Benefits of a program associating exercise therapy and therapeutic education on fatigue in multiple sclerosis

Abstract

Literature findings have proven the efficacy of exercise training on fatigue symptoms in multiple sclerosis (MS). Other studies showed a benefit of educational programs on fatigue management in MS. A 2-week hospital-based rehabilitation program associating both of these aspects was created in 2016. The aim of this study was to analyze the efficacy of this program. Pre- and post-prospective observational study of patients with MS of EDSS below 7 presenting with disabling fatigue. Patients were evaluated before and 3 months after the program. Assessments included the 6-min walking test, the maximal oxygen uptake (VO 2 max) in a cycling exercise test, the numerical scale (NS) of fatigue, the Multiple Sclerosis Fatigue Self-Efficacy Scale (MSFSE, max = 100), which assesses patients’ subjective feeling of self-efficacy to manage their fatigue, and level of weekly sport or physical activity. Twenty-seven patients completed the program and 17 received the 3-month assessment (10 evaluation pending). Mean age was 43, mean EDSS was 3.4. Among the 17 patients, 5 suffered a relapse of MS before the 3-months follow-up. Mean 6-minutes walking distance was 398 ± 73 m pre-program and 407 ± 87 m at 3 months. Mean VO 2 max before was 71 ± 24% and 76 ± 24% after. VO 2 max increased for 78% of patients ( n = 9). Mean fatigue NS remained stable at 5/10. Mean MSFSE score increased from 56 ± 20 to 75 ± 25. Among patients who had no physical activity before the program, 75% had started a regular activity, which was maintained at 3 months. Among patients who had a previous physical activity, 44% increased their activity level. This 2-week program including education and exercise training did not seem to modify walking ability and fatigue, but patients improved their physical activity and their feeling of self-efficacy. It thus appeared that the educational aspects of the program were the most beneficial on the long term.