A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis.

The impact of flavonoids on fatigue has not been investigated in relapsing and remitting multiple sclerosis (RRMS). OBJECTIVE: To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS. METHODS: A randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley, UK (ISRCTN69897291). During a 6-week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation. RESULTS: 40 people with multiple sclerosis (10 men, 30 women, age 44±10 years) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data were <20% and adherence to intervention of allocated individuals was >75%. There was a small effect on fatigue (Neuro-QoL: effect size (ES) 0.04, 95% CI -0.40 to 0.48) and a moderate effect on fatigability (6 min walk test: ES 0.45, 95% CI -0.18 to 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved. CONCLUSION: A flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS.

Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities.

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±2.56 m (95% CI: 1.81 to 12.10, effect size (es): 0.25, p<0.01). The continuous group increased by 4.71±4.24 m (95% CI: -3.80 to 13.22, es: 0.06), intermittent by 12.94±4.71 m (95% CI: 3.97 to 21.92, es: 0.28) and combined by 3.22±4.60 m (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. CONSORT-trial registration number (ISRCTN89009719).

Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs.

People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.