Effects of inpatient energy management education and high-intensity interval training on health-related quality of life in persons with multiple sclerosis: A randomized controlled superiority trial with six-month follow-up

Nadine Patt; Marie Kupjetz; Jan Kool; Ruth Hersche; Max Oberste; Niklas Joisten; Roman Gonzenbach; Claudio Renato Nigg; Philipp Zimmer; Jens Bansi

doi:10.1016/j.msard.2023.104929

Effects of inpatient energy management education and high-intensity interval training on health-related quality of life in persons with multiple sclerosis: A randomized controlled superiority trial with six-month follow-up

Mult Scler Relat Disord. 2023 Oct:78:104929. doi: 10.1016/j.msard.2023.104929. Epub 2023 Aug 6.

Authors

Affiliations

¹ Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317 Valens, Switzerland; Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland. Electronic address: [email protected].
² Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Otto-Hahn-Straße 3, 44227 Dortmund, Germany.
³ Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317 Valens, Switzerland.
⁴ Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928 Manno, Switzerland.
⁵ Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931 Cologne, Germany.
⁶ Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; Department of Health Science, Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012 Bern, Switzerland.
⁷ Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317 Valens, Switzerland; Department of Health, Physiotherapy, OST - Eastern Swiss University of Applied Sciences, Rosenbergstrasse 59, 9001 St.Gallen, Switzerland.

PMID: 37579643
DOI: 10.1016/j.msard.2023.104929

Abstract

Background: Fatigue is one of the most frequent symptoms in persons with multiple sclerosis (pwMS) and impacts health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for the treatment of fatigue in pwMS. However, high-quality evidence exists only for unimodal interventions, such as physical therapies/exercise or energy/fatigue management programmes. The primary objective of the current study was to test the hypothesis that a combination of inpatient energy management education (IEME) and high-intensity interval training (HIIT) is superior to a combination of progressive muscle relaxation (PMR) and moderate continuous training (MCT) for improving HRQoL at 6-month follow-up in fatigued pwMS.

Methods: A randomized (1:1) controlled superiority trial with fatigued pwMS >18 years of age, with Expanded Disability Status Scale (EDSS) score ≤6.5, recruited at the Valens clinic, Switzerland. Participants in the experimental group performed IEME twice and HIIT 3 times per week and those in the usual care group performed PMR twice and MCT 3 times per week, during a 3-week inpatient rehabilitation stay. Primary outcome was HRQoL (Physical and Mental Component Scales of the Medical Outcome Study 36-item Short Form Health Survey (SF-36)), assessed at entry to the clinic (T₀), after 3 weeks' rehabilitation (T₁) and 4 (T₂) and 6 (T₃) months after T₀. Secondary outcomes included SF-36 subscales, fatigue (Fatigue Scale for Motor and Cognitive Functions (FSMC)), mood (Hospital Anxiety and Depression Scale (HADS)), self-efficacy for performing energy conservation strategies (Self-Efficacy for Performing Energy Conservation Strategies Assessment (SEPECSA)), self-perceived competence in activities of daily living (Occupational Self Assessment (OSA)) and cardiorespiratory fitness (peak oxygen consumption (VȮ_2peak)). Data were analysed using a mixed model for repeated measures approach.

Results: A total of 106 pwMS (age (years): 49.75 (9.87), 66% female, EDSS: 4.64 (1.32)) were recruited. There were no significant group × time interaction effects in the primary and secondary outcomes. There were significant between-group differences in the pairwise comparisons of the group × time interaction in favour of the IEME + HIIT group at: (i) T₁ in cardiorespiratory fitness (p = 0.011) and SEPECSA (p = 0.032); (ii) T₂ in SF-36 mental health subscale (p = 0.022), HADS anxiety subscale (p = 0.014) and SEPECSA (p = 0.040); (iii) T₃ in SF-36 physical functioning subscale (p = 0.012) and SEPECSA (p = 0.003).

Conclusion: IEME + HIIT was not superior to PMR + MCT regarding the effects on HRQoL (SF-36 Physical and Mental Component Scales) at 6-month follow-up in pwMS. However, there were significant between-group differences in favour of IEME + HIIT in physical functioning and mental health (SF-36 subscales), anxiety (HADS), cardiorespiratory fitness (VȮ_2peak) and self-efficacy (SEPECSA) at different measurement time-points that need to be considered in clinical practice.

Keywords: Energy management education; Fatigue; Health-related quality of life; High-intensity interval training; Multidisciplinary rehabilitation; Multiple sclerosis.