Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with MS, 2020

[rvallee]

Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with Multiple Sclerosis

https://www.mdpi.com/1660-4601/18/1/17/htm

Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84–77.96); p = 0.03) and lessens activity variability (Mean difference = −0.63; 95% CI (−1.25–0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = −0.36; 95% CI (−1.02–0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.

Not very relevant to us but always interesting to see how similar studies are run in other diseases. I am not aware if PEM is a thing in MS, rare or not.

One interesting thing is the definition of pacing:

Activity pacing is a strategy to divide one’s daily activities into smaller, more manageable portions, in a way that should not exacerbate their symptoms, which then allows gradual progressive increases in activity

The last sentence is definitely more aspirational about what pacing should do, rather than what it is.

We hypothesise the approach would decrease fatigue, increase activity levels, and decrease activity variability in people with MS.

Results:

Significant group × time interactions were found, showing an increase in activity level (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84–77.96); p = 0.03) and a lessened activity variability (a more even spread of activities throughout the day)

No significant interaction or main effect of time were detected in fatigue severity

 

[InitialConditions]

I spot Excel plots...

 

[NelliePledge]

That description of pacing is pacing up not pacing yourself

 

[Snow Leopard]

I spot Excel plots...

I remember those in my undergraduate days. We'd get bad marks for producing ugly plots like this, and especially those awful horizontal scale lines.

 

[InitialConditions]

I remember those in my undergraduate days. We'd get bad marks for producing ugly plots like this, and especially those awful horizontal scale lines.

Yes, and sometimes it's more serious than just looking terrible. Excel is not really fit to do publication-quality data and statistical analysis.

 

[Woolie]

So, prescribing an activity programme which incorporates a gradually increasing component causes people to increase their activity. That's a demonstration of compliance, not an outcome. There was no accompanying reduction in self-reported fatigue.

Even as a demonstration of compliance the results are not that persuasive. Participant numbers are very low (less than a dozen people per group), and the intervention and control groups were not matched on baseline activity levels at all. The control group was far less active to start with.

I really hope this doesn't give health professionals licence to go around telling MS patients what's "best for them".