Disease-Modifying Therapies Affect Quality of Life Differently for Men and Women
After three years of disease-modifying therapy (DMT) for multiple sclerosis (MS), physical health-related quality of life (HRQL) declines were experienced by both men and women, but especially in men, according to a study presented at the Fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). Karen V. L. Turpin, MSc, BScN, a PhD student at the University of Alberta in Edmonton, Canada, and colleagues examined the course of changes in HRQL over a three-year period in men and women with relapsing-remitting MS who were being treated with DMTs. The researchers used data from a study of 185 patients with relapsing-remitting MS carried out in Saskatchewan, Canada, that was designed to evaluate the long-term impact of DMTs. Study participants completed the SF-36 HRQL survey at three time points: pre-DMT, follow-up at one year, and follow-up at three years. The researchers investigated the course of changes over time in SF-36 subscale scores and the summary scale scores stratified by sex.
The majority of the sample was female (70.3%). The average age of the sample at the study initiation was 39.2, and the average Expanded Disability Status Scale (EDSS) score was 2.4 (ambulatory with minimal to mild disability). For women, there were initial improvements in all scores at one year. At two years, all scores had decreased and three of the physical health subtest scores (but not the mental health scores) had fallen below initial values. Men showed improvement at one year on role limitations due to physical and mental health problems and on the mental health summary scale. Most men’s gains were retained through year three, but there were substantial declines in the physical HRQL domain scores that were greater than declines experienced by women.
Overall, the researchers found that, compared with pre-DMT scores, there were sustained improvements in mental health at three years, but declines in physical health. Sex differences were apparent in the patterns of improvement and worsening over the course of the three-year follow-up, with the degree of improvement and worsening being especially marked for men. The sustained improvement in mental health scores suggests that, despite a worsening physical health, DMTs may lead to better mental and social health. This is important, the researchers said, because psychosocial well-being has been reported to be the most salient aspect of health for persons with relapsing-remitting MS.
Exercise Training Reduces Fatigue in Patients With MS
Exercise training is associated with a significant moderate reduction in fatigue among patients with multiple sclerosis (MS), according to data presented at the Fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).
Lara A. Pilutti, PhD, from the University of Illinois at Urbana-Champaign, and colleagues conducted a meta-analysis to provide a quantitative review of randomized controlled trials examining the effects of exercise training on symptomatic fatigue in persons with MS. Electronic databases (eg, Web of Science, PubMed, PsycINFO, and Google Scholar) were searched for articles published between 1960 and October 2012 using the key words fatigue, tiredness, energy, mood, or lassitude in combination with exercise, physical activity, rehabilitation, or fitness with the additional search term multiple sclerosis. The initial search resulted in 311 articles, of which 74 were reviewed in detail, and 17 met inclusion criteria and provided enough data to compute effect sizes.
The 43 effect sizes from 17 randomized controlled trials with 568 MS participants yielded a weighted mean effect size of 0.45. The weighted mean effect size was slightly heterogeneous. Exploratory moderator analyses indicated that study location, disease duration, training supervision, and mode of exercise might be important variables for understanding the effects of exercise training on symptomatic fatigue.
Overall, exercise training was associated with a significant, nearly one-half standard deviation reduction in symptomatic fatigue among persons with MS. The overall effect size was substantially higher than that reported in other meta-analyses examining the effect of exercise training on walking mobility and quality of life. Further, the researchers reported that the overall effect size found in this study represents a clinically significant change in fatigue with exercise training based on a one-point change in Fatigue Severity Scale scores.
The cumulative evidence supports the association of exercise training with a significant, moderate reduction in fatigue among persons with MS. Based on their findings, the researchers recommend that exercise training should be considered as an effective alternative therapy for the management of fatigue in persons with MS.