Measuring the Effects of the Commonest Exercise Programs on Subjective Fatigue in People with MS: A Randomized Effectiveness Trial, 2026, Anna Boi

[Mij]

Abstract

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Purpose:​

To test and compare the effects of the four most common exercise-based interventions employed to manage subjective fatigue and functional impairments due to multiple sclerosis.

Methods:​

Persons with multiple sclerosis complaining of fatigue as a main symptom were enrolled. After a comprehensive baseline assessment evaluating subjective fatigue impact and severity (primary endpoints), quality of life, cardiorespiratory performance, and mobility and motor-functional outcomes, participants were randomly assigned to an 8-wk intervention consisting of strength training (ST) or aerobic training (AT) or strength + aerobic (Combo) or global rehabilitation (Rehab).

Results:​

Sixty-two mildly–moderately disabled PwMS (median Expanded Disability Status Scale 3.5 ± 1.6; age 46.6 ± 11.8 yr; 75% women) completed the study. No adverse events were reported. Between-group comparisons did not detect significant differences among groups. Considering training-induced effects separately for each group, AT showed the largest reduction in the Fatigue Severity Score (−18.8%; −0.81 points [pts], confidence interval [CI]: −1.53, −0.09, P = 0.03), followed by ST (−16.8%; −0.84 pts, CI: −1.56, −0.12, P = 0.02). Fatigue impact assessed by Modified Fatigue Impact Scale was significantly reduced after AT (−35.3%; −12.44 pts, CI: −19.00, −5.87, P < 0.01), followed by Combo (−33.8%; −13.36 pts; CI: −20.38, −6.34, P < 0.01) and Rehab (−26.2%; −8.18 pts; CI: −16.10, −0.26, P = 0.04). Regarding motor-functional outcomes, beyond the expected training-specific effects (e.g., muscle strength gains after ST, increased cardiorespiratory fitness after AT), comfortable and fastest walking speed increased significantly after Rehab (+0.16 m·s−1, CI: 0.08, 0.23, P < 0.01; +0.22 m·s−1, CI: 0.11, 0.329, P < 0.01, respectively) exceeding established thresholds for clinically important changes. Also, the increased distance covered in 6 min was found to exceed clinically important thresholds after ST (+55 m, CI: 9.15, 101.02, P = 0.02) and Combo (+62 m, CI: 14.04, 109.13, P = 0.01).

Conclusions:​

Although the superiority of one treatment over the others has yet to be claimed, and all interventions proved beneficial to reduce fatigue impact, only AT and ST reduced both fatigue severity and impact, with the former intervention associated with the largest within-group effect sizes. When testing the effects of interventions on mobility outcomes, AT led to the largest improvements, followed by Combo.
LINK

 

[Utsikt]

Regarding motor-functional outcomes, beyond the expected training-specific effects (e.g., muscle strength gains after ST, increased cardiorespiratory fitness after AT), comfortable and fastest walking speed increased significantly after Rehab (+0.16 m·s−1, CI: 0.08, 0.23, P < 0.01; +0.22 m·s−1, CI: 0.11, 0.329, P < 0.01, respectively) exceeding established thresholds for clinically important changes. Also, the increased distance covered in 6 min was found to exceed clinically important thresholds after ST (+55 m, CI: 9.15, 101.02, P = 0.02) and Combo (+62 m, CI: 14.04, 109.13, P = 0.01).

So now increased fitness isn’t an expected training-specific effect?

There is no mention of the results of the QoL measurements in the abstract - were they negative?

What about baseline values of BMI, fitness, activity levels?

 

[Peter T]

As the article seems to be behind a paywall it is not possible to tell from just the abstract where participants were in the course of their MS. Given some 85% of MS involves a relapsing and remitting course, evaluating any impact of any interventions requires some consideration of whether or not the subjects are concurrently experiencing some spontaneous remission.

Also given all groups displayed some ‘improvement’ surely a no treatment control and a non exercise intervention arm are required. On the basis of the abstract it could be that an eight week flower arranging course or any other intervention might have an equally positive effect.

 

[rvallee]

I don't see how this tells us anything about any of this. There is no control group, too many variations and differences between people in a fluctuating disease. It's also taken entirely in isolation, which is ironic given the whole "holistic" marketing. This requires commitment, time and energy. Do they have to compensate other exertion in order to keep up with it?

This whole way of doing things isn't good enough. Clinical trials concluding things like "the superiority of one treatment over the others has yet to be claimed" only adds up more confusion than anything. And then they try to suggest that superiority anyway. Plus all the measures, at least they are actual measures, are the target of the treatment. Being better at playing with a yo-yo may be a fine outcome for a yo-yo skills program, but it doesn't mean anything outside of that. This fundamentally misunderstands fatigue, as is tradition.

It's fine to sell food with disclaimers such as "may contain traces of date kernels". It's not fine to sell a package of dates that "may contain dates".

Ironically a main takeaway, if the results could be somehow interpreted, is that rehabilitation doesn't seem to add anything. And why would it? But I wouldn't base this on this single trial, it just doesn't tell us much that is useful, and not because the paper is behind a pay-wall.

In the end this is the same as the most generic advice that can be claimed with some confidence about exercise: move, a bit, don't sit too long at a time, find something enjoyable, change as needed if it gets boring, benefits taper off quickly unless you need to be fit".