Comparative Effectiveness of 4 Exercise Interventions Followed by 2 Years of Exercise Maintenance in Multiple Sclerosis: A Randomized Controlled Trial

Tibor Hortobágyi; Pongrác Ács; Petra Baumann; Gábor Borbély; György Áfra; Emese Reichardt-Varga; Gergely Sántha; József Tollár

doi:10.1016/j.apmr.2022.04.012

Comparative Effectiveness of 4 Exercise Interventions Followed by 2 Years of Exercise Maintenance in Multiple Sclerosis: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2022 Oct;103(10):1908-1916. doi: 10.1016/j.apmr.2022.04.012. Epub 2022 May 16.

Authors

Tibor Hortobágyi¹, Pongrác Ács², Petra Baumann³, Gábor Borbély², György Áfra², Emese Reichardt-Varga², Gergely Sántha², József Tollár⁴

Affiliations

¹ Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary.
² Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary.
⁴ Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Dentistry, Oral and Maxillofacial Surgery, Pécs, Hungary; Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Hungary; Széchényi István University, Digital Development Center, Győr, Hungary. Electronic address: tollarjozsef86@gmail.com.

PMID: 35584738
DOI: 10.1016/j.apmr.2022.04.012

Abstract

Objective: To determine the effects of exergaming (EXE) on quality of life (QOL), motor, and clinical symptoms in multiple sclerosis (MS). We compared the effects of EXE, balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group on clinical and motor symptoms and quality of life (QOL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting.

Design: A randomized controlled trial, using before-after test design.

Setting: University hospital setting.

Participants: Of 82 outpatients with MS, 70 were randomized (N=70), and 68 completed the study.

Interventions: The initial high-intensity and high-frequency interventions consisted of 25 one-hour sessions over 5 weeks. After the 5-week-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1 hour.

Main outcome measures: The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29).

Secondary outcomes: Measures 5 aspects of health-related QOL (EuroQol 5-Dimension questionnaire), Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT), and static BAL (center of pressure).

Results: MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6) (all P<.05). QOL improved most in EXE (3 points), CYC, and BAL (2) (all P<.05). TAT and BBS improved significantly (P<.05) but similarly (P>.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m) (all P<.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE.

Conclusions: A total of 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QOL, and subsequent 2-year-long thrice weekly maintenance programs further slowed symptom worsening and improved QOL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QOL in PwMS.

Keywords: Posture; Rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Exercise Therapy / methods
Humans
Multiple Sclerosis*
Muscle Stretching Exercises*
Postural Balance
Quality of Life
Surveys and Questionnaires