Exercise for people with MS

Transcription

1 Research Explored Exercise for people with MS Susan Coote, PhD,

2 Outline of presentation Brief history of exercise and MS Physical Activity levels Bridging the evidence-action gap Activity Matters

3 Brief History of Exercise in MS When the diagnosis of multiple sclerosis is suspected admission to hospital should be arranged, [ ] to ensure proper rest in bed. McApine 1957 BMJ [bed rest] the most important therapy, accepted and unchallenged by all authors Laubenthal 1975

4 Uhtoff s Syndrome 1890: Dr Wilhelm Uhthoff - impairment of vision in MS patients during physical exertion Present Symptom change is transient Smith et al 2006 Heat sensitivity common Flesner et al 2011

5 What do we know about the effect of exercise? Publications (n) Turning point Petajan, Gappmeier et al 1996 Aerobic training to improve fitness and quality of life for clients with multiple sclerosis Year Dalgas, 2014, RIMS

6 Evidence for Exercise Extensive and consistent data support the beneficial effects of exercise training on muscular strength, aerobic capacity, and ambulatory performance Motl & Pilutti Nat Rev Neurol 2012 Moderate-intensity exercise performed 2 times per week is effective for increasing aerobic and muscular fitness among adults with mild to moderate disability resulting from MS. Exercise training may be effective in improving mobility and symptoms of fatigue. Latimer-Cheung et al APMR 2013

7

8 Are people with MS exercising? Only 28% PwMS do any exercise Turner et al 2012 Activity levels in people with MS and healthy controls Sandroff et al 2012

9 Key questions Bridging the evidence practice gap How can we enable people to become more active?

10 Website resource

11 Activity Matters in MS Research Evidence Needs of pwms MS Website Behaviour Change Theory Knowledge Translation Theory

12 Interviews with People with MS Activity Matters Project Review of the evidence for different forms of exercise Videos people with MS, instructors, researchers Draft of website, initial evaluation of website Review of the literature on PA behaviour change interventions in MS Systematic review of correlates of exercise

13 Interviews Casey, Hayes, Coote in press D&R

14 Review of the evidence Safety High levels of structured exercise and physical activity are related to a reduced number of relapses (Tallner et al 2011) some evidence possibility of a disease-modifying potential of exercise in MS patients, future studies using better methodologies are needed to confirm this (Dalgas & Stenager 2012) Literature review of relapses and adverse events reported in exercise training studies slight reduction in relapse rate for exercise training compared with control (RR = 0.75) few adverse events (~2% of persons who engaged in exercise training across the studies) (Pilutti et al 2014)

15 Pilutti et al 2013 Fatigue

16 Ensari et al 2014 Depression

17 Gunn et al 2015 Balance

18 Pearson et al 2015 Mobility

19 Quality of Life Exercise Medication for Symptoms Kuspinar et al MSJ 2012

20 Review of Evidence Review of meta-analyses & reviews Yoga Exercise in Water Walking

21 Videos Captured and edited range of videos People with MS, instructors, researchers Sample; People with MS talk about the benefits of walking

22 Review of Existing Evidence 6 PA Behaviour interventions Do they meet the criteria to be defined as theory based? Motl et al % of criteria

23 Review of Existing Evidence Of the 44 possible physical activity behaviour change techniques, how many did they use? Range 16-19

24 Review of draft of website in motion methodology 6 people with MS Given tasks to find things on website Usability questionnaire Focus groups

25 Review of Correlates of PA Systematically searching for studies 43 so far Results to follow

26 Review of benefits Future Plans Review of specific exercises Research Evidence Interviews at start Review behavioural interventions Behaviour Change Theory Website Needs of pwms MS In motion study Review of correlates of PA Knowledge Translation Theory Clinicians resources Steering committee

27 Key messages: Lots of evidence for the benefits of exercise and physical activity Uptake is poor knowledge translation important Activity Matters Website resource Step it Up Exercise and Education

28 Acknowledgements

29 How do we deliver exercise programmes to sustain long term PA behaviour? Exercise self-efficacy key correlate of PA for the general population (Bauman et al. 2012) EXSE identified as a cross-sectional (Motl et al. 2006, Ferrier et al 2010) & prospective (Suh et al. 2011) correlate of PA for people with MS Internet based PA intervention (Dlugonski et al. 2011, Motl and Dlugonski 2011, Dlugonski et al. 2012) Based on Social Cognitive Theory Benefits, Outcome Expectations, Self Monitoring, Goal Setting, Self Efficacy, Barriers and Facilitators, Maintenance

30 Step it Up RCT of exercise plus behaviour change 10 week strength and walking programme n=64 recruited Results March 2016 Qualitative data beneficial