentially to better quality of life nd greater independence.”
Expanded Research Is Recommended
This work offers a model by which healthcare professionals may improve outcomes for home-based exercise programs, Dr. Willingham notes.
People with MS with EDSS scores greater than 4 may benefit most from a home-based exercise program. But they may also have substantial mobility limitations, poorer cardiovascular health, and additional barriers to engaging in exercise, he explains. “Future work exploring the efficacy of this approach in people with MS who have EDSS scores greater than 4 may help inform care strategies across the continuum of care.”
