Combining energy management education with high-intensity interval training improves physical functioning and mental health in patients with multiple sclerosis.

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“In our previous MS studies comparing high-intensity interval training (HIIT) with moderate continuous training (MCT) during 3 weeks of inpatient rehabilitation, we found that HIIT is more effective in improving cardiorespiratory fitness (maximal oxygen uptake; VO_2peak) and behind-the-scenes serum concentrations of disease-associated biomarkers,” Nadine Patt, PhD-candidate, explains. “However, studies on the long-term effects of HIIT on HRQOL were lacking.”

Patt and colleagues also compared inpatient energy management education (IEME) with progressive muscle relaxation (PMR) during 3 weeks of inpatient rehabilitation in patients with MS in previous work, which showed that IEME had higher scores in the physical functioning HRQOL domain. While IEME resulted in better physical functioning at 4-month follow-up, it was unknown whether this effect persists until the 6-month follow-up, Patt says.

Further, the effects of exercise on subjective measures, such as fatigue, and studies on the long-term effects of HIIT on HRQOL were lacking. “Additionally, patient-reported outcome measures (PROMs) are often included only as secondary endpoints,” Patt says. “Therefore, we aimed to combine HIIT with IEME and investigate the effects of the combination on HRQOL at 6-month follow-up.”

For a study published in Multiple Sclerosis and Related Disorders, the researchers compared IEME plus HIIT with PMR plus moderate continuous training (MCT) in patients with MS and fatigue.

IEME Plus HIIT Led to Better Fitness, Energy Conversion

The randomized controlled superiority trial enrolled 106 patients with MS (median age, 49.75 years; 66% female; EDSS score, 4.64) from the Valens Clinic. As inpatients for 3 weeks, the experimental group performed IEME twice and HIIT 3 times per week, and the usual care group performed PMR twice and MCT 3 times per week. The primary outcome was HRQOL, assessed at clinic entry, after 3 weeks’ rehabilitation, and 4 and 6 months after clinic entry. Secondary outcomes were scores for Short Form-36 subscales, fatigue, self-efficacy for performing energy conservation strategies, self-perceived competence in activities of daily living, and cardiorespiratory fitness.

Using a mixed model for repeated measures approach, the authors found no significant group–time interaction effects between the two groups in the primary or secondary outcomes. However, pairwise comparisons of group–time interaction revealed several significant differences at specific timepoints that favored IEME plus HIIT. That group had better cardiorespiratory fitness (P=0.011) after 3 weeks’ rehabilitation, better energy conversation, and less anxiety at 4 months after clinic entry (P=0.032), and better physical functioning and energy conservation at 6 months after clinic entry.

“The IEME plus HIIT group had improved self-efficacy for structuring their everyday life depending on their current energy resources and were able to cope with their fatigue more efficiently,” says Patt. “These between-group differences were observed at different timepoints and need to be considered in clinical practice (Figure).”

Directions for Future Research

There is a need for more multicenter studies with a large group of participants that focus on outcomes at least 3 months postdischarge, Patt explains.

“Additionally, PROMs should be assessed as primary outcomes, not just biomarkers,” says Patt. “Further research on multidisciplinary interventions to improve the HRQOL of patients with MS is warranted to provide sustainable multidisciplinary rehabilitation interventions for patients with MS and fatigue. To sustain HRQOL improvements beyond the 3-week inpatient rehabilitation stay and to improve the sustainability of the intervention effects, research should also address the continuity of outpatient care after patients with MS are discharged from inpatient settings.”

While the results of the study need to be verified, the researchers believe they support the value of exercise, no matter what modality patients with MS choose.

“Patients with MS should be encouraged to exercise despite fatigue and to use diaries to analyze their energy profiles and structure their daily routines,” Patt continues. “Exercise quickly increases fitness and energy levels, allowing patients with MS to maintain active and satisfying daily lives that include social participation.”