Fatigue is a significant symptom that people with Multiple Sclerosis (MS) suffer from. It is the most commonly reported symptom with around 75-95% of people with MS experiencing fatigue. 50-60% also report fatigue as their worst problem, and many report it as a major reason for unemployment. Fatigue has been defined by the Multiple Sclerosis Council for Clinical Practice Guidelines (1998) as “a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual or desired activities.” It is important to note that this fatigue is different to “normal” fatigue in terms of ease of onset, interference with physical functioning and role fulfillment, as well as the impact of heat on fatigue.
Much research has gone into the management of fatigue in MS. There are a number of medications used, though none of these have proven effective in completely alleviating or managing this symptom. So what about exercise? In the past, and as recently as 2005, the common perception regarding exercise in MS is that it would have a detrimental effect on fatigue. However, a large body of evidence is emerging to support the opposite….exercise of a moderate intensity can actually reduce fatigue levels.
A large group based exercise study was recently published by Tarakci et al (2013). They randomised 99 patients into either the exercise group or a waitlist control. The intervention group completed three times per week exercise classes for twelve weeks. The 60-minute exercise sessions consisted of flexibility, range of motion, strengthening, core stabilisation, balance, coordination and functional activities. The patients were asked to exercise at a moderate intensity. The results showed a decrease in fatigue measured by a subjective questionnaire in the exercise group. Interestingly, however, in this study was the finding that the control group had an increase in their fatigue scores. Hence, this study suggests that not only can exercise improve fatigue, but also lack of exercise can cause fatigue levels to increase. This result can have significant impact on the way health professionals and people with MS approach exercise.
This study is simply one of many that I found through a search of the literature to support the use of exercise to help manage fatigue in people with MS. While there have been some studies that have not shown a particular benefit to fatigue, there have been no studies which have shown a worsening of fatigue levels. It appears, through reading the literature however, that exercise needs to be of a moderate intensity and performed regularly over a period of time. Some short studies that measured the effects over a 3 week period failed to detect any meaningful change, indicating that exercise needs to become a habit that is practiced over the long term.
So if you have, or know anyone with, MS who suffers from fatigue, send them in the direction of a Neurological Physiotherapist who can advise them on how to use exercise to help manage this disabling symptom.
Tarakci, E., Yelden, I., Huseyinsinoglu, B.E., Zenginler, Y., & Eraksoy, M. (2013). Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomised controlled trial. Clinical Rehabilitation, 27, 813-822.