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Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities
Collett J, Dawes H, Meaney A, Sackley C, Barker K, Wade D, Izardi H, Bateman J, Duda J, Buckingham E
Multiple Sclerosis Journal 2011 May;17(5):594-603
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The most effective exercise dose has yet to be established for multiple sclerosis (MS). OBJECTIVE: The aim of this study was to investigate the effect of different exercise intensities in people with MS. METHODS: We completed a randomized comparator study of three cycling exercise intensities, with blinded assessment, was carried out in Oxford. Sixty-one adults with MS who fulfilled inclusion criteria were randomized at entry into the study, using a computer-generated list held by an exercise professional, into either: continuous (at 45% peak power, n = 20), intermittent (30 sec on, 30 sec off at 90% peak power, n = 21) or combined (10 min intermittent at 90% peak power then 10 min continuous at 45% peak power, n = 20) exercise for 20 min twice a week for 12 weeks in a leisure facility. Groups were assessed at: baseline, halfway (6 weeks), end intervention (12 weeks) and follow-up (24 weeks). Primary outcome measure was 2 min walk. RESULTS: Fifty-five participants were included in the analysis (n = continuous 20, intermittent 18, combined 17). No differences were found between groups. After 6 weeks, considering all participants, 2 min walk distance increased by 6.96 +/- 2.56m (95% CI 1.81 to 12.10, effect size (ES) 0.25, p < 0.01). The continuous group increased by 4.71 +/- 4.24m (95% CI -3.80 to 13.22, ES 0.06), intermittent by 12.94 +/- 4.71m (95% CI 3.97 to 21.92, ES 0.28) and combined by 3.22 +/- 4.60m (95% CI -6.01 to 12.46, ES 0.04). Two minute walk did not significantly change between further assessments. Between 6 and 12 weeks there was a drop in attendance that seemed to be associated with the intermittent and combined groups; these groups also had a greater number of adverse events (leg pain during cycling most common) and dropouts (n = continuous 1, intermittent 5, combined 10). Considering all participants, 6 weeks of cycling exercise produced benefits in mobility that were maintained with further sessions. CONCLUSION: While no differences were found between groups, greater benefit may be associated with higher-intensity exercise, but this may be less well tolerated.

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