Structured Abstract
Multiple Sclerosis Structured Abstract - MS #5
Aerobic training to improve fitness and quality of life for clients with multiple sclerosis
CITATION: Petajan, J. H., Gappmaier, E., White, A. T., Spencer, M. K., Mino, L., & Hicks, R. W. (1996). Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology, 39, 432-441.
LEVEL OF EVIDENCE: IA3a
RESEARCH OBJECTIVE/QUESTION
The effect of a 15-week aerobic fitness program on daily activities, mood, and levels of fatigue in clients with MS
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
Randomly assigned clients with MS to treatment or control group
SAMPLING PROCEDURE
Convenience sample - Recruited from community through MS society and physician referrals.
SAMPLE
|
N = 46 |
Mean age = 40 |
Male = 15 |
Female = 31 |
21 treatment and 25 controls. Confirmed diagnosis of MS, Kurtzke EDSS scores of 6 or less, no history of cardiovascular, respiratory, orthopedic, metabolic or other medical condition. Not involved in physical activity program within the past 6 months.
OUTCOMES
|
x |
Life roles |
x |
Tasks |
|
Activities |
| |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome Area |
Measures |
Reliability |
Validity |
|
Neurological Examination (blinded) |
Kurtzke's Functional System scales, Kurtzke EDSS and Incapacity Status scale |
NR |
NR |
|
Physiological Measurements - workload capabilities (VO2max, heart rate, workload) |
Leg and arm ergometer, open circuit indirect calorimetric, ECG |
NR |
NR |
|
Strength (maximum voluntary isometric contraction) |
Computerized force measurement |
NR |
NR |
|
Body composition |
Caliper skin thickness |
NR |
NR |
|
Affective states (tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment) |
Profile of Mood States (POMS) |
"highly reliable" |
NR |
|
Sickness-related changes in behavior (physical dimension and psychosocial dimension) |
Sickess Impact Profile (SIP) |
Reliability "carefully tested" |
Validy "carefully tested" |
|
Impact of fatigue on daily function |
Fatigue Severity Scale (FSS) |
"high degree of internal consistency" |
"high degree of validity" |
NR=Not Reported
INTERVENTION
Description
Supervised 40-minute aerobic exercise program followed by a 10-minute stretching period.
Who delivered
Therapist
Setting
Clinic
Frequency
Three 50-minute programs a week
Duration
15 weeks
RESULTS
Multivariate analysis
- No significant changes in neurological impairment.
- Significant group x time interaction (p < .01) for VO2max
and physical work capacity, but not for heart rate. Improvement of 22% for treatment and 1% control for VO
2max and improvement of 48% for treatment and 12% for control.
- Significant group x time interaction for both UE and LE
strength for treatment and control (mean ± SE) (treatment UE pre = 1309 ± 68, UE post = 1532 ± 92; LE pre = 2125 ± 136, LE post = 2362 ± 140) (control UE pre = 1561, ± 88, UE post = 1532 ± 92; LE pre = 2644 ± 169, LE post = 2716 ± 167) (in Newtons)
- Significant decrease in skinfold thickness for
treatment (pre 70, +/-5, post 64, +/-4, p < .05) not in control group (pre 79, +/-6, post 81, +/-7, p < .05) (in mm). No significant changes in body fat.
- Trend toward decreased bad moods in treatment but not
in control.
- Significant group by time interaction for physical
dimension of SIP (p < .05). Significant changes from baseline noted in mobility and recreation for treatment group at posttest.
- No differences in fatigue as measured by FSS (Wilcoxon
rank sum test).
CONCLUSIONS
Biases - attention, # of outcomes, masking, recall, sample size, drop outs, expectation
A 15-week aerobics program produced changes in overall fitness including VO2max, physical work capacity, skinfold thickness, UE strength, and LE strength and some improvements in the physical dimension on the SIP. There was no significant improvement in the neurological scores, fatigue, psychosocial dimension of the SIP, or mood, although there is a trend toward improved mood.
Limitations
- Treatment got more attention than the controls.
- There were numerous measurements and statistical tests. Some of these tests could be significant merely due to chance.
- Therapists were not blinded to group of subjects.
- Clients had to recall data about their functional abilities.
- Eight subjects dropped out of the program. 6 for nothing associated with MS or program and 2 due to exacerbation.
- Those in treatment group might expect to get better.
COMMENTARY
OT relevant study. This suggests that an exercise program may be benificial for improving component abilities. It is less apparent how well these component abilities translate into functional abilities. Exercise may improve mood, although further research is necessary to determine whether this is true.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Nancy Baker, ScD, OTR, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
