DALLAS – Exercise is generally safe for individuals with multiple sclerosis, according to a systematic review of randomized, controlled trials, supporting the promotion of exercise in this patient group.
The analysis showed that persons with MS who exercised had 27% lower risk of relapse, compared with patients who didn’t exercise. However, those who exercised had a 67% higher risk of adverse events, but the rate was no higher than adverse events (AEs) in healthy populations.
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Researchers found that people with multiple sclerosis who exercise have a lower risk of relapse in comparison with other MS patients who did not exercise.
"Patients with MS should not be deterred from exercise participation for concern of experiencing a relapse or adverse events, and such patients would further be expected to experience the many benefits of exercise training documented in the literature," wrote Mr. Matthew E. Platta and his colleagues in a study that was published in the Journal of the Neurological Sciences (2014 May 19 [doi:10.1016/j.jns.2014.05.016]).
Although reviews have shown the benefits of exercise for individuals with MS, none have looked at the risks of relapse and other AEs, Mr. Platta said at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.
Mr. Platta, a graduate student in the department of kinesiology and community health at the University of Illinois at Urbana-Champaign, and his colleagues analyzed 26 trials, including 1,295 participants. The trials were published up to November 2013 and examined the effect of exercise on MS relapses and adverse events. All trials included a nontreatment control arm.
The exercises included yoga, resistance training, aerobics, aquatics, and combined aerobics and resistance training.
Results showed that there were 26 relapses in the control groups, compared with 29 in the exercise group, corresponding with 6.3% and 4.6% of participants in the control and exercise groups, respectively.
The exercise group also had a 27% lower relative risk of relapse.
As for AEs, there were 5 in the control group, compared with 13 in the exercise group (or 1.2% and 2.0% in each group, respectively).
But the exercise group had a 67% higher relative risk of AEs, compared with the control group. However, the rate was not higher than the rates of AEs associated with exercise training in healthy populations, the researchers said.
The most common AEs in the control group were illness, ankle sprain, knee pain, and fall. The exercise group had additional AEs, including stroke, low back pain, trigeminal neuralgia, traffic accident, upper respiratory tract infection, rheumatoid arthritis flare up, and hernia. The most common types of AEs were musculoskeletal injuries (46%) and illnesses (23%).
"MS patients and clinicians can expect a low occurrence of AEs with exercise training, and, when AEs do occur, such events are commonly musculoskeletal in nature," Mr. Platta and his colleagues wrote.
There was no difference in the dropout rate between the two groups. The authors noted that "Future research might consider the inclusion of behavioral strategies for reducing dropout in RCTs of exercise training in MS."
They said that some of the analysis limitations include lack of complete reporting on the exercise training protocols, and potential for attention bias in the exercise group, compared with the control group.
Also, there was considerable variation in the type and prescription of exercises, they said. The sessions were between 1 and 5 days per week for 20-90 minutes per day. The duration of the programs was 4-24 weeks. Mr. Platta said there were too few trials to analyze the effect of different types of exercise separately.
The authors added that it is also important to record frequency and severity of temporary symptomatic changes in response to acute exercise bouts.
"Take-home message is that, taking into account that there are a lot of benefits to exercise, our findings show that the amount of relapses and adverse events are not too high to prevent physicians from recommending exercise [to individuals with MS]."
Mr. Platta and his coauthors had no disclosures.
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