Response Heterogeneity With Exercise Training and Physical Activity Interventions Among Persons With Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a heterogeneous disease, both in its pathology and symptomology. This poses a challenge for the medical management and rehabilitation of MS; however, physical activity and exercise training are rehabilitation approaches that have demonstrated beneficial effects on many of the burdensome consequences of MS such as mobility impairment and fatigue. Given the heterogeneous course of MS, it is possible that outcomes of physical activity and exercise training interventions demonstrate heterogeneity both in the magnitude and pattern of change, but there has been little focus on response heterogeneity with these interventions among persons with MS. In this narrative review, a search of the existing literature was performed to identify studies that reported individual participant data, which was used to describe the variability in the response to physical activity and exercise training interventions among persons with MS. Inter-individual variability seemingly occurs across outcomes and modalities, which underscores the consideration of factors that might influence response heterogeneity. Factors related to MS disease characteristics, nervous system damage, and the degree of MS-related disability might influence individual responsiveness. Large-scale studies that permit the examination of heterogeneity and its predictors will inform future research on the area of physical activity and exercise training in MS, and lead to the development of individually tailored rehabilitation approaches that will more effectively elicit change.

Three distinct physical behavior types in fatigued patients with multiple sclerosis

“…Several interventions, including exercise training, have been developed to reduce fatigue by improving physical behavior, but the results are insufficient [9]. One explanation for this is that in MS patients, not only the general symptomology is heterogeneous, but also the response to exercise seems highly heterogeneous [10, 11]. As a consequence, considerable variability might be present in the symptoms of fatigue, PB, and in their interaction across and within patients [12, 13].…”

“…This suggests that patients with similar levels of fatigue are likely to show varying PB, and that interventions do not match PB starting levels of all patients. More insight in the variability of PB in fatigued MS patients is needed, as better understanding will contribute to the development of more personalized interventions and improve disease management in rehabilitation [10]. To date, the heterogeneity of PB at the start of interventions for fatigued MS patients has not been considered.…”

Data Collection in Multiple Sclerosis: The MSDS Approach

“…Medical care that is specially tailored to the patient improves the course of the disease by reducing side effects to a minimum. In addition, the acceptance of the medication is increased, which in turn improves the effect of the medication (55)(56)(57)(58).…”

VO2peak Response Heterogeneity in Persons with Multiple Sclerosis: To HIIT or Not to HIIT?

“…A recent published review concluded that response heterogeneity following exercise intervention still remains understudied among pwMS. Since many studies that present individual data were characterized by small samples, the value of information is limited [24].…”

“…In order to give more detailed, individualized training and rehabilitation recommendations for pwMS, it remains crucial to identify predictors influencing training response in larger cohorts [6,24]. Therefore, this secondary analysis of two RCTs in 131 pwMS examines participants' characteristics (gender, age, MS phenotype, neurological disability, baseline fatigue and baseline fitness) and the training modality as potential influencing factors on the training response following HIIT vs. MCT.…”