Although it’s not surprising that inactive people with multiple sclerosis (MS) benefit from moderate regular exercise, a new study reported in BioMed Central Neurology shows that the benefits may be enhanced by the addition of social cognitive theory (SCT) education. At 3 months follow-up to the Step It Up multicenter randomized controlled trial conducted in inactive patients with MS with mild to moderate disability, patients who used SCT plus exercise showed greater cognitive processing abilities and improvements in aerobic capacity compared with patients who did not undergo SCT training.
The investigators recruited 65 patients, 18 or older with confirmed MS and Patient Determine Disease Steps (PDDS) scores from 0 to 3 from 3 urban neurology clinics in the Republic of Ireland. All patients at baseline reported sedentary lifestyles measured as <30 minutes of strenuous exercise weekly over the past 6 months.
All patients in the Step It Up study undertook a progressive exercise program designed to achieve the minimal recommended guidelines for people with mild to moderate MS — 30 minutes of moderate aerobic exercise and resistance exercise twice per week — by the end of the 10-week intervention trial. Each patient attended 6 group exercise classes and were randomly assigned to participate in either attention control sessions or SCT. The first group (n=32) received education on topics such as diet, vitamin D, hydration, vaccination, and other health issues unrelated to exercise. The SCT group (n=33) received alternative education aimed at behavior changes that included self-efficacy training, setting goals and outcome expectations, overcoming barriers, and understanding exercise benefits.
There were no statistically significant differences between the two groups in secondary outcomes by the end of the trial; however, at 3-month follow up, “small-to-moderate improvements” in symptoms of anxiety and depression began to emerge that were associated only with the addition of SCT. These small benefits (.25 to .50 improvements in standard deviation), along with similar improvements in perceptions of the psychological impact of MS, cognitive processing speed, aerobic capacity, estimated energy expenditure, exercise planning, and social support, were all maintained at 6-month follow-up.
Overall, both groups showed improvements in quantity of physical activity and strength, and the study reconfirmed the positive effects of exercise on fatigue in MS. Both types of education were associated with improvements in goal-setting behavior at 3 and 6 months, although the expected improvements in self-efficacy as a result of SCT were not significant compared with the control group.
The main limitation to the study was that it was not adequately powered to full assess secondary outcomes, but the results did suggest trends toward secondary benefits to SCT worth further exploration.
Coote S, Uszynski M, Herring MP, et al. Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education – secondary results of the step it up randomised controlled trial [published online June 24, 2017]. BMC Neurology. doi:10.1186/s12883-017-0898-y