STUDY: Effectiveness of walking exercise program in improving fatigue in relapsing remitting multiple sclerosis patients

Effectiveness of walking exercise program in improving fatigue in relapsing remitting multiple sclerosis patients
Author(s): N. Shalaby, H. Hashem, A. Gomaa, A. Elmazny, A. Ragab, H. Shehata
ECTRIMS Online Library. Shalaby N.Oct 11, 2018; 228794

Background: Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS) reported by over 80% of the patients. MS related fatigue is sustained over time and significantly impacts quality of life (QoL). There is a strong evidence that exercises, including aerobic exercise and resistance exercise, such as walking, promote muscle power, functions and mobility-related activities and improve fatigue. Objective. to evaluate the effect of a specially designed walking exercise program on fatigue in patients with relapsing remitting multiple sclerosis (RRMS). 

Subjects and methods: A pilot prospective study including 60 RRMS patients with EDSS ≤4 having fatigue according to fatigue severity scale (FSS) (Arabic version). Patients with moderate to severe depression (Beck depression inventory (BDI) of ³ 17) were excluded. Study subjects were equally divided into two groups; one receiving the experimental treatment plan consisting of 6 weeks of walking exercise program (WEP) on a treadmill three days per week. Each session included three phases; easy walk, brisk walk, then cooling down, with weekly increments of speed and time, starting initially by 10-15 minutes to reach 25-32 minutes by the end of last week. The control group received amantadine. FSS was assessed in both groups at the end of 6 and 12 weeks. 

Results: The patients mean age was 30. 6±6.7, with 47 females and 13 males, with a ratio of 3.6/1. The baseline mean total FSS score for the whole study group was 56.73±8.4. Both groups were age, gender, and FSS matched at baseline. The mean total FSS after 6 and 12 weeks in the WEP group compared with control group were 35.67± 10.7 vs 49.63±8.6; P= 0.0001and 29.11±9.9 vs 50.87±8.4; P=0.0001 respectively. Concerning the intragroup differences, the mean total FSS significantly improved after 6 weeks and showed more improvement after 12 weeks (59.67±6.5 vs 35.67±10.7 vs 29.11±9.9; P=0.0001), whereas no difference was found in the control group at similar intervals (51.78±7.4 vs 49.63±8.6 vs 50.87±8.4; P>0.05). 

Conclusion: A specially designed walking exercise program with gradual increments in time and speed for 12 weeks can improve fatigue in RRMS patients. A long term follow-up is recommended to verify the maintained effect on such improvement.

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