Nine high quality studies provide strong evidence that exercise therapy can make a difference in the daily living and quality of life of those with the disease, say Dr. Bernard Uitdehaag and colleagues of the Vrije Universitei Medical Centre in the Netherlands.
Exercise therapy also improved the mood of MS patients in exercise therapy programs, compared to patients who did not participate in the therapy. The researchers did not find any evidence that exercise therapy affected patients' fatigue or their sense of how ill they were.
Despite the evidence supporting exercise for MS patients, however, Uitdehaag says it's too early to recommend systematic referral of patients for exercise training.
So far, there is no clear indication of how much exercise is beneficial for people who have various types of the degenerative disease, Uitdehaag explains. Only patients who seem able to exercise and who are sufficiently motivated to train should begin the therapy, he says.
"Patients for exercise training should also be referred to therapists with sufficient experience in treating MS patients," Uitdehaag says.
The review appears in the January issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Multiple sclerosis is a degenerative nerve disease that damages the protective fatty sheath around nerves in the brain and spinal cord. Some patients experience a pattern of disease flare-up followed by disease free periods, while others may have a steady worsening of the disease over time. According to the Multiple Sclerosis Foundation, between 350,000 and 500,000 people in the United States currently have multiple sclerosis.
"No intervention has proven effective in modifying long-term disease prognosis in multiple sclerosis, but exercise therapy is considered to be an important part of symptomatic and supportive treatment for these patients," Uitdehaag says.
Exercise therapy probably does not affect the disease process itself, according to co-author Dr. Gert Kwakkel. He says exercise may help "patients learn to compensate (for) their existing deficits. Systematic physical training may reduce disuse, in particular for those who suffer from fatigue."
The average of age of patients in the reviewed studies ranged from 34 to 51 years old, with varying types and severities of multiple sclerosis. The researchers suggest future studies should include a greater number of older individuals, severely disabled patients and patients who have been living with the disease for more than 18 years.
The studies also included a wide range of exercise programs and definitions of improved health and fitness, making it difficult to decide what kinds of exercise are best for MS patients. Uitdehaag and colleagues found no evidence that any specific exercise therapy programs were better for health and mobility than other exercise programs.
The researchers also found no signs in any of the studies that exercise therapy was harmful to the health of MS patients. The National Multiple Sclerosis Society suggests that MS patients exercise with frequent rest breaks, since heat can aggravate MS symptoms.
"With this type of exercise-rest-exercise patterns, physical therapy may be quite effective, with very good results," according to the Society's recommendations.
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Bernard Uitdehaag, VU Medical Centre at +31 20 444 2834 or bmj.uitdehaag@vumc.nl.
1 M.B. Rietberg et al. Exercise therapy for multiple sclerosis (Review. The Cochrane Database of Systematic Reviews 2005, Issue 1
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
BY BECKY HAM, SCIENCE WRITER
HEALTH BEHAVIOR NEWS SERVICE