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 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. 66.7, 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 56.738.4. 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 49.638.6; P= 0.0001and 29.119.9 vs 50.878.4; P=0.0001 respectively. Concerning the intragroup differences, the mean total FSS significantly improved after 6 weeks and showed more improvement after 12 weeks (59.676.5 vs 35.6710.7 vs 29.119.9; P=0.0001), whereas no difference was found in the control group at similar intervals (51.787.4 vs 49.638.6 vs 50.878.4; 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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