Exercise therapy for multiple sclerosis

 

Abstract

Background

No intervention has proven effective in modifying long-term disease prognosis in Multiple Sclerosis (MS) but exercise therapy is considered to be an important part of symptomatic and supportive treatment for these patients.

Objectives

To assess the effectiveness of exercise therapy for patients with MS in terms of activities of daily living and health-related quality of life.

Search methods

We searched the Cochrane MS Group Trials Register (searched: March 2004), Cochrane Central Register of Controlled Trials (CENTRAL) "The Cochrane Library Issue 2, 2004", MEDLINE (from 1966 to March 2004), EMBASE (from 1988 to March 2004 ), CINAHL (from 1982 to March 2004), PEDro (from 1999 to March 2004). Manual search in the journal 'Multiple Sclerosis' and screening of the reference lists of identified studies and reviews. We also searched abstracts published in proceedings of conferences.

Selection criteria

Randomised Controlled Trials (RCTs) that reported on exercise therapy for adults with MS, not presently experiencing an exacerbation; outcomes that include measures of activity limitation or health-related quality of life or both.

Data collection and analysis

Two reviewers independently extracted data and methodological quality of the included trials. Disagreements were resolved by discussion. The results were analysed using a best-evidence synthesis based on methodological quality.

Main results

Nine high-methodological-quality RCTs(260 participants) met the inclusion criteria. Six trials focussed on comparison of exercise therapy versus no exercise therapy, whereas three trials compared two interventions that both met our definition of exercise therapy. Best evidence synthesis showed strong evidence in favour of exercise therapy compared to no exercise therapy in terms of muscle power function, exercise tolerance functions and mobility-related activities. Moderate evidence was found for improving mood. No evidence was observed for exercise therapy on fatigue and perception of handicap when compared to no exercise therapy. Finally, no evidence was found that specific exercise therapy programmes were more successful in improving activities and participation than other exercise treatments. No evidence of deleterious effects of exercise therapy was described in included studies.

Authors' conclusions

The results of the present review suggest that exercise therapy can be beneficial for patients with MS not experiencing an exacerbation. There is an urgent need for consensus on a core set of outcome measures to be used in exercise trials. In addition, these studies should experimentally control for 'dose' of treatment, type of MS and should include sufficient contrast between experimental and control groups.

 

Plain language summary

The impact of excercise therapy for multiple sclerosis

MS is a chronic disease of the central nervous system. The variable distribution of the damage in the myelin sheath of nerves may lead to loss of strength, sensation, co-ordination and balance causing severe and progressive limitations of function in daily life. To date, there is no effective treatment for MS, however, a number of studies suggest that exercise interventions aimed to improve daily functioning of patients with MS are effective. Nine randomized controlled trials of exercise therapy for MS patients were included in this review six of which used no therapy as the comparator. There was strong evidence in favor of exercise therapy, compared to no therapy, regarding muscle function and mobility while no evidence was found of improved fatigue, in one study only. No one specifically targeted exercise program was more successful than others. No eleterious effects were described in the included studies.

 

摘要

背景

多發性硬化症之運動療法

截至目前為止，沒有明確的證據顯示任何一種介入性治療可以有效的改變多發性硬化症的長期預後，但是運動療法被認為可以提供這些病人症狀改善與控制的一個重要治療。

目標

以日常的活動能力與生活品質為依據來評估運動療法對多發性硬化症病人的效果

搜尋策略

我們搜尋了考科藍多發性硬化症組專門登錄(搜尋時間：2004年3月)、考科藍對照試驗中心登錄(中心)(考科藍圖書館,議題2, 2004年)、MEDLINE(從1966年到2004年3月)、EMBASE(從1988年到2004年3月)、CINAHL(從1982年到2004年3月)、PEDro(從1999年到2004年3月)。 手動搜尋雜誌“多發性硬化症”，以及篩選引用文獻列表裡確定的研究與文獻回顧。 我們也搜尋了學會發表論文集的摘要。

選擇標準

針對非急性發作期的多發性硬化症病人，採用運動療法的隨機對照試驗報告中，分析其預後指標包括活動受限程度或健康相關的生活品質或以上兩者。

資料收集與分析

兩個文獻回顧者互不受影響的分析資料與符合上述標準的試驗。相佐的意見藉由討論解決。結果以最佳證據分析的方式來分析。

主要結論

包括260位參與者的9個具有優良方法學品質的隨機對照試驗達到收錄標準，其中6個試驗主要在比較運動療法實行與否有何不同，另外3個試驗則比較不同的運動療法有無差異。結果發現有最佳的證據顯示施行運動療法，能改善肌肉力量、運動耐力、及身體移動相關的活動，改善情緒上也有中等程度的證據支持，至於疲倦感及殘障的認知情形在運動實行與否則無不同。最後，還沒有哪一種運動療法比起其他運動更能改善活動及參與度，這些研究並沒有提到運動療法有任何的副作用。

作者結論

目前本回顧的結果建議非急性發作的多發性硬化病人使用運動療法是有助益的，我們急迫的需要制定評估成效指標的共識。另外這些研究也必須實驗性的控制運動量、多發性硬化的型態並且有足夠的對照組。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對多發性硬化症病人而言，運動療法被視為是一種重要的症狀性與支持性的療法。多發性硬化症是一種慢性的中樞神經疾病。根據神經髓鞘受傷分佈的不同會導致失去力量，感覺，協調性或平衡感進而導致嚴重與漸進性生活功能上的侷限。到目前為止，尚未有有效的治療，然而，有很多的研究顯示以提昇日常生活功能為目的之運動的介入是有幫助的。此篇文獻回顧包含了9個隨機對照,探討針對多發性硬化症病人的運動療法之試驗，其中6個是沒有採取任何治療的對照組。有強烈的證據顯示出運動療法相對於沒有治療有其助益性，包括肌肉的功能、運動能力，但對於體力衰弱感則無助益(僅有一篇研究指出有幫助)。目前沒有任何一種特別的運動形式明顯優於其他種，在收錄研究裡，並沒有顯示出害處。