Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: An 8-week randomized controlled trial.

BACKGROUND: Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS). A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS. OBJECTIVE: To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS. METHODS: A total of 80 PwMS (69 female) were randomized to twice-weekly home-based Pilates guided by a DVD) or wait-list control. Validated questionnaires assessed anxiety, depressive and fatigue symptoms at baseline, weeks 2, 4, 6 and 8. Using intention to treat, repeated measures analysis of covariance (RM-ANCOVA) adjusted for baseline physical activity examined between-group differences across time. Hedges' d quantified the magnitude of differences in outcome change. Sensitivity analyses examined female-only samples. RESULTS: Group × time interactions were statistically significant for all outcomes (all p ⩽ 0.005). Pilates significantly reduced (all p ⩽ 0.03) depressive symptoms (Quick Inventory of Depressive Symptomatology, d = 0.70; Hospital Anxiety and Depression Scale-Depression, d = 0.74), anxiety (State-Trait Anxiety Inventory, d = 0.30; Hospital Anxiety and Depression Scale-Anxiety, d = 0.49), cognitive (d = 0.44), physical (d = 0.78), psychosocial (d = 0.56) and total fatigue (d = 0.76). Female-only results were materially the same. CONCLUSION: Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms among PwMS with minimal-to-mild mobility disability, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms.Trial Registration: ClinicalTrials.gov (NCT04120207).

Participant experiences of eight weeks of supervised or home-based Pilates among people with multiple sclerosis: a qualitative analysis.

PURPOSE: An exploratory qualitative study investigating participants' experiences of a feasibility study of supervised and home-based Pilates. METHODS: All 10 females who participated in an eight-week supervised (n = 4) or home-based Pilates (n = 6) program were invited and agreed to be interviewed. Data were collected via semi-structured interviews and researcher observations of participant experiences. Data were analysed using codebook thematic analysis framework. RESULTS: Two domain summaries emerged: (1) the suitability of home-based Pilates in particular for this population. Participants indicated that supervised and home-based Pilates was a safe, intensity-appropriate, and implementable exercise method to improve mental health outcomes among persons with multiple sclerosis (PwMS), and (2) the benefits experienced by PwMS while participating in Pilates. Home-based Pilates reduced both exercise participation and accessibility barriers commonly experienced by PwMS. Furthermore, PwMS reported improvements in mental health outcomes following Pilates, in both exercise environments. CONCLUSIONS: PwMS reported experiencing improved mood following regular Pilates training and indicated that home-based in particular reduced barriers regularly experienced by this population. Results support Pilates as a feasible exercise modality providing potential mood improvements among PwMS. Future appropriately powered home-based randomised controlled trials to further explore the effects of Pilates training on mental health among PwMS with minimal-to-mild mobility disability are warranted.Implications for RehabilitationParticipants in this study described the mental health benefits experienced from engaging in Pilates, a non-traditional exercise modality.Home-based Pilates overcame participatory and accessibility barriers to exercise among people with multiple sclerosis (MS).Participants valued that Pilates was low intensity and did not exacerbate fatigue.Home-based Pilates is a feasible exercise method for people with MS with minimal-to-mild mobility disability.

Moderators of Exercise Effects on Depressive Symptoms in Multiple Sclerosis: A Meta-regression.

CONTEXT: This study examined the extent to which patient and trial characteristics moderate the effects of exercise on depressive symptoms among people with multiple sclerosis. EVIDENCE ACQUISITION: Twenty-four effects were derived from 14 articles published before August 2016 located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Trials involved 624 people with multiple sclerosis and included both randomization to exercise training or a non-exercise control condition and measurement of depressive symptoms at baseline and at mid- and/or post-intervention. Hedges' d effect sizes were computed, study quality was assessed, and random effects models were used for all analyses. Meta-regression quantified the extent to which patient and trial characteristics moderated the estimated population effect. Analyses were completed in September 2016 and updated in February 2017. EVIDENCE SYNTHESIS: Exercise training significantly reduced depressive symptoms by a heterogeneous mean effect Δ of 0.55 (95% CI=0.31, 0.78, p<0.001). Significant improvement in fatigue moderated the overall effect (ß=0.37, p≤0.03). Significantly larger antidepressant effects resulted from trials in which exercise significantly improved fatigue (Δ=1.04, 95% CI=0.53, 1.55, k=8) compared with no significant improvement in fatigue (Δ=0.41, 95% CI=0.21, 0.60, k=14, z=2.91, p≤0.004). CONCLUSIONS: Exercise significantly improves depressive symptoms among people with multiple sclerosis. Exercise-induced improvements in fatigue significantly moderated exercise effects on depressive symptoms. Future trials may benefit from focusing on using exercise to concurrently improve depressive symptoms and fatigue as a symptom cluster.

Physical rehabilitation interventions in nonambulatory people with multiple sclerosis: a systematic review.

There is an expanding body of research on exercise intervention for multidisciplinary rehabilitation of people with multiple sclerosis (PwMS). Most of this research focuses on people with mild/moderate MS who are ambulatory. As the costs of care increases with increasing disability, it is important to evaluate the evidence for interventions in nonambulatory PwMS. The aim of this study was to evaluate the evidence regarding physical rehabilitation interventions in nonambulatory PwMS. The databases AMED, CINAHL, MEDLINE, EMBASE and PSYCHARTICLES were searched up to 31 May 2011. Reference lists, Google Scholar and PEDro were also searched. Trials of physical rehabilitation interventions in nonambulatory PwMS that analysed nonambulatory results separately were included. Pharmacological, surgical, medical and assistive device interventions were excluded. Risk of bias was assessed and the GRADE approach was used to classify the quality of evidence. Sixteen low-grade studies, only three of which were randomized controlled trials (RCTs), were found. There are trends of improvement following some interventions such as cooling suits, respiratory training and multidisciplinary rehabilitation, but there is no high-grade evidence in terms of the benefits of interventions in this population. The effectiveness of physical rehabilitation interventions in nonambulatory PwMS remains unclear. Although trends in the results suggest positive benefits, conclusions cannot be drawn about the effectiveness of interventions in this population because of the small number and poor quality of studies. As approximately 25% of PwMS are nonambulatory and considerable costs are associated with their care, it is imperative that efforts be to increase the quality of evidence for nonambulatory PwMS.