Developing a Customised Programme of Exercise to Reduce Fatigue and Improve Societal Participation in Kuwaiti Patients with Multiple Sclerosis

Abstract

Background: It is now widely accepted that physical training therapy is more reliable and effective than medication in improving fatigue in patients with Multiple Sclerosis (MS). However, efforts are still being made to maximise the benefits of training and hence increase
independence and optimise the levels of daily functioning in those patients. The present research is a step in that direction. Towards this end, a 12-week training programme with new design guidelines has been developed and tested on a group of fatigued Kuwaiti MS patients with no previous training experience.

Method: This was a mainly quasi controlled study (ABA design) with an independent assessor studying the effects of 12-week period of exercise on fatigue measure using the Modified Fatigue Impact Scale (MFIS). In addition to fatigue, a range of both quantitative and qualitative data were collected and these were: Expanded Disability Status Scale (EDSS), , Hospital Anxiety and Depression Scale (HADS), Barthel index (BI), Berg Balance Scale (BBS), Timed Up and Go (TUG), the 10-metre walk, the 6-minute walk, and the 9-Peg-hole test. Handgrip strength, knee, elbow and hip flexion and extension and shoulder adduction were also assessed. Two short and semi-structured interviews were administered to obtain additional information on the impact of fatigue on the participants and their attitude towards training.

The training programme consisted of 3x30-minute weekly sessions of resistance or combined training. Initially, combined training consisted of 15 minutes of treadmill walking, followed by 2 sets of 9 stretching and strengthening exercises, 15-20 repetitions. For resistance training, participants performed 3 sets of 15-20 reps of stretching and strengthening exercise. In week
7 onward, treadmill walking time was increased by 5 minutes, and resistance training sets were increased by one.

Results: We recruited 26 patients (mean age 37.54, 8 males and 18 females). Following the 12-week training programme, tests showed significant improvements in fatigue, fine mobility and static and dynamic balance (TUG); short duration walking speed (10m test);
exercise tolerance (6-minute walk); balance and fear of fall (BBS); left and right shoulder flexion and adduction, and left and right elbow, knee and hip flexion and extension (MMT). All these gains were still maintained four weeks after the training intervention had been terminated. However, there was no significant effect of training on anxiety and depression (HADS); mobility disability (EDSS); personal basic functional activities (B1); fine motor coordination and finger dexterity (9-HolePeg) and hand grip (JAMAR). Results of the study
also show that support for Kuwaiti MS patients is lacking and that the rigid cultural norms place those patients under a great deal of unnecessary stress and pressure

Conclusion: MS patients with mild to moderate disabilities can gain immensely from individualised and customised resistance and combined training programmes. There is good reason to suggest that their gains can be increased even further with improved attitude towards training. Societal stressors are a significant confounder and these need to be addressed before an randomised controlled trial is carried out.