Development of Evidence-Informed Physical Activity Guidelines for Adults With Multiple Sclerosis
01 Sep 2013-Archives of Physical Medicine and Rehabilitation (Arch Phys Med Rehabil)-Vol. 94, Iss: 9, pp 1829-1836
TL;DR: The application of international standards for guideline development in the creation of evidence-based physical activity guidelines for people with MS are described, which state that to achieve important fitness benefits, adults with MS who have mild to moderate disability need at least 30 minutes of moderate intensity aerobic activity 2 times per week.
About: This article is published in Archives of Physical Medicine and Rehabilitation.The article was published on 2013-09-01. It has received 232 citations till now. The article focuses on the topics: Exercise prescription & Physical fitness.
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TL;DR: There is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength among those with mild to moderate disability from MS and exercise may improve mobility, fatigue, and health-related quality of life.
502 citations
TL;DR: Evidence from clinical trials that suggests beneficial effects of exercise training on muscle strength, aerobic capacity and walking performance, and on fatigue, gait, balance and quality of life is discussed.
Abstract: Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammatory demyelination and neurodegeneration within the CNS. This damage of CNS structures leads to deficits of body functions, which, in turn, affect patient activities, such as walking, and participation. The pathogenesis and resulting consequences of MS have been described as concepts within the International Classification of Functioning, Disability and Health (ICF) model--an international standard to describe and measure health and disability. Evidence suggests that exercise training in people with MS has the potential to target and improve many of the components outlined in the ICF model. Although the body of research examining the effects of exercise training on depression, cognition and participatory outcomes is not sufficiently developed, some preliminary evidence is promising. Exercise training is proposed to affect inflammation, neurodegeneration, and CNS structures, but current evidence is limited. In this Review, we discuss evidence from clinical trials that suggests beneficial effects of exercise training on muscle strength, aerobic capacity and walking performance, and on fatigue, gait, balance and quality of life. Issues with current studies and areas of future research are highlighted.
350 citations
TL;DR: The main limitations to promoting exercise through the patient-clinician interaction are the inadequate quality and scope of existing evidence, incomplete understanding of the mechanisms underlying the beneficial effects of exercise in people with multiple sclerosis, and the absence of a conceptual framework and toolkit for translating the evidence into practice.
Abstract: Summary Exercise can be a beneficial rehabilitation strategy for people with multiple sclerosis to manage symptoms, restore function, optimise quality of life, promote wellness, and boost participation in activities of daily living. However, this population typically engages in low levels of health-promoting physical activity compared with adults from the general population, a fact which has not changed in the past 25 years despite growing evidence of the benefits of exercise. To overcome this challenge, the main limitations to promoting exercise through the patient–clinician interaction must be addressed. These limitations are the inadequate quality and scope of existing evidence, incomplete understanding of the mechanisms underlying the beneficial effects of exercise in people with multiple sclerosis, and the absence of a conceptual framework and toolkit for translating the evidence into practice. Future research to address those limitations will be essential to inform decisions about the inclusion of exercise in the clinical care of people with multiple sclerosis.
278 citations
TL;DR: A systematic review of relapse and other AEs reported in randomized controlled trials (RCTs) of exercise training in MS found exercise training was not associated with an increased risk of relapse, and risk of AEs was not higher than in healthy populations.
201 citations
Cites background from "Development of Evidence-Informed Ph..."
...This is critical considering the evidence for benefits of exercise training in MS [2] combined with the development of guidelines for broad-scale promotion of exercise training in this population [3]....
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...[3] Latimer-Cheung AE, Martin Ginis KA, Hicks AL, et al....
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TL;DR: It is suggested that balance may improve through exercise interventions, but that the magnitude of the improvements achieved in existing programs may not be sufficient to impact falls outcomes.
135 citations
References
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TL;DR: It is shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies and it is possible to produce a Checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses.
Abstract: OBJECTIVE: To test the feasibility of creating a valid and reliable checklist with the following features: appropriate for assessing both randomised and non-randomised studies; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting, internal validity (bias and confounding) and power, but also for external validity. DESIGN: A pilot version was first developed, based on epidemiological principles, reviews, and existing checklists for randomised studies. Face and content validity were assessed by three experienced reviewers and reliability was determined using two raters assessing 10 randomised and 10 non-randomised studies. Using different raters, the checklist was revised and tested for internal consistency (Kuder-Richardson 20), test-retest and inter-rater reliability (Spearman correlation coefficient and sign rank test; kappa statistics), criterion validity, and respondent burden. MAIN RESULTS: The performance of the checklist improved considerably after revision of a pilot version. The Quality Index had high internal consistency (KR-20: 0.89) as did the subscales apart from external validity (KR-20: 0.54). Test-retest (r 0.88) and inter-rater (r 0.75) reliability of the Quality Index were good. Reliability of the subscales varied from good (bias) to poor (external validity). The Quality Index correlated highly with an existing, established instrument for assessing randomised studies (r 0.90). There was little difference between its performance with non-randomised and with randomised studies. Raters took about 20 minutes to assess each paper (range 10 to 45 minutes). CONCLUSIONS: This study has shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies. It has also shown that it is possible to produce a checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses. Further work is required to improve the checklist and the training of raters in the assessment of external validity.
6,849 citations
TL;DR: The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of randomized clinical trials (RCTs) and the final criteria list (the Delphi list) was satisfactory to all participants.
2,150 citations
TL;DR: The Canadian Society for Exercise Physiology, in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada, has developed the new Canadian Physical Activity Guidelines.
Abstract: The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stake- holders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5-11 years), Youth (aged 12-17 years), Adults (aged 18-64 years), and Older Adults (aged ‡65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guide- lines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evi- dence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines rep- resents the most current synthesis, interpretation, and application of the scientific evidence to date.
1,168 citations
Book•
13 Sep 2006
TL;DR: This chapter discusses skeletal Muscle Adaptation to Regular Physical Activity and Sedentary Behaviour and Inactivity Physiology, and an Integrated View of Physical Activity, Fitness and Health Index.
Abstract: Chapter 1 Why Study Physical Activity and Health? Chapter 4 Sedentary Behaviour and Inactivity Physiology Chapter 8 Skeletal Muscle Adaptation to Regular Physical Activity Chapter 17 Physical Activity, Fitness, and Children Chapter 23 From Science to Physical Activity Guidelines Chapter 25 An Integrated View of Physical Activity, Fitness and Health Index.
857 citations
TL;DR: Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified, and higher levels of physical activity reduce the risk for premature all-cause mortality.
Abstract: This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality.
830 citations